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Research Article

The long-term effects of perceived instructional leadership on teachers’ psychological well-being during COVID-19

Roles Conceptualization, Methodology, Writing – original draft, Writing – review & editing

Affiliations School of Information Engineering, Shandong Youth University of Political Science, Jinan, Shandong, China, Faculty of Education, Qufu Normal University, Qufu, Shandong, China

Roles Investigation, Writing – review & editing

Affiliation Faculty of Education, Jiangxi Science and Technology Normal University, Nanchang, Jiangxi, China

Roles Conceptualization, Methodology, Supervision, Writing – review & editing

* E-mail: [email protected] (I-HC); [email protected] (JHG)

Affiliation Chinese Academy of Education Big Data, Qufu Normal University, Qufu, Shandong, China

Roles Supervision, Validation, Writing – review & editing

Affiliation Department of English, National Changhua University of Education, Changhua, Taiwan

Roles Data curation, Writing – review & editing

Affiliation Yangan Primary School of Qionglai City, Qionglai, Sichuan, China

Affiliation Gaogeng Nine-year School, Qionglai, Sichuan, China

Roles Validation, Writing – review & editing

Affiliation Shandong Provincial Institute of Education Sciences, Jinan, Shandong, China

Xiu-Mei Chen,
Xiao Ling Liao,
I-Hua Chen,
Jeffrey H. