narrative essay on covid 19

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Read these 12 moving essays about life during coronavirus

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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How to Write About Coronavirus in a College Essay

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

Writing About COVID-19 in College Essays

Getty Images

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

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

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

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

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

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

Writing About COVID-19 for a College Application

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

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

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

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

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

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

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

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

Above all, she urges honesty.

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

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

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

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

Writing About Coronavirus in Main and Supplemental Essays

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

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

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

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

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

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

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

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

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

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

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

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

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

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Home > LIBRARIES > Archives and Special Collections > Personal Narratives of COVID-19

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

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

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

Questions to guide your response:

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

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

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

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

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

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

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

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

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

COVID19: How it Has Changed Our Lives

Anirudh Ramesh

sentiments during the pandemic

Amanda DeJesus

Covid-19 experience

Cole Corregano

George's Quarantine Experience

George K. Waweru

Personal COVID-19 submission

Tyler Abline

COVID-19 Personal Narrative-Andrew

Andrew Tiess

Time Capsule

Eric Sweeney

Samuel Perez

View from the front door

Nicholas Shraga

Nick's COVID experience

Nicholas DeMizio

Redefining the Essential

Blake Harrsch

COVID-19 Experience

Samantha Vail

My COVID-19 Experience

Stephanie Wickman

covid-19 reconnection video

Robert Caola

Liem Pham's COVID-19 Audio Message

Michael Turiansky

Pandemic Update: Extra Credit, Peer Upload for Gennarino Conzemius

Arianna Braccio

Shawnessy Earle

Abigail Graham

Aurelio Licata

Missing Life Before the Pandemic

Victoria Saniko

The collective cannot be ignored

Kaitlynn Chaljub

Life with Covid 19

Viktoria Olowski

Alex's Corona Lifestyle

Alexandra H. Dittmar

Choosing Selflessness in Times of Crisis

Jacob M. Barnoski

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• Volume 48, Issue 2
• COVID-19 narratives and layered temporality
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• Jessica Howell
• English , Texas A&M University , College Station , Texas , USA
• Correspondence to Dr Jessica Howell, English, Texas A&M University, College Station, TX 77843, USA; jmhowell{at}tamu.edu

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

• literature and medicine
• patient narratives
• medical humanities

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No data are available.

This article is made freely available for personal use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

https://doi.org/10.1136/medhum-2021-012258

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

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

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

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

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

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

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

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

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

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

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

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

Defying closure and cure: postcolonial and speculative fiction

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Ethics statements

Patient consent for publication.

Not applicable.

Ethics approval

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

Acknowledgments

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

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

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

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

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

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

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

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

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Contributors JH is the sole author.

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

Competing interests None declared.

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

Provenance and peer review Not commissioned; externally peer reviewed.

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Coronavirus: My Experience During the Pandemic

Anastasiya Kandratsenka George Washington High School, Class of 2021

At this point in time there shouldn't be a single person who doesn't know about the coronavirus, or as they call it, COVID-19. The coronavirus is a virus that originated in China, reached the U.S. and eventually spread all over the world by January of 2020. The common symptoms of the virus include shortness of breath, chills, sore throat, headache, loss of taste and smell, runny nose, vomiting and nausea. As it has been established, it might take up to 14 days for the symptoms to show. On top of that, the virus is also highly contagious putting all age groups at risk. The elderly and individuals with chronic diseases such as pneumonia or heart disease are in the top risk as the virus attacks the immune system. 

The virus first appeared on the news and media platforms in the month of January of this year. The United States and many other countries all over the globe saw no reason to panic as it seemed that the virus presented no possible threat. Throughout the next upcoming months, the virus began to spread very quickly, alerting health officials not only in the U.S., but all over the world. As people started digging into the origin of the virus, it became clear that it originated in China. Based on everything scientists have looked at, the virus came from a bat that later infected other animals, making it way to humans. As it goes for the United States, the numbers started rising quickly, resulting in the cancellation of sports events, concerts, large gatherings and then later on schools. 

As it goes personally for me, my school was shut down on March 13th. The original plan was to put us on a two weeks leave, returning on March 30th but, as the virus spread rapidly and things began escalating out of control very quickly, President Trump announced a state of emergency and the whole country was put on quarantine until April 30th. At that point, schools were officially shut down for the rest of the school year. Distanced learning was introduced, online classes were established, a new norm was put in place. As for the School District of Philadelphia distanced learning and online classes began on May 4th. From that point on I would have classes four times a week, from 8AM till 3PM. Virtual learning was something that I never had to experience and encounter before. It was all new and different for me, just as it was for millions of students all over the United States. We were forced to transfer from physically attending school, interacting with our peers and teachers, participating in fun school events and just being in a classroom setting, to just looking at each other through a computer screen in a number of days. That is something that we all could have never seen coming, it was all so sudden and new. 

My experience with distanced learning was not very great. I get distracted very easily and   find it hard to concentrate, especially when it comes to school. In a classroom I was able to give my full attention to what was being taught, I was all there. However, when we had the online classes, I could not focus and listen to what my teachers were trying to get across. I got distracted very easily, missing out on important information that was being presented. My entire family which consists of five members, were all home during the quarantine. I have two little siblings who are very loud and demanding, so I’m sure it can be imagined how hard it was for me to concentrate on school and do what was asked of me when I had these two running around the house. On top of school, I also had to find a job and work 35 hours a week to support my family during the pandemic. My mother lost her job for the time being and my father was only able to work from home. As we have a big family, the income of my father was not enough. I made it my duty to help out and support our family as much as I could: I got a job at a local supermarket and worked there as a cashier for over two months. 

While I worked at the supermarket, I was exposed to dozens of people every day and with all the protection that was implemented to protect the customers and the workers, I was lucky enough to not get the virus. As I say that, my grandparents who do not even live in the U.S. were not so lucky. They got the virus and spent over a month isolated, in a hospital bed, with no one by their side. Our only way of communicating was through the phone and if lucky, we got to talk once a week. Speaking for my family, that was the worst and scariest part of the whole situation. Luckily for us, they were both able to recover completely. 

As the pandemic is somewhat under control, the spread of the virus has slowed down. We’re now living in the new norm. We no longer view things the same, the way we did before. Large gatherings and activities that require large groups to come together are now unimaginable! Distanced learning is what we know, not to mention the importance of social distancing and having to wear masks anywhere and everywhere we go. This is the new norm now and who knows when and if ever we’ll be able go back to what we knew before. This whole experience has made me realize that we, as humans, tend to take things for granted and don’t value what we have until it is taken away from us. 

Articles in this Volume

[tid]: dedication, [tid]: new tools for a new house: transformations for justice and peace in and beyond covid-19, [tid]: black lives matter, intersectionality, and lgbtq rights now, [tid]: the voice of asian american youth: what goes untold, [tid]: beyond words: reimagining education through art and activism, [tid]: voice(s) of a black man, [tid]: embodied learning and community resilience, [tid]: re-imagining professional learning in a time of social isolation: storytelling as a tool for healing and professional growth, [tid]: reckoning: what does it mean to look forward and back together as critical educators, [tid]: leader to leaders: an indigenous school leader’s advice through storytelling about grief and covid-19, [tid]: finding hope, healing and liberation beyond covid-19 within a context of captivity and carcerality, [tid]: flux leadership: leading for justice and peace in & beyond covid-19, [tid]: flux leadership: insights from the (virtual) field, [tid]: hard pivot: compulsory crisis leadership emerges from a space of doubt, [tid]: and how are the children, [tid]: real talk: teaching and leading while bipoc, [tid]: systems of emotional support for educators in crisis, [tid]: listening leadership: the student voices project, [tid]: global engagement, perspective-sharing, & future-seeing in & beyond a global crisis, [tid]: teaching and leadership during covid-19: lessons from lived experiences, [tid]: crisis leadership in independent schools - styles & literacies, [tid]: rituals, routines and relationships: high school athletes and coaches in flux, [tid]: superintendent back-to-school welcome 2020, [tid]: mitigating summer learning loss in philadelphia during covid-19: humble attempts from the field, [tid]: untitled, [tid]: the revolution will not be on linkedin: student activism and neoliberalism, [tid]: why radical self-care cannot wait: strategies for black women leaders now, [tid]: from emergency response to critical transformation: online learning in a time of flux, [tid]: illness methodology for and beyond the covid era, [tid]: surviving black girl magic, the work, and the dissertation, [tid]: cancelled: the old student experience, [tid]: lessons from liberia: integrating theatre for development and youth development in uncertain times, [tid]: designing a more accessible future: learning from covid-19, [tid]: the construct of standards-based education, [tid]: teachers leading teachers to prepare for back to school during covid, [tid]: using empathy to cross the sea of humanity, [tid]: (un)doing college, community, and relationships in the time of coronavirus, [tid]: have we learned nothing, [tid]: choosing growth amidst chaos, [tid]: living freire in pandemic….participatory action research and democratizing knowledge at knowledgedemocracy.org, [tid]: philly students speak: voices of learning in pandemics, [tid]: the power of will: a letter to my descendant, [tid]: photo essays with students, [tid]: unity during a global pandemic: how the fight for racial justice made us unite against two diseases, [tid]: educational changes caused by the pandemic and other related social issues, [tid]: online learning during difficult times, [tid]: fighting crisis: a student perspective, [tid]: the destruction of soil rooted with culture, [tid]: a demand for change, [tid]: education through experience in and beyond the pandemics, [tid]: the pandemic diaries, [tid]: all for one and 4 for $4, [tid]: tiktok activism, [tid]: why digital learning may be the best option for next year, [tid]: my 2020 teen experience, [tid]: living between two pandemics, [tid]: journaling during isolation: the gold standard of coronavirus, [tid]: sailing through uncertainty, [tid]: what i wish my teachers knew, [tid]: youthing in pandemic while black, [tid]: the pain inflicted by indifference, [tid]: education during the pandemic, [tid]: the good, the bad, and the year 2020, [tid]: racism fueled pandemic, [tid]: coronavirus: my experience during the pandemic, [tid]: the desensitization of a doomed generation, [tid]: a philadelphia war-zone, [tid]: the attack of the covid monster, [tid]: back-to-school: covid-19 edition, [tid]: the unexpected war, [tid]: learning outside of the classroom, [tid]: why we should learn about college financial aid in school: a student perspective, [tid]: flying the plane as we go: building the future through a haze, [tid]: my covid experience in the age of technology, [tid]: we, i, and they, [tid]: learning your a, b, cs during a pandemic, [tid]: quarantine: a musical, [tid]: what it’s like being a high school student in 2020, [tid]: everything happens for a reason, [tid]: blacks live matter – a sobering and empowering reality among my peers, [tid]: the mental health of a junior during covid-19 outbreaks, [tid]: a year of change, [tid]: covid-19 and school, [tid]: the virtues and vices of virtual learning, [tid]: college decisions and the year 2020: a virtual rollercoaster, [tid]: quarantine thoughts, [tid]: quarantine through generation z, [tid]: attending online school during a pandemic.

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

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

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

Introduction

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

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

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

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

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

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

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

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

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

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

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

Literature Review

Covid-19 pandemic and educational interventions.

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

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

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

Health Literacy and Models of Health Behavior Change

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

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

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

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

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

Role of Visuals in Science and Health Education

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

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

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

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

Visual Storytelling for Science and Health Communication

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

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

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

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

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

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

Heuristic-Systematic Model of Information Processing

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

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

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

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

Health Communication and the Extended Parallel Process Model

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

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

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

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

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

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

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

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

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

Educational Platform—Lifeology “Flashcard” Courses

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

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

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

Study Procedure

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

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

Stimulus Content

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

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

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

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

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

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

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

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

Variables and Scales

Following news about covid-19.

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

Perceived Knowledge About COVID-19

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

Understanding and Learning

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

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

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

Attention and Absorption

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

Perceived Threat

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

Self-Efficacy

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

Behavioral Intentions

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

Demographics

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

Data Collection, Cleaning, and Analysis

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

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

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

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

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

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

Demographics and Descriptives

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

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

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

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

Content Experiences—Course Understanding, Learning, and Absorption

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

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

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

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

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

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

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

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

Attention to Visuals

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

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

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

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

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

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

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

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

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

Course Impacts on Behavioral Intentions

Analytical approach.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Implications

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

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

Limitations

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

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

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

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

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

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

Takeaways and Recommendations

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

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

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

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

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

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

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

Data Availability Statement

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

Ethics Statement

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

Author Contributions

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

Conflict of Interest

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

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

Publisher’s Note

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

Supplementary Material

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

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

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

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

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

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

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

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

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

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

10 N/A scores given to calculations and charts

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

12 Entered as dummy variables relative to the control group

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

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

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

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

Reviewed by:

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

*Correspondence: Paige Brown Jarreau, [email protected]

This article is part of the Research Topic

Evidence-Based Science Communication in the COVID-19 Era

I am not invincible: My COVID-19 story

David J. Vega Mar 26, 2020

Yes, I tested positive for COVID-19. I fell victim to this virus: a nasty, lingering virus that gave me the worst symptoms I’ve experienced to this day that I wouldn’t wish upon anyone. My story is to warn you that this is not the common cold or a regular flu. This virus is serious.

My name is David, and I am an otherwise healthy 27-year-old male with no past medical history. I am a fourth-year medical student, who will soon be a doctor starting residency in June. I am a health freak, I work out five to six times a week, I have a six-pack on a good day, and I completely took my health for granted.

I thought I was INVINCIBLE—I thought I was immune to this coronavirus because I am healthy and young. But I was wrong.

In early March, reports of novel transmission of the coronavirus were just starting to appear in the United States. I had heard about the nursing home in Seattle, the synagogue in New Rochelle, New York. It was a precarious situation, but community transmission of the virus was not quite so widespread.

‘Sure, I’ll wash my hands,’ ‘I’ll social distance after that party,’ I thought. Looking back, there were too many opportunities for me to have caught this virus. I did not take my health seriously. I figured I could avoid the virus, but in the off-chance I were to get it, it would be like a mild flu or a bad cold. I flew home from a two-month global medicine elective in Africa, ventured on long flights home and around lots of people at Nairobi and JFK airport. I went to a beach party during my week stay in Florida and saw lots of friends before heading back to Indiana to finish up my last semester of medical school. I was not careful. I did not take the necessary precautions. I did not think it could happen to me.

The fact of the matter is – you NEVER know.

A day after arriving in Indiana, symptoms started to kick in. On Thursday, March 12, I woke up with fever, chills, fatigue, generalized muscle aches, and joint pain. Probably just a bad case of the flu, right? No cough, no shortness of breath, no difficulty breathing, no respiratory problems whatsoever. No nausea, no diarrhea. JUST Fever and chills.

Thinking ‘I’ll get over it soon,’ I took some Ibuprofen and Tylenol and stayed in bed most of the day. The next day, I had a routine doctor’s appointment. I was almost turned away because of my symptoms, but I fought to be seen. My oral temperature was 101 degrees Fahrenheit, and I was put in an isolation room for my appointment. My provider, thankfully wearing complete PPE, performed a quick flu test (Influenza A, B, and RSV), which resulted negative that same day. It would later reflex to COVID-19 because of the negative result and I then began the seven-day wait for results.

My symptoms, however, only continued to worsen. The fever was unrelenting. I had no appetite. I had lost about 10 pounds. I loaded up on my daily multivitamins and Emergen-C; I continued to use Ibuprofen and Tylenol every six hours because my body was asking for ANYTHING to take away the misery.

It was not until Day 6 that I decided to drop the Ibuprofen after reading some expert opinions that NSAIDs may actually alter the immune response against the virus. Admittedly, I did feel WAY better the next day after dropping Ibuprofen. My fever and chills—although still present—felt improved. I continued to use only Tylenol spaced out now in the morning and before bedtime. By Day 7, still feeling chills in the morning, I opted out of using any Tylenol and tried to help my body fight this virus on its own. I attempted a little home bodyweight workout and instantly got lightheaded and felt very nauseous. My body was still desperately fighting this thing.

Day 8: I woke up in the usual sweats from the night before, but felt no fever or chills during the day—I felt much improved. I told myself I would take it easy that day. I was begging and pleading to God for an end to all of this.

After waiting SEVEN ENTIRE DAYS in self-quarantine, I finally received my results: positive for COVID-19, continue self-quarantine for another seven days. Ironically, this arrived an hour before receiving my Match Day residency assignment for emergency medicine at the University of Miami. March 20th was certainly a big day of “results” for me.

By Day 13, I had not used any fever-reducing medicine in six days. For the last few days, my symptoms were mostly confined to nighttime-fatigue, sweats, chills, but by Day 13, all of my symptoms had completely gone away. I reintroduced exercise little by little and can now get through a whole hour workout without getting totally winded.

Why am I telling this story?

Because I encourage you to learn from my mistakes. Because I didn’t listen when numbers started climbing. And now they continue to climb. 55,000-plus patients diagnosed in our country, more than 1,000 people deceased.

Because this virus is REAL. And it SUCKS. To say it was almost two weeks before I was feeling like my normal self. Because I am a “healthy young adult,” but “mild” COVID-19 made my life a living hell.

Because people around the world are DYING from this virus—and doctors must make resource allocation decisions (e.g. in Italy) as to who should get that last ICU bed or that last ventilator because hospitals are at FULL CAPACITY. After returning from a two-month global medicine trip in Africa, I witnessed patients dying on a daily basis due to resource-allocation purposes. And now we are starting to see the same issues in New York City and other densely populated communities in the United States.

We NEED you to STAY HOME, because our health professionals are RUNNING out of masks for themselves and ventilators for patients. The CDC is so desperate that they recently issued new guidelines for health professionals to use bandanas and scarves as substitutes for N95 masks. We NEED you to STAY HOME because these health professionals are sacrificing their lives at the frontline to make sure those affected can stay alive.

I had the two biggest celebrations of my life canceled (Match Day and graduation) for the good of those around me and the rest of the country. Now is NOT the time to go to that party. Now is NOT the time to meet up friends at the bar, to go out to eat, to celebrate your spring break, to go to the beach or the park. I promise you, the celebration can wait.

So please, as a medical professional, as a young adult, I implore for all of you to STAY HOME. I firsthand can now see how this VIRUS takes LIVES. 1 out of 5 people hospitalized from COVID-19 are young adults aged 20-44; I was LUCKY to not be one of them.

As many as 10-20 percent of people show no symptoms, so you may be spreading this virus and injuring those you love without realizing it. We DON’T know who has it and who does not, and we do not have the resources to test everyone, so please STAY HOME. Social-distancing and self-quarantine is just as important for the ELDERLY as for the YOUTH.

We NEED you to do your part to FLATTEN the curve and prevent the growing spread to more and more people every day. If we all do our part, then this self-quarantine can eventually come to an end and we can soon resume what our lives used to be.

My name is David and I am NOT Invincible. And neither are you.

Editor’s note: David Vega is a fourth-year medical student at IU School of Medicine. After traveling overseas and in Florida earlier this month, Vega returned to the IU School of Medicine—Indianapolis campus on March 11, and soon developed symptoms of COVID-19 the following day, March 12. He was tested for the virus on March 13, and received his positive test result on March 20. He informed all individuals with whom he had contact since his return to Indianapolis of his positive test.

"Staying home truly saves lives."

David Vega shares his advice after being diagnosed with COVID-19.

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COVID-19 Was a Turning Point for Health

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

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

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

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

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

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

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

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

A version of this essay appeared on Substack.

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

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Research Article

The impact of narrative writing on empathy, perspective-taking, and attitude: Two randomized controlled experiments on violations of Covid-19 protection regulations

Contributed equally to this work with: Martina Bientzle, Marie Eggeling

Roles Conceptualization, Data curation, Funding acquisition, Methodology, Writing – original draft

* E-mail: [email protected]

Affiliation Knowledge Construction Lab, Leibniz-Institut fuer Wissensmedien, Tuebingen, Germany

Roles Conceptualization, Investigation, Methodology, Writing – original draft

Roles Conceptualization, Investigation, Writing – review & editing

Affiliation Department of Psychology, Eberhard Karls University Tuebingen, Tuebingen, Germany

Roles Conceptualization, Funding acquisition, Supervision, Writing – original draft

Affiliations Knowledge Construction Lab, Leibniz-Institut fuer Wissensmedien, Tuebingen, Germany, Department of Psychology, Eberhard Karls University Tuebingen, Tuebingen, Germany

• Martina Bientzle, 
• Marie Eggeling, 
• Marie Kanzleiter, 
• Kerstin Thieme, 
• Joachim Kimmerle

• Published: July 12, 2021
• https://doi.org/10.1371/journal.pone.0254501
• Reader Comments

Two randomized controlled experiments investigated if writing a narrative text about a fictional person who shows disapproved of behavior in the Covid-19 pandemic influenced empathy, perspective-taking, attitude, and attribution of causes regarding that person’s behavior.

In both studies, a fictional scenario was described, and participants answered questions regarding empathy, perspective-taking, attitude, and attribution regarding a fictional person’s disapproved of behavior (pre-post-measurement). Participants were randomly assigned to one of two conditions. In the experimental condition, they wrote a narrative text about the fictional person. In the control condition, they wrote about an unrelated topic.

We found that writing a narrative text increased empathy more strongly than writing about an unrelated topic; Study 1: p = 0.004, part. η 2 = 0.06, Study 2: p < .001, part. η 2 = 0.19. This did not apply to perspective-taking; Study 1: p = 0.415; Study 2: p = 0.074. We also found that writing a narrative text about a fictional person resulted in a more positive attitude toward this person; Study 1: p = 0.005, part. η 2 = 0.06; Study 2: p<0.001, part. η 2 = 0.10. Finally, in Study 2 we found that participants who wrote a narrative text attributed the person’s behavior to internal causes to a lesser degree; p = 0.007, part. η 2 = 0.05.

Our findings indicate that empathy and attitude are positively modifiable through narrative writing tasks. Empathy training could potentially prevent discrimination related to Covid-19.

Trial registration

The studies presented in this article were pre-registered on the pre-registration platform AsPredicted (aspredicted.org) before we began data collection; registration numbers and URL: #44754 https://aspredicted.org/vx37t.pdf (Study 1), and #44753 https://aspredicted.org/ig7kq.pdf (Study 2).

Citation: Bientzle M, Eggeling M, Kanzleiter M, Thieme K, Kimmerle J (2021) The impact of narrative writing on empathy, perspective-taking, and attitude: Two randomized controlled experiments on violations of Covid-19 protection regulations. PLoS ONE 16(7): e0254501. https://doi.org/10.1371/journal.pone.0254501

Editor: Marcel Pikhart, University of Hradec Kralove: Univerzita Hradec Kralove, CZECH REPUBLIC

Received: February 17, 2021; Accepted: June 28, 2021; Published: July 12, 2021

Copyright: © 2021 Bientzle et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All data files are available from the OSF database (accession link: https://osf.io/4zg2w/?view_only=747a2855dd5d475894c1429c15cffd4b ).

Funding: The research reported here was funded in part by the Leibniz Science Campus Tuebingen awarded to JK and MB and budget resources of the Leibniz-Institut fuer Wissensmedien, Tuebingen, Germany. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Introduction

The consequences of the Covid-19 pandemic have been a worldwide challenge for more than a year now. To control the spread of the virus and protect people’s health, governments introduced different restrictions and regulations, for example, limiting contact and wearing face masks. The perception of and adherence to these regulations differ a lot across individuals, societies, and countries. An important characteristic of the restrictions to prevent the spread of Covid-19 is that violations can have adverse health effects not only for offenders themselves but also for others. Behavior that is actively harmful to health is generally stigmatized by society and thus triggers prejudice [ 1 ]. Drug abuse is an example of such stigmatized behavior. Specific diseases, such as AIDS, obesity, or mental illness can also lead to stigmatization [ 2 , 3 ]. Therefore, it is no surprise that just being sick from Covid-19 already has a stigma attached to it [ 3 ]. One explanation for the stigmatization is that observing behavior associated with ill health can trigger strong negative feelings and reactions and consequently lead to negative attitudes toward individuals who exhibit this behavior [ 4 ]. The more strongly people are critically perceived to be responsible for their own behavior, the less empathy is shown toward them [ 5 ]. Especially in times marked by fear and the threat of a virus, a punitive and intolerant attitude toward others can be observed [ 6 ].

People try to understand why others behave the way they do, especially when it comes to critical or stigmatized behavior. The attribution of causes for that behavior helps to classify situations correctly in everyday life and to be able to react appropriately [ 7 ]. However, when evaluating behavior, especially disapproved of behavior of others, people underestimate the role of external, situational factors. They tend instead to attribute the negative behavior to internal causes, that is, to the other person’s personality [ 8 ], a phenomenon referred to as the fundamental attribution error [ 9 ].

Perspective-taking and empathy

Attribution errors can be revised in subsequent information-processing steps [ 10 ]. However, these reconsiderations do not happen easily, as they require sufficient levels of attention, motivation, and effort. Taking the perspective of another person can enable those required processes and is thus associated with improving one’s attitude toward the other person [ 11 ] and reducing attribution errors [ 12 ]. Perspective-taking comprises the active consideration of other people’s mental conditions and their subjective experience. Perspective-taking includes both cognitive and affective mechanisms [ 13 ]. Empathy, as an affective component, can have its effect through two different mechanisms: Parallel empathy implies experiencing the same emotion as the target person, that is, one feels as that other person; reactive empathy entails feeling for another with emotional concern for that person’s well-being. Perspective-taking can be effective through both types of empathic responses. Putting oneself in the situation of a person who shows disapproved of health behavior may increase empathetic concern, especially when focusing on that person’s individual feelings [ 14 ]. As for cognitive mechanisms, a number of modes of action are known. We refer here particularly to one of those modes as a shift in attributional thinking. This means that people who engage in perspective-taking tend to assign greater importance to non-dispositional than to dispositional aspects.

Previous research has shown that empathy is related to lower levels of aggression, increased prosocial helping behavior [ 15 ], and to increased well-being [ 16 ]. Former research has also found that empathy and perspective-taking training can improve attitudes toward stigmatized groups like Syrian refugees [ 17 ], Romani people [ 18 ], immigrants [ 19 ], AIDS patients, drug users, or foreigners [ 20 , 21 ]. Perspective-taking can also durably reduce transphobia [ 22 ] and racist bias in a clinical context [ 23 ].

We argue that a positive basic attitude even toward people who behave problematically is useful in bringing about positive changes in behavior. Stigmatization otherwise tends to increase alienation and divide society further. Devaluation is unlikely to win a person over to different health behavior.

Narrative writing to reduce stigmatization

Narrative or creative writing has been shown to be effective as one intervention for increasing empathy and perspective-taking in training sessions [ 24 – 26 ]. Unlike non-fictional texts, narrative texts are not about generalizable facts but about specific, individual peculiarities of circumstances, situations, or people. During a narrative writing intervention, participants usually write a short text or story about one or more fictional characters and these characters’ traits, personal experiences, and relationships to others [ 27 ]. In their systematic review, Milota and colleagues [ 28 ] found that narrative writing training for medical students led to greater empathy [ 29 , 30 ] and a better awareness of patients’ perspectives [ 31 ]. Possible reasons for the effectiveness of narrative writing for increasing empathy and perspective-taking are the identification with a character and the reflection on their possible emotions. Narrative writing has also demonstrated social relevance for current situations, in that it can reduce political polarization [ 32 ]. To assist inexperienced writers, the writing assignment can be preceded by character development to engage the writer with the person being described [ 33 ].

Research questions and hypotheses

We conducted two experiments to investigate whether writing a narrative text about a fictional person who shows disapproved of behavior in response to the Covid-19 pandemic influenced empathy, perspective-taking, attitude, and attribution of causes regarding that person’s behavior. In Study 1, the disapproved of behavior consisted of violating restrictions by going to work with typical Covid-19 symptoms; in Study 2, the disapproved of behavior was violating restrictions by not wearing a mask on the train. In both studies, participants were put into a fictional situation and wrote either about the fictional person (experimental condition) or about an unrelated topic (in both studies about the room where they stayed during the experiment; control condition). Given the confluence of perspective-taking and empathy described above [ 13 ], we stated the following hypotheses:

• Hypothesis 1 . Writing a narrative text about a fictional person will increase empathy (H1a) and perspective taking (H1b) more strongly than writing about an unrelated topic.
• Hypothesis 2 . Writing a narrative text about a fictional person will result in a more positive attitude toward this person than writing about an unrelated topic.
• Hypothesis 3 . Participants who write a narrative text about a fictional person will attribute that person’s behavior to a lesser degree to internal causes than participants who write about an unrelated topic.

As an open research question, we investigated if the intervention had an impact on individual attitudes toward Covid-19 protection restrictions in general.

Materials and methods

Ethical approval.

The studies presented here were part of a research project that was approved by the Ethics Committee of the Leibniz-Institut für Wissensmedien (approval number: LEK 2020/032).

Power analysis for ANOVAs with α = 0.05, an intended power of 95%, and a medium effect size of f = 0.25 revealed a required sample size of N = 158 for each experiment.

We excluded participants who (1) indicated that they were not adequately motivated to participate in the study, (2) did not have adequate German language skills, or (3) indicated that the recommendation not to go to work with typical Covid-19 symptoms/to wear a face mask while riding a train was unnecessary. This last exclusion criterion was implemented because this study was about how people dealt with disapproved of behavior, and therefore we only wanted to include participants in the sample who actually disapproved of this behavior. We also did not invite participants who were younger than 18 years old or who did not speak German fluently.

N = 1878 potential participants on the online participant recruitment platform Prolific ( https://www.prolific.co ) fulfilled our inclusion criteria and were invited to participate in the studies. Data collection for both experiments was conducted at the same time, and after accepting the invitation, participants were randomly assigned to either Study 1 or Study 2.

N = 155 people started participating in Study 1; 21 participants had to be excluded from the data analysis because they had not given their consent (n = 1), canceled the survey early (n = 9), indicated that they had not been adequately motivated to participate in the study (n = 6), or indicated that the recommendation not to go to work with typical Covid-19 symptoms was unnecessary (n = 5). After these exclusions, the data from N = 134 participants (experimental condition: n = 65 participants; control condition: n = 69 participants) were analyzed. There were no group differences regarding gender (female: n = 53; male: n = 79; diverse: n = 2; χ 2 = 2.218, p = 0.330) or age (M = 28.77, SD = 8.90; t(132) = 1.884, p = 0.062).

N = 158 people started participating in Study 2; 22 participants had to be excluded from the data analysis because they had not given their consent (n = 3), canceled the survey early (n = 11), indicated that they had not been adequately motivated to participate in the study (n = 4), or indicated that the recommendation to wear a face mask when riding a train was unnecessary (n = 4). After these exclusions, the data from N = 136 participants (experimental condition: n = 66 participants; control condition: n = 70) were analyzed. There were no group differences regarding gender (female: n = 65; male: n = 71; χ 2 = 0.250, p = 0.617) or age (M = 30.70, SD = 9.54; t(134) = -0.24, p = 0.815).

A detailed overview of the sampling procedure can be seen in Fig 1 .

• PPT PowerPoint slide
• PNG larger image
• TIFF original image

https://doi.org/10.1371/journal.pone.0254501.g001

The instructions as well as the design and the dependent measures were adopted from a study by Shaffer and colleagues [ 28 ]. The experiments were conducted online, using the participant recruitment platform Prolific and the online tool Qualtrics Survey Software [ 34 ]. Qualtrics Survey Software performed the randomized assignment of participants to conditions based on a computer-controlled random generator without human intervention. Before starting the survey, participants provided their written informed consent. Then the fictional scenario was described, after which participants answered questions regarding empathy, perspective-taking, attitude, and attribution of causes regarding the fictional person’s behavior. Next, participants were randomly assigned to one of two conditions. In the experimental condition, they received the instructions to write a narrative text about the fictional person who showed the disapproved behavior. To prepare for this task, they were instructed to imagine the fictional person in a concrete way and think about possible answers to questions regarding the person (e.g., name, age, living situation). The only constraint was that the fictional person should be regarded to be at least as intelligent as the participants themselves. Then participants were asked to take a minimum of ten minutes to write their scene. In the control condition, participants received the instructions to write for ten minutes about the room they were staying in during the experiment. An automatic timer in the survey prevented them from continuing to the next page before this writing time had passed. After finishing the writing task, participants answered again the same questions regarding empathy, perspective-taking, attitude, and attribution. In addition, they were asked for their own opinion about the specific violation in question, their motivation while taking part in the study, and demographic data (age and gender). As an exploratory measure they were asked for their attitude toward Covid-19 protection restrictions in general.

Shaffer and colleagues [ 35 ] used the fictional scenario of seeing a pregnant woman smoking a cigarette in a parking lot in front of a supermarket. The studies presented here aimed at replicating and extending the findings of Shaffer and colleagues [ 35 ] by using typical situations where people show adverse health behavior in the context of the current Covid-19 pandemic, and in doing so exhibit behavior that may also be potentially harmful to the health of others.

The fictional scenario for Study 1 was: “You enter a bakery. The saleswoman serving you shows symptoms typical of a Coronavirus infection. She coughs strongly and looks feverish.”

The fictional scenario for Study 2 was: “You are traveling by train. While doing so, you notice that a female railroad employee is not wearing a face mask during a ticket inspection, despite the Coronavirus protection regulations.”

All dependent variables were assessed twice: after reading the description of the situation (t1) and after writing the text (t2).

Empathy and perspective-taking were measured using an adapted version of the Saarbrückener Persönlichkeitsfragebogen (SPF) [ 36 ]. The SPF is the German version of the Interpersonal Reactivity Index (IRI) [ 37 ], consisting of the four subscales perspective-taking , empathic concern , fantasy , and personal distress . As in the study by Shaffer and colleagues [ 35 ], we used only the subscales perspective-taking and empathic concern . The four perspective-taking subscale items measure the ability to cognitively put oneself in the other person’s position, while the four items of the empathic concern subscale measure emotional involvement in the feelings of others. The items were adapted to the fictional scenarios used in our experiments ( Table 1 ). Participants were asked to indicate their agreement to the statements on a scale from “don’t agree at all” (0) to “fully agree” (100). Internal consistency scores for the perspective-taking scale were excellent (Cronbach alpha in Study 1 at t1: α = 0.93 and t2: α = 0.90; Cronbach alpha in Study 2 at t1: α = 0.90 and t2: α = 0.92); internal consistency scores for the empathy scale were acceptable to good (Cronbach alpha in Study 1 at t1: α = 0.81 and t2: α = 0.89; Cronbach alpha in Study 2 at t1: α = 0.68 and t2: α = 0.88). All items are shown in Table 1 .

https://doi.org/10.1371/journal.pone.0254501.t001

Attitude was measured with a feeling thermometer [ 38 ]. Feeling thermometers are frequently used to measure feelings and attitudes toward individuals or groups [ 39 ]. This attitude measure was used analogously to a thermometer that measures temperature and allowed the attitude toward the fictional person to be ranked on a visual-analog scale of 0–10. Zero symbolized a very “cold” or negative attitude toward the fictional person, the value 5 corresponded to a neutral attitude, and a value of 10 symbolized a very “warm” or positive attitude.

Attribution was measured with three single items (see Table 2 ), following the procedure used by Shaffer and colleagues [ 35 ]. Participants were again asked to indicate their agreement with the statements on a scale from “not at all” (0) to “very much” (100).

https://doi.org/10.1371/journal.pone.0254501.t002

The exploratory measure attitude toward the Covid-19 protection restrictions was measured at t2 with ten items adapted from the Risk-Taking Attitude and Risky Driving Behavior questionnaire [ 40 ] (see Table 3 ). Participants were asked to indicate their agreement with the statements on a scale from “don’t agree at all” (0) to “fully agree” (100). Internal consistencies for the scale were good (Cronbach alpha in Study 1: α = 0.81; Cronbach alpha in Study 2: α = 0.87).

https://doi.org/10.1371/journal.pone.0254501.t003

At the end of the survey, participants responded to three items regarding their motivation to answer the questions honestly and carefully, and one item regarding their attitude toward the demand not to go to work with typical Covid-19 symptoms/to wear a face mask in public.

Data analysis was performed using IBM SPSS 25 statistics for Windows. Normal distribution was not given for most variables. Therefore, we performed analyses of variance (ANOVA), including repeated measure analysis to test our hypotheses, since simulation studies have shown that ANOVAs are robust to violations of the normal distribution assumption [ 41 , 42 ]. We provide means (M) and standard deviations (SD) as well as F-values, p-values, and partial eta-squared ( part. η 2 ) as an indicator of effect size.

Empathy and perspective-taking

There was a significant increase in empathy for the participants in both studies across both conditions; Study 1: F(1, 132) = 33.95, p < .001, part. η 2 = 0.21; Study 2: F(1, 134) = 36.95, p < .001, part. η 2 = 0.22. At t1, participants indicated less empathy (Study 1: M = 36.34, SD = 21.34; Study 2: M = 27.48, SD = 18.27) than at t2 (Study 1: M = 44.74, SD = 23.25; Study 2: M = 34.90, SD = 24.14). In Hypothesis 1a, we had stated that writing a narrative text about a fictional person would increase empathy more strongly than writing about an unrelated topic. The data of both studies supported this hypothesis ( Fig 2 and Table 4 ); Study 1: F(1, 132) = 8.49, p = 0.004, part. η 2 = 0.06, Study 2: F(1,134) = 32.10, p<0.001, part. η 2 = 0.19.

Confidence intervals are represented by the error bars attached to each column.

https://doi.org/10.1371/journal.pone.0254501.g002

https://doi.org/10.1371/journal.pone.0254501.t004

There was also a significant increase in perspective-taking for the participants in both studies across both conditions; Study 1: F(1, 132) = 32.36, p < .001, part. η 2 = 0.20; Study 2: F(1, 134) = 33.88, p < .001, part. η 2 = 0.20. At t1, they indicated a lower score in perspective-taking (Study 1: M = 56.20, SD = 26.10; Study 2: M = 51.44, SD = 27.40) than at t2 (Study 1: M = 66.76, SD = 21.37; Study 2: M = 62.28, SD = 25.41). Contrary to Hypothesis 1b, there were no significant interaction effects of time and condition in Study 1 (F(1, 132) = 0.67, p = 0.415, part. η 2 = 0.005) or in Study 2 (F(1, 134) = 3.25, p = 0.074, part. η 2 = 0.02). Writing a narrative text about a fictional person did not increase perspective-taking any more strongly than writing about an unrelated topic.

Again, we found a significant effect of time in both studies; Study 1: F(1, 132) = 93.86, p < .001, part. η 2 = 0.42; Study 2: F(1, 134) = 61.47, p < .001, part. η 2 = 0.31. At t1, the attitude was more positive (Study 1: M = 3.95, SD = 2.41; Study 2: M = 3.51, SD = 2.41) than at t2 (Study 1: M = 2.40, SD = 1.92; Study 2: M = 2.24, SD = 1.89) across both conditions. We stated in Hypothesis 2 that writing a narrative text about a fictional person would result in a more positive attitude toward this person than writing about an unrelated topic. The data of both studies supported this assumption: Study 1: F(1, 132) = 8.07, p = 0.005, part. η 2 = 0.06; Study 2: F(1, 134) = 15.50, p < .001, part. η 2 = 0.10 ( Fig 3 ).

https://doi.org/10.1371/journal.pone.0254501.g003

Attribution

We observed significant pre-post differences regarding the first attribution item in both studies (Study 1: F(1, 132) = 22.25, p<0.001, part. η 2 = 0.14; Study 2: F(1, 134) = 10.91, p = 0.001, part. η 2 = 0.08) but no significant interaction effects (Study 1: F(1, 132) = 2.42 p = 0.122, part. η 2 = 0.02; Study 2: F(1, 134) = 1.65 p = 0.201, part. η 2 = 0.01). This showed that participants were less likely to believe that the fictional person was to blame for her disapproved of health behavior after writing the text (Study 1: M = 64.37, SD = 25.08; Study 2: M = 71.21, SD = 24.54) than before (Study 1: M = 70.25, SD = 21.18; Study 2: M = 76.92, SD = 22.02), regardless of whether they wrote about the person or an unrelated topic.

Only in Study 2 was there a significant pre-post effect regarding the second attribution item (Study 1: F(1, 132) = 0.561, p = 0.455, part. η 2 = 0.004; Study 2: F(1, 134) = 16.59, p < .001, part. η 2 = 0.11). In Study 2, participants were more likely to believe that external factors, such as life circumstances, were responsible for the fictional person’s disapproved of health behavior after writing the text (Study 1: M = 67.89, SD = 23.57; Study 2: M = 52.41, SD = 27.99) than before (Study 1: M = 66.81, SD = 22.74; Study 2: M = 45.51, SD = 26.91). Again, there were no significant interaction effects (Study 1: F(1, 132) = 1.51, p = 0.221, part. η 2 = 0.01; Study 2: F(1, 134) = 0.005, p = 0.943, part. η 2 <0.001). We observed that writing a narrative text about a fictional person did not decrease attribution of the negative health behavior to internal causes more strongly than writing about an unrelated topic.

Regarding the third attribution item, there was a significant pre-post effect in Study 1 only (Study 1: F(1, 132) = 9.08, p = 0.003, part. η 2 = 0.06; Study 2: F(1, 134) = 1.10, p = 0.297, part. η 2 = 0.008). In Study 1, participants believed to a lesser degree that the fictional person had the freedom to make better choices at t2 (Study 1: M = 62.39, SD = 26.33; Study 2: M = 71.66, SD = 27.04) than a t1 (Study 1: M = 66.43, SD = 24.88; Study 2: M = 73.04, SD = 29.05). In addition, there was a significant interaction effect in Study 2 (Study 1: F(1, 132) = 2.98, p = 0.087, part. η 2 = 0.02; Study 2: F(1, 134) = 7.57, p = 0.007, part. η 2 = 0.05). This effect was consistent with Hypothesis 3, indicating that participants who wrote a narrative text about the fictional person attributed that person’s behavior to a lesser degree to internal causes than participants who wrote about an unrelated topic.

Attitude toward the Covid-19 protection restrictions

As an open research question, we investigated if the intervention had an impact on the individual attitudes toward the Covid-19 protection restrictions in general. In both studies, we found no significant effect (Study 1: t(132) = -1.201, p = 0.232; Study 2: t(134) = -1.106, p = 0.271).

The studies presented here examined the influence of a narrative writing intervention on empathy, perspective-taking, attitude, and attribution of causes toward a fictional person who exhibited disapproved of health behavior. As expected, empathy and attitude toward the fictional person changed more positively in the experimental group than in the control group. Contrary to the hypotheses and in contrast to the results of Shaffer and colleagues [ 35 ], no stronger change in perspective-taking was found in the experimental group compared to the control group. Regarding attribution, the pattern of results was mixed—the result of Shaffer and colleagues [ 35 ] was replicated in only one case (Study 2, attribution item 3). Such an inconsistent result should be interpreted with great caution, and even more so since attribution was only measured with single items and not with a validated scale. The results of both studies suggest that empathy and attitude can be modified to become more positive through a narrative writing task. This fits with previous research showing that people can be trained in empathy and attitude specifically and simultaneously [ 25 , 35 , 43 ] and that even ten to fifteen minutes of writing training can be sufficient for this purpose.

In contrast to the cognitive process of perspective-taking, empathy as an affective component changed more strongly through the narrative writing task in the experimental than in the control group. There are several possible explanations for this finding. It is possible that narrative writing has a stronger effect on an affective level. For example, writing tasks have already been shown in several clinical studies to be effective in minimizing depressive rumination and improving emotion processing [ 44 – 46 ]. In addition, Shapiro and colleagues [ 26 ] postulated that creative writing elicits increased emotions. Another explanation could be that perspective-taking is a more complex process and thus requires more time than a ten-minute narrative writing task allows.

The fact that most of the dependent variables in the experimental condition as well as in the control condition changed in a positive direction over time indicates that the writing task of the control condition also induced an effect. Since both conditions involved a ten-minute writing task, perhaps writing a text alone had an effect, because it helped participants focus better on themselves and activate a specific mindset. The participants of the control group described the environment around them. This could have increased their self-awareness and mindfulness. Previous research has shown that even non-emotional narrative writing, in which participants were instructed to write about their daily lives, may increase mindfulness [ 47 ]. Whether the activity of writing itself caused the effect cannot be answered in the context of our studies. However, it is rather unlikely that a writing task that does not require any self-awareness would have the same impact on empathy and attitude. Further studies are needed to explain the effects found in these studies.

Even though we found significant changes in the dependent variables in the experimental condition, it is unclear which step of the writing task induced these changes. Before actually writing, participants answered questions on character development, which may have already caused participants to think more deeply about the fictional person. Thinking more deeply about the characters one plans to write about before actually starting to write a text is a normal preparation step. It is possible that either these questions, or the writing task alone, or a combination of these two steps contributed to the changes in the dependent variables, which leaves the question open.

In previous studies, it also remained ambiguous in some cases which factors of the intervention led to particular effects. For example, DasGupta and Charon [ 24 ] combined a face-to-face meeting with a writing task. Moreover, narrative medicine training sessions combined reading, writing, and discussing people and situations [ 48 ]. In future studies, it would be interesting to investigate which steps exactly are responsible for the changes in perceptions.

Moreover, we cannot rule out the possibility that the effects we observed were experimenter demand effects, at least in part. Participants of the experimental group were asked to write about a person who showed disapproved of behavior in the Covid-19 pandemic before and after answering questions regarding empathy and perspective-taking. Sensing experimenter expectations, the participants might have replied that they were able to feel more empathy toward the person even if they did not actually experience these feelings. However, if our findings were mere experimenter demand effects, perspective-taking and empathy should show the same pattern of results, which was not the case.

Finally, our procedure of excluding observations on the basis of post-treatment criteria can be criticized [ 49 ]. We excluded participants who indicated that they were not adequately motivated to participate in the study and who assessed the Covid-19 restrictions addressed in the studies as unnecessary. It is possible that these criteria were influenced by the treatment, which in turn could lead to a posttreatment bias. In future studies, these variables should be collected before treatment implementation.

Empathy, perspective-taking, and attitude toward patients play a significant role in social interactions and especially in the healthcare system [ 50 , 51 ]. Therefore, for a fair healthcare system and equal treatment of all patients, investment should be made in empathy training for healthcare workers. Our findings indicate that empathy and attitude can be modified in a positive direction through even a narrative writing task that does not take much time. The present studies as well as other recent work on Covid-19 [ 3 , 52 , 53 ] showed that new socially stigmatized behaviors are emerging due to the Covid-19 pandemic. Empathy training could potentially address this occurrence to prevent early stigma and discrimination related to Covid-19.

Practice implications

For educational institutions in the medical context, but also for schools or other training institutes, narrative writing could be an efficient and creative soft-skill method to strengthen interpersonal relationships and community empathy. Narrative writing has also demonstrated current social relevance, in that it can reduce political polarization [ 32 ]. In contrast to consuming audio-visual media, writing necessarily requires an active and mindful engagement with the subject matter.

Acknowledgments

The authors would like to thank Penelope Pinson for her proof reading.

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Editor in Chief's Introduction to Essays on the Impact of COVID-19 on Work and Workers

On March 11, 2020, the World Health Organization declared that COVID-19 was a global pandemic, indicating significant global spread of an infectious disease ( World Health Organization, 2020 ). At that point, there were 118,000 confirmed cases of the coronavirus in 110 countries. China had been the first country with a widespread outbreak in January, and South Korea, Iran and Italy following in February with their own outbreaks. Soon, the virus was in all continents and over 177 countries, and as of this writing, the United States has the highest number of confirmed cases and, sadly, the most deaths. The virus was extremely contagious and led to death in the most vulnerable, particularly those older than 60 and those with underlying conditions. The most critical cases led to an overwhelming number being admitted into the intensive care units of hospitals, leading to a concern that the virus would overwhelm local health care systems. Today, in early May 2020, there have been nearly 250,000 deaths worldwide, with over 3,500,000 confirmed cases ( Hopkins, 2020 ). The human toll is staggering, and experts are predicting a second wave in summer or fall.

As the deaths rose from the virus that had no known treatment or vaccine countries shut their borders, banned travel to other countries and began to issue orders for their citizens to stay at home, with no gatherings of more than 10 individuals. Schools and universities closed their physical locations and moved education online. Sporting events were canceled, airlines cut flights, tourism evaporated, restaurants, movie theaters and bars closed, theater productions canceled, manufacturing facilities, services, and retail stores closed. In some businesses and industries, employees have been able to work remotely from home, but in others, workers have been laid off, furloughed, or had their hours cut. The International Labor Organization (ILO) estimates that there was a 4.5% reduction in hours in the first quarter of 2020, and 10.5% reduction is expected in the second quarter ( ILO, 2020a ). The latter is equivalent to 305 million jobs ( ILO, 2020a ).

Globally, over 430 million enterprises are at risk of disruption, with about half of those in the wholesale and retail trades ( ILO, 2020a ). Much focus in the press has been on the impact in Europe and North America, but the effect on developing countries is even more critical. An example of the latter is the Bangladeshi ready-made-garment sector ( Leitheiser et al., 2020 ), a global industry that depends on a supply chain of raw material from a few countries and produces those garments for retail stores throughout North America and Europe. But, in January 2020, raw material from China was delayed by the shutdown in China, creating delays and work stoppages in Bangladesh. By the time Bangladeshi factories had the material to make garments, in March, retailers in Europe and North American began to cancel orders or put them on hold, canceling or delaying payment. Factories shut down and workers were laid off without pay. Nearly a million people lost their jobs. Overall, since February 2020, the factories in Bangladesh have lost nearly 3 billion dollars in revenue. And, the retail stores that would have sold the garments have also closed. This demonstrates the ripple effect of the disruption of one industry that affects multiple countries and sets of workers, because consider that, in turn, there will be less raw material needed from China, and fewer workers needed there. One need only multiply this example by hundreds to consider the global impact of COVID-19 across the world of work.

The ILO (2020b) notes that it is difficult to collect employment statistics from different countries, so a total global unemployment rate is unavailable at this time. However, they predict significant increase in unemployment, and the number of individuals filing for unemployment benefits in the United States may be an indicator of the magnitude of those unemployed. In the United States, over 30 million filed for unemployment between March 11 and April 30 ( Bureau of Labor Statistics, 2020 ), effectively this is an unemployment rate of 18%. By contrast, in February 2020, the US unemployment rate was 3.5% ( Bureau of Labor Statistics, 2020 ).

Clearly, COVID-19 has had an enormous disruption on work and workers, most critically for those who have lost their employment. But, even for those continuing to work, there have been disruptions in where people work, with whom they work, what they do, and how much they earn. And, as of this writing, it is also a time of great uncertainty, as countries are slowly trying to ease restrictions to allow people to go back to work--- in a “new normal”, without the ability to predict if they can prevent further infectious “spikes”. The anxieties about not knowing what is coming, when it will end, or what work will entail led us to develop this set of essays about future research on COVID-19 and its impact on work and workers.

These essays began with an idea by Associate Editor Jos Akkermans, who noted to me that the global pandemic was creating a set of career shocks for workers. He suggested writing an essay for the Journal . The Journal of Vocational Behavior has not traditionally published essays, but these are such unusual times, and COVID-19 is so relevant to our collective research on work that I thought it was a good idea. I issued an invitation to the Associate Editors to submit a brief (3000 word) essay on the implications of COVID-19 on work and/or workers with an emphasis on research in the area. At the same time, a group of international scholars was coming together to consider the effects of COVID-19 on unemployment in several countries, and I invited that group to contribute an essay, as well ( Blustein et al., 2020 ).

The following are a set of nine thoughtful set of papers on how the COVID-19 could (and perhaps will) affect vocational behavior; they all provide suggestions for future research. Akkermans, Richardson, and Kraimer (2020) explore how the pandemic may be a career shock for many, but also how that may not necessarily be a negative experience. Blustein et al. (2020) focus on global unemployment, also acknowledging the privileged status they have as professors studying these phenomena. Cho examines the effect of the pandemic on micro-boundaries (across domains) as well as across national (macro) boundaries ( Cho, 2020 ). Guan, Deng, and Zhou (2020) drawing from cultural psychology, discuss how cultural orientations shape an individual's response to COVID-19, but also how a national cultural perspective influences collective actions. Kantamneni (2020) emphasized the effects on marginalized populations in the United States, as well as the very real effects of racism for Asians and Asian-Americans in the US. Kramer and Kramer (2020) discuss the impact of the pandemic in the perceptions of various occupations, whether perceptions of “good” and “bad” jobs will change and whether working remotely will permanently change where people will want to work. Restubog, Ocampo, and Wang (2020) also focused on individual's responses to the global crisis, concentrating on emotional regulation as a challenge, with suggestions for better managing the stress surrounding the anxiety of uncertainty. Rudolph and Zacher (2020) cautioned against using a generational lens in research, advocating for a lifespan developmental approach. Spurk and Straub (2020) also review issues related to unemployment, but focus on the impact of COVID-19 specifically on “gig” or flexible work arrangements.

I am grateful for the contributions of these groups of scholars, and proud of their ability to write these. They were able to write constructive essays in a short time frame when they were, themselves, dealing with disruptions at work. Some were home-schooling children, some were worried about an absent partner or a vulnerable loved one, some were struggling with the challenges that Restubog et al. (2020) outlined. I hope the thoughts, suggestions, and recommendations in these essays will help to stimulate productive thought on the effect of COVID-19 on work and workers. And, while, I hope this research spurs to better understand the effects of such shocks on work, I really hope we do not have to cope with such a shock again.

• Akkermans J., Richardson J., Kraimer M. The Covid-19 crisis as a career shock: Implications for careers and vocational behavior. Journal of Vocational Behavior. 2020; 119 [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Blustein D.L., Duffy R., Ferreira J.A., Cohen-Scali V., Cinamon R.G., Allan B.A. Unemployment in the time of COVID-19: A research agenda. Journal of Vocational Behavior. 2020; 119 [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Bureau of Labor Statistics (2020). Labor Force Statistics from the Current Population Survey. Retrieved May 6, 2020 from https://data.bls.gov/cgi-bin/surveymost .
• Cho E. Examining boundaries to understand the impact of COVID-19 on vocational behaviors. Journal of Vocational Behavior. 2020; 119 [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Guan Y., Deng H., Zhou X. Understanding the impact of the COVID-19 pandemic on career development: Insights from cultural psychology. Journal of Vocational Behavior. 2020; 119 [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Johns Hopkins (2020) Coronavirus Outbreak Mapped: Retrieved May 5, 2020 from https://coronavirus.jhu.edu/map.html .
• International Labor Organization ILO monitor: COVID-19 and the world of work. Third edition updated estimates and analysis. 2020. https://www.ilo.org/wcmsp5/groups/public/@dgreports/@dcomm/documents/briefingnote/wcms_743146.pdf Retrieved May 5, 2020 from:
• International Labor Organization (2020b) COVID-19 impact on the collection of labour market statistics. Retrieved May 6, 2020 from: https://ilostat.ilo.org .
• Kantamneni, N. (2020). The impact of the COVID-19 pandemic on marginalized populations in the United States: A research agenda. Journal of Vocational Behavior, 119 . [ PMC free article ] [ PubMed ]
• Kramer A., Kramer K.Z. The potential impact of the Covid-19 pandemic on occupational status, work from home, and occupational mobility. Journal of Vocational Behavior. 2020; 119 [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Leitheiser, E., Hossain, S.N., Shuvro, S., Tasnim, G., Moon, J., Knudsen, J.S., & Rahman, S. (2020). Early impacts of coronavirus on Bangladesh apparel supply chains. https://www.cbs.dk/files/cbs.dk/risc_report_-_impacts_of_coronavirus_on_bangladesh_rmg_1.pdf .
• Restubog S.L.D., Ocampo A.C., Wang L. Taking control amidst the Chaos: Emotion regulation during the COVID-19 pandemic. Journal of Vocational Behavior. 2020; 119 [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Rudolph C.W., Zacher H. COVID-19 and careers: On the futility of generational explanations. Journal of Vocational Behavior. 2020; 119 [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Spurk D., Straub C. Flexible employment relationships and careers in times of the COVID-19 pandemic. Journal of Vocational Behavior. 2020; 119 [ PMC free article ] [ PubMed ] [ Google Scholar ]
• World Health Organization (2020). World Health Organization Coronavirus Update. Retrieved May 5, 2020 from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019 .

A personal narrative of my COVID experience

One of the Experts by Experience supporting the Prevention and Early Detection Theme of ARC EoE, the University of Hertfordshire shares her reflections and experiences of life during COVID 19. Her personal narrative shines a light on the value of community and the importance of hearing individual voices from these communities to guide what, how and why we do research.

I am an Expert by Experience supporting the Prevention and Early Detection Theme of ARC EoE and the University of Hertfordshire. I live with my parents who are in their mid – late 70s in a rural Village of around 1000 people.

Before COVID my life really revolved around my Expert by Experience work and involvement in Church and community activities so mostly all outdoors and with people.  I used public transport to get around.  When COVID struck, like most people, my diary cleared within a few days and my life moved indoors and on to my laptop and phone.

There was initially extreme anxiety amongst my community groups about how to identify the vulnerable, a great desire to help, and a lot of pressure to do something.  This was very difficult as we were in a pandemic and we were very concerned about spreading infection.  It felt very powerless.

Before COVID I ran a popular weekly craft group which also provided a lot of social support.  Fortunately, one of the Group members set up a local craft group on Facebook immediately on lockdown and a lot of members joined.  Those not online I have continued to contact via phone, text and email regularly so we keep connected until we can meet again. 

Then the authorities banded together and the Church went online and continued the Food Banks which was all great.  I contacted some of the local groups to see how we could work together and  started mapping my community in terms of what resources were available to support people as I felt a coordinated community response was the best approach to pool our resources and identify potential gaps.  For me generally though it felt like a disconnect between the authorities and residents.  I felt that we were all worried about the same thing, the vulnerable and people falling through the gaps but somehow, we were not able to join up in much of a practical way. 

I also found there was also a big confusion over who the vulnerable were.  Some people did not see themselves as vulnerable while others not seen as vulnerable clearly were. Even though my parents are in their 70s, it was very difficult to know whether they were eligible for supermarket priority slots (not that we could get any anyway and we soon gave up trying).  This caused a lot of tension and arguments when the food started to run down as to how to get supplies as no one wanted anyone to go out.  A friend whose only method of communication was the phone ran out of phone credit early on and I spent the rest of lockdown concerned about them until I could go and knock on the door again once restrictions had lifted.

Fortunately, quite early on, our local supermarket began home delivery by email order and card and a local business set up a fruit and veg stall on one of the local farms. This helped greatly in the early days of lockdown as getting fresh supplies was very difficult.  Some people I know felt this gave them more independence rather than relying on others to get food for them.  Our local shop was also very supportive of our community and local pharmacies did home deliveries of prescriptions.

After much stress and feeling powerless being told to stay at home and also wanting to stay safe and not spread infection, I finally found the best way to support my community was from my laptop and phone, sharing official info from the Government website and our Councils, local Library resources, Neighbourhood Watch, local Surgery Patient Participation Group, Local Resilience Forum and Third Sector contacts and other trusted sources via our community Facebook page, email and phone.  I was able to quickly pass on public health info as well as info on local supplies as resources and information emerged.  I also printed official COVID posters for the local notice boards as nothing was appearing on the council boards due to the situation.

From the beginning of lockdown I started to use social media more for public information but found the COVID information very useful but the volume of it was becoming overwhelming and decided to also post things to help motivate, inspire and lift spirits particularly in the depths of lockdown such as daily photos of flowers from the garden, a Virtual History tour using our village photo archive and an armchair quiz. These have been very popular and I found it a good way of checking in with people I knew as they responded to posts. It was also useful to help get lost items of post redelivered and get lost cats back home.

Before lockdown I was getting increasingly anxious about the situation and was very happy once we were in lockdown as I felt safe.  After some time, I was worried that it felt too safe and I was then anxious about going out as most days I stayed in.  The outside environment felt very unsafe as germs could be anywhere, on surfaces, in the air and it felt that nowhere was safe.  When I did go out into the Village I have known all my life, it felt very strange, quite disorientating and even crossing the road seemed daunting. When it was mentioned that lockdown was going to end then I became very anxious and this has only increased over the weeks.  I still hardly go out.  I always wear a mask when I am near or with people even though I know nothing about whether masks are effective or necessary and it is probably starting to look a little odd, I feel safer with one on.

Throughout lockdown I was terrified I had COVID as I was quite unwell for some time early on with digestive symptoms not listed by the Government but which were reported in the media.  It was difficult to tell if they were COVID or stress related and I was not sure what to do. I had telephone consultations with GPs and found these excellent. I would like this option to continue.

I have found a lot of official advice to be confusing particularly now that restrictions are lifting and am not sure who I can meet as the situation is changing rapidly.  There is a lot of pressure from friends who are bored, fed up and want to meet up.  Some friends have been asking to meet up for weeks but I don’t want to go out as I am not sure if it is safe. It feels now that they might think I am avoiding them when really, I am afraid. Some friends have been shielding and are highly anxious, afraid and are not sure how to begin to take those first steps outside.

I look at the terrible things which are happening as reported in the media and feel even more afraid of going out.  Not knowing what to expect when going out, how I am supposed to behave, how other people are going to behave, what shops, banks, etc are open, opening times and especially whether toilets are open makes it difficult to even think about going out to Town centres and whether it is actually worth it.  I used to get public transport but cannot imagine doing this now which also makes it very difficult. 

Despite being highly anxious about technology which made it difficult to try or use Zoom at the beginning of lockdown, I am so glad that I persevered with all the problems of anxiety and unstable internet connection etc as it has meant that I have been able to continue with a small amount of work, some community activities, access webinars, creative sessions and undertake online Spot the Signs Suicide training.  Zoom has opened up so many opportunities and now I am afraid of having to go back into buildings for any reason and want the online world to continue. It also cuts out all the problems, the stress and tiredness of travelling on public transport as it enables me to manage my health much better.  I think it makes things more accessible for those who are disabled, managing health conditions or who have caring responsibilities.

I think people are going to need a lot of support: getting acclimatized to going out again and knowing what to expect and how to behave when outside. Help and support adjusting to unemployment, new work environments, working from home etc. Support with bereavement, loss and change. 

Being indoors every day during lockdown caused a lot of tension in the house as everyone was anxious about the situation and doing anything was so difficult.  Constant hand washing, checking for symptoms, checking for information on the news, talking and thinking about COVID.  We had lots of arguments over food and going out for supplies.

COVID has been quite traumatising, watching the horror of the situation unfold on a global and local scale.  Doing anything at all in the early days was so challenging and it felt like it was all I thought about.  There has been such a lot of loss that I think it will take a long time for the full impact to be felt and dealt with.  Fearing for the lives of friends who have been ill with COVID and not being able to see them felt very powerless and am not sure how to grieve the loss of a family member when we were not able to attend their direct funeral early on in lockdown. 

It has been difficult to plan the future when everything is so uncertain and there seems no end to it. The foundations of our lives have been and continue to be affected; our surroundings. employment, housing, the food we eat, money and resources, transport, education and skills, families, friends and communities have all been affected. All of these practical everyday concerns are connected to mental health problems and will be greater and need addressing.  Our community food bank definitely saw a big increase in demand.

At the beginning it seemed that we were all in it together and that there were probably few people who were not thinking about COVID. Then it became apparent that there were great divides, between generations, income groups etc that were all differently affected and that some had not been affected at all whilst others had lost so much. For me it shone a spotlight on all the problems in our society such as poverty which were greatly exacerbated by the situation. 

Technology poverty was also greatly apparent.  One day everything was outdoors and people, the next day everything went online and the whole world just vanished.  Councils, Churches, shops, services all shut their doors and put their services online.  My great concern throughout was for those not online and I feel that more needs to be done now to support people to get more connected in as many preferred ways as possible.  Teaching people how to text, setting up email accounts, teaching skills around accessing online resources and services, video conference technology, as well as connection through neighbours, local groups, services, etc

Community became more important than ever .  We need to strengthen the links and foster greater connections between neighbours, community groups, third sector, businesses, faith groups, services etc.

Keeping what has been useful; the use of video conference technology for meetings enables people who generally use public transport/or are unable or find it difficult to leave home to participate in involvement or research work e.g. disabilities, health conditions, carer commitments etc.  Explore the use of technology for online training resources for the public on all forms of healthcare, caring, support groups might be useful to continue.

Prevention and early detection in health and social care

Research in patient and public involvement

We have a research theme dedicated to finding out the best ways to involve patients, service users, carers and members of the public in research.

COVID-19 narratives and layered temporality

Affiliation.

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

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

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

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

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Community Reflections

My life experience during the covid-19 pandemic.

Melissa Blanco Follow

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Affiliation with sacred heart university.

Undergraduate, Class of 2024

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

Class assignment, Western Civilization (Dr. Marino).

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

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Persuasive Essay Guide

Persuasive Essay About Covid19

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

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

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

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

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

Read on to get started on your essay.

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

Steps to Write a Persuasive Essay About Covid-19

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

Step 1: Choose a Specific Thesis Statement

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

Step 2: Research and Gather Information

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

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

Step 3: Outline Your Essay

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

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

Step 4: Write the Introduction

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

Step 5: Provide Background Information

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

Step 6: Develop Body Paragraphs

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

Step 7: Address Counterarguments

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

Step 8: Write the Conclusion

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

Step 9: Revise and Proofread

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

Step 10: Cite Your Sources

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

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

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Examples of Persuasive Essay About Covid19

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

Check out some more PDF examples below:

Persuasive Essay About Covid-19 Pandemic

Sample Of Persuasive Essay About Covid-19

Persuasive Essay About Covid-19 In The Philippines - Example

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

Examples of Persuasive Essay About Covid-19 Vaccine

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

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

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

Covid19 Vaccine Persuasive Essay

Persuasive Essay on Covid Vaccines

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

Examples of Persuasive Essay About Covid-19 Integration

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

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

Persuasive Essay About Working From Home During Covid19

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

Examples of Argumentative Essay About Covid 19

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

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

Here are some examples of argumentative essays on Covid19.

Argumentative Essay About Covid19 Sample

Argumentative Essay About Covid19 With Introduction Body and Conclusion

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

Examples of Persuasive Speeches About Covid-19

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

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

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

Persuasive Speech About Covid-19 Example

Persuasive Speech About Vaccine For Covid-19

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

Tips to Write a Persuasive Essay About Covid-19

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

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

Choose a Specific Angle

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

Provide Credible Sources 

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

Use Persuasive Language

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

Organize Your Essay

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

Emphasize Benefits

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

Use Visuals -H3

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

Call to Action

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

Revise and Edit

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

Seek Feedback 

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

Tough Essay Due? Hire Tough Writers!

Common Topics for a Persuasive Essay on COVID-19 

Here are some persuasive essay topics on COVID-19:

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

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

To sum it up,

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

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

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

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

Frequently Asked Questions

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

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

What impact does COVID-19 have on society?

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

Caleb S. has been providing writing services for over five years and has a Masters degree from Oxford University. He is an expert in his craft and takes great pride in helping students achieve their academic goals. Caleb is a dedicated professional who always puts his clients first.

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March 19, 2024

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Study shows narrative conversion messages boost attitudes about COVID vaccinations among unvaccinated adults

by Mike Krings, University of Kansas

Public health communicators have tried numerous methods to encourage people to accept COVID-19 vaccinations and boosters. And while some messages were ineffective, new University of Kansas research discovered a specific type of narrative message—a conversion message—can directly improve attitudes and indirectly reduce resistance among people who have never been inoculated for COVID-19.

The experimental study also found that people were persuaded differently depending on their pre-treatment levels of general vaccine hesitancy beliefs.

Researchers tested two-sided conversion messages—in which a person told a story about how they were initially resistant to getting vaccinated for COVID-19 but eventually refuted these beliefs and changed their mind after infection—against one-sided advocacy messages, in which people said they always intended to get vaccinated after contracting COVID-19. The results confirmed that conversion messages improved attitudes.

Jeff Conlin, assistant professor of journalism & mass communications , led the study, in which participants were randomly assigned one of three conversion messages or one of three advocacy messages. After reading the message, participants answered questions assessing how they perceived the strength of the argument and the extent to which the author of the message was similar to themselves.

"Overall, compared to advocacy messages, conversion messages were more effective in increasing positive attitudes toward COVID-19 vaccines. Since the entire sample was unvaccinated, we were also interested in how conversion messages could reduce their resistance," Conlin said. "Our findings revealed the route to decreasing resistance was circuitous but also significant."

The researchers employed an analytical method called structural equation modeling to reduce measurement error and understand the broader relationships, or paths, between message manipulations and cognitive variables. The analysis showed significant indirect effects of conversion messages on resistance to vaccination through intervening cognitive processes .

Results in the final accepted structural equation model showed that resistance was significantly reduced following conversion message exposure through a path that initially included homophily or participants' perceived similarity of the author to themselves. It was then tested through argument strength, or participants' assessment of how convincing the message seemed, and finally, through elevated attitudes about COVID-19 vaccination.

"We wanted to understand better the relationships between intervening variables, or what was happening after message exposure but before people formed their attitudes and resistance intentions because these constructs represent different mechanisms of cognitive processing—fast and slow thinking," Conlin said.

The authors' explanation for the results was that there was likely a high degree of matching between the conversion message author's perceived psychological state and the beliefs held by the unvaccinated sample. As participants moved from homophily, or from a less effortful mode of fast-processing to argument strength, an effortful slow-scrutinizing process, they may have recognized that their judgment about vaccination was called into question.

More effortful processing was needed to compensate for a reduction in their confidence in self-judgments, which resulted in a need to evaluate the arguments in the message more closely.

"What's interesting is that participants were not just relying on a mental shortcut of recognizing the similarity between the author and themselves before forming attitudes and intentions—they were also scrutinizing the argument," Conlin said. "Ultimately, participants found the outcome of the message was acceptable. Along with increasing positive attitudes , these results showed that participants' intentions to resist COVID-19 vaccines were indirectly reduced."

The researchers also found different indirect routes to reduce vaccination resistance depending on participants' self-reported levels of general vaccine hesitancy. Participants who exhibited higher levels of hesitancy (prior to receiving the message treatment) showed reduced resistance through homophily, followed by argument strength.

Meanwhile, participants who exhibited lower levels of vaccine hesitancy used only argument strength, not homophily, when processing the message. For this group, however, indirect message effects on intentions to resist were not significant.

According to the authors, the findings lend empirical support to established dual processing theories such as the Heuristic Systematic Model that describe additive and biased serial processing, which also can be applied to practice.

Practically speaking, if public health communicators know that both types of processing occur serially, as opposed to simultaneously, and that homophily plays a default role, they can look for matches between a storyteller with a compelling conversion story and the target audience, Conlin said.

"What the author of the conversion message reveals about their former beliefs should overlap with current beliefs held by the target audience. Not only that, but the reasons the author shares about their conversion experience need to be convincing and well-told," he said.

The research is published in the journal Health Communication .

The work builds on research Conlin and colleagues previously conducted that showed two-sided conversion messages were more effective in persuading vaccine-hesitant participants than one-sided advocacy messages prior to the mass availability of vaccines.

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History Group Finds Little Evidence of K-12 ‘Indoctrination’

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The combination of COVID-19 school closures and rising culture wars put a harsh spotlight on educators, but none had it worse than the nation’s social studies educators.

Social studies has long been a political punching bag, but it reached a new peak around 2021, with teachers accused of indoctrinating students in a variety of political viewpoints, teaching students to “hate” the United States, and coloring key moments of U.S. history with a paintbrush of contemporary “woke” politics.

Pushback hasn’t been limited to conservatives, either: Lessons based on slavery simulations and other damaging, ahistorical lessons periodically go viral and create an uproar.

Fueled by this rhetoric, policymakers in some 18 states have passed legislation or other rules regulating how teachers can discuss issues of racism , sexism, and inequality in the classroom. Discussing critical race theory, the study of institutional racism, and even current events is banned or limited in some states, and under attack in others.

But preliminary findings from a new study by the American Historical Association, a professional organization of historians provides evidence that most middle and high school teachers history teachers strive to keep their lessons politically neutral. In the essay, published in TIME magazine , 97 percent of the about 3,000 teachers surveyed for the study said the top objectives of a social science lesson is to turn students into critical thinkers and informed citizens.

“The divisive concepts legislations that have been introduced by lawmakers make assumptions about what teachers are teaching. We always knew that teachers don’t really teach critical race theory in their classrooms. But not one [piece of legislation] had any data on what’s being taught,” said Jim Grossman, the executive director of the AHA.

Few teachers rely on political extremes to teach their lessons, but still most must navigate the rhetorical accusations that they’re indoctrinating students, the AHA concluded.

Over three quarters of teachers surveyed said they cobble together a multitude of online resources,from such sources as the Library of Congress, the federally funded Smithsonian Institution websites, and YouTube educational series like Crash Course, run by popular YouTubers John and Hank Green. Teachers tend to use textbooks only as a reference, rather than source material.

Teachers’ top paid resources include Newsela (52 percent), which features news articles culled from a variety of media and Discovery Education materials (30 percent), while the top free resources included inquiry-based lessons from the Stanford History Education Group and the archives of various federal museums, as well as Teachers Pay Teachers, a marketplace of lessons priced by teachers.

“We found that teachers don’t use materials from contentious sources, so the accusation that teachers are teaching kids to hate America is simply untrue,” said Grossman.

Decentralization can counter indoctrination

As part of the study, AHA reviewed the K-12 social studies content standards of all 50 states, interviewed district officials and history department heads, and conducted a survey of 3,000 educators in nine states. Collectively, the effort took two years.

The diffuse nature of control overhistory standards, means that there are local variations in the resources that teachers access, and how they teach history in class. But generally, Grossman said, teachers appear to keep their own politics outside the classroom. “They aren’t telling students to feel guilty about what their parents or grandparents did,” he said.

In fact, the decentralized structure and local control likely acts as a shield against widespread indoctrination, said the authors in their preliminary findings. But it does pose the risk of teachers relying on “unvetted” resources slipping into a curriculum.

Kevin Levin, a history educator who conducts professional development workshops with educators on teaching history, said that vetting digital material—now a primary source of information—is a skill that teachers still need to develop.

“Some teachers do use reliable materials, but just as many are plugging terms into a search engine and clicking the first thing. This has potential to mislead,” said Levin. This danger is heightened now, because technology like ChatGPT can fuel false information that doesn’t come with any warning.

Teachers need training

Most teachers, said Levin, are trying to navigate thorny issues like the legacy of slavery and white supremacy by arming themselves with as much information as possible. “They want to improve their content knowledge, in case they face pushback against their lessons,” said Levin.

But threading this information needle isn’t easy. Teachers that have attempted to use or interpret newer concepts, like white privilege, have gotten in trouble and even disciplined.

History teachers don’t personally have to be politically neutral, said Levin, but they must maintain a balance of diverse of views within their classrooms. Not only does that protect against allegations of partisan teaching, but it alsodevelops students’ skills to grapple with complicated questions. “Students have to be taught how to think. That is different from telling them what to think,” said Grossman.

Levin uses several techniques to expose teachers to different points of view in his training sessions. He shares lectures by historians, travels with them to field trips at historical sites, and shares teaching resources that teachers can take into their classrooms, especially topics that teachers know little about, or find hard to teach.

“When teachers can share more materials in class, it helps students understand that the past is just as complicated as the present, and there’s no one interpretation. Students are not treated as sponges, who only absorb and regurgitate one interpretation,” said Levin.

The AHA recommends better, content-rich PD for history teachers, who are mostly left on their own to find appropriate materials. Teachers, the survey found, have indicated that “missteps” in class happen because they lack information on a particular topic, not because they’re trying a partisan approach.

“School districts should focus on history teachers and keep them up to date on current information or train them better in information literacy. It can help them keep up with how misinformation is spread,” said Grossman.

Some aspects of history education are inevitably challenging, Levin said. Allowing students to arrive at their own conclusions goes against the notion that they should be taught a particular version of past events, as was the case in prior generations where a narrative of American exceptionalism prevailed.

“The controversy we are witnessing is an admission that the past conservative view of history has failed. There is an attempt to turn things back, but in the digital age, its impossible to control the narrative,” said Levin.

The AHA will release its full report this fall. Grossman hopes it will temper the accusations laid against history teachers, and prompt more support for their training and development as educators who inspire critical thinking in their classrooms.

“We are providing an empirical basis to come to the same conclusion that we should’ve come to logically,” he said. “Our data shows that educators are using history [lessons] to develop people who cannot be indoctrinated in the future.”

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Charles M. Blow

The Potency of Trump’s ‘Lost Cause’ Mythmaking

By Charles M. Blow

Opinion Columnist

At an Ohio rally this month, Donald Trump saluted the insurrectionists who stormed the Capitol on Jan. 6, 2021, calling them “unbelievable patriots” and referring to those who’ve been locked up for their involvement on that terrible day as “hostages.”

This was a continuation of Trump’s “Lost Cause” mythmaking that began during his successful presidential campaign in 2016 and was ramped up in service of his efforts to remain in power despite his 2020 loss and the deadly riot that those efforts stoked.

More than 1,200 people have been charged related to Jan. 6. And though it shouldn’t have to be said, let’s be clear: Those who’ve been tried, convicted and imprisoned for storming the Capitol aren’t hostages, they’re criminals.

But Lost Cause narratives aren’t about truth. They’re about negating the truth.

Which is what happened when the Lost Cause mythology was constructed after the Civil War. The cause of the war was framed as “Northern aggression” rather than slavery. A lore about happy slaves and benevolent enslavers proliferated. The narrative valorized those who seceded from and fought against the United States.

And it has survived to some degree for over 150 years, tucked into the cracks of our body politic. It still surfaces in ways that may seem remote from the Confederate Lost Cause myth, but that definitely promote it.

It manifested itself last year when Florida changed its African American history standards to say that the enslaved “ in some instances ” benefited from their enslavement, and in Nikki Haley’s hesitance on the campaign trail to state the obvious, that slavery was the cause of the Civil War.

It manifested itself in the infamous torchlight march in Charlottesville and in the bitter resistance to removing Confederate monuments.

Trump has his own version of the Lost Cause, one that’s not completely untethered from the old one, but one that’s miniaturized, personal and petty.

The Confederate Lost Cause narrative came after enormous loss: Hundreds of thousands of soldiers had died, the South was decimated and its economy was hobbled. Trump’s Lost Cause, on the other hand, is about the grievances he promotes, his inability to accept losing to Joe Biden and his utter disregard for democratic norms.

Trump’s version grows out of a more recent vintage of the Lost Cause narrative, one that has been around at least since George Wallace’s first presidential campaign in the 1960s. One in which a sense of displacement and dispossession is driven by a lost cultural advantage.

David Goldfield, a historian at the University of North Carolina Charlotte and the author of “Still Fighting the Civil War: The American South and Southern History,” told me that many of Trump’s supporters feel that they’ve lost something similar to what white Southerners felt they had lost after the Civil War: “They were no longer relevant. They were no longer listened to. And on top of that, there were lots of other voices that were in play in public that were not there before.”

The Pulitzer Prize-winning Yale historian David Blight, who has written on several occasions about Trump’s Lost Cause, told me that Trump’s iteration has all the necessary elements: a story of loss, culprits, ready-made villains and “an enormous narrative of grievance.”

As Blight explained, Trump “feeds on this imagined tale of what could have been, should have been, might have been and once again can be retrieved; the glory can be retrieved.”

And Trump invokes his Lost Cause in combination with another false telling, one of unprecedented happiness and unity — in which all the glory belongs to him. As he told a crowd at Mar-a-Lago on Super Tuesday, “African American, Asian American, Hispanic American, women, men, people with diplomas from the best schools in the world and people that didn’t graduate from high school, every single group was doing better than ever before.” He continued, “Our country was coming together.”

What he ignores is that his presidency began with the Women’s March, the day after his inauguration, and ended not long after the 2020 summer of protests, driven by outrage over the murder of George Floyd. Trump didn’t bring the country together; he tore it further apart.

Unlike previous Lost Cause appeals, Trump’s has the advantage of a modern communications environment: 24-hour cable news, an internet replete with partisan news sites and social media — an octopean virtual world that reaches deep into the darkest places of our politics.

And Trump’s appeal is getting a do-over, a chance not to simply recast history — to win the narrative — but to win the actual contest and convert an electoral loss into an electoral victory.

In this election, disciples of the MAGA movement not only have an opportunity to enshrine Trump’s fallacies. MAGA also might rise again.

The Times is committed to publishing a diversity of letters to the editor. We’d like to hear what you think about this or any of our articles. Here are some tips . And here’s our email: [email protected] .

Follow the New York Times Opinion section on Facebook , Instagram , TikTok , WhatsApp , X and Threads .

Charles M. Blow is an Opinion columnist for The New York Times, writing about national politics, public opinion and social justice, with a focus on racial equality and L.G.B.T.Q. rights. @ CharlesMBlow • Facebook

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Doctor Accuses Media and Medical Industry of COVID-19 Vaccine Misinformation

Brian Gottstein / March 15, 2024

One doctor challenges COVID-19 vaccine safety and accuses the media and medical industry of misinformation, citing data on increased deaths and disabilities after vaccinations. Pictured: President Joe Biden receives a fourth dose of the Pfizer/BioNTech COVID-19 vaccine on March 30, 2022, in Washington, D.C. (Photo: Anna Moneymaker/Getty Images)

From President Joe Biden to the former head of the Centers for Disease Control and Prevention to your local physician, those in authority repeated the mantra that COVID-19 vaccines were “safe and effective.”

However, Dr. Pierre Kory, a pulmonary critical care physician and the head of a team of medical professionals who develop prevention and treatment protocols for COVID-19 , begged to differ. Appearing on “The Tucker Carlson Encounter” on X, Kory said the data didn’t support such a statement but actually supports the opposite conclusion.

Kory is president of the Front Line COVID-19 Critical Care Alliance, an organization started by five intensive care unit doctors who were on the front lines of patient treatment when the coronavirus pandemic hit the U.S. He gained national attention for advocating widespread off-label use of certain drugs such as ivermectin as treatments for COVID-19.

Kory told Carlson that excess fatalities and disability claims started to skyrocket when people started taking the COVID-19 vaccines. He said data showing a dramatic increase in deaths among young people and white-collar workers drew him to ask these questions: “Why was there an explosion in dying in the youngest and healthiest sectors of society, and why did the employed fare far worse than those that weren’t?”

Americans’ life expectancy dropped by three years during the three years of the pandemic, he said, and in those same three years, 4 million Americans joined the disability rolls.

Since the pandemic , Kory said he has seen more people coming into his clinic complaining about a whole series of problems they developed after taking the vaccines.

He said that what we call “long COVID” doesn’t seem to be a result of COVID-19 at all because his patients’ long COVID symptoms began after they got their vaccinations, not after they contracted the disease.

The media, government officials, and medical societies have worked to suppress information that was counter to the message that vaccines were safe and effective, Kory said.

Kory told Carlson that the pharmaceutical industry influences the major medical journals to print pieces that are favorable to pharmaceuticals. When doctors read the articles in those journals, he said, they often treat them as gospel truth.

He personally saw that studies that went against the “vaccine agenda” didn’t get published in major journals, Kory said, while studies that favored the vaccines and tried to debunk alternatives were the ones that got published. According to Kory, those studies favorable to vaccines were heavily manipulated and not based in science.

The critical care physician told Carlson that the media and medical professionals attacked him for promoting ivermectin as a successful treatment for COVID-19 patients in his own practice. The drug had been used safely around the world for years but was suddenly considered dangerous when doctors wanted to use it to fight coronavirus infections.

With ivermectin, Kory said his organization was “fighting a war, a global disinformation campaign, trying to destroy early effective treatment drugs [like ivermectin] in order to prop up this vaccine campaign.”

Watch Kory’s full interview with Carlson here:

Ep. 81 They’re still claiming the Covid vax is safe and effective. Yet somehow Dr. Pierre Kory treats hundreds of patients who’ve been badly injured by it. Why is no one in the public health establishment paying attention? pic.twitter.com/IekW4Brhoy — Tucker Carlson (@TuckerCarlson) March 13, 2024

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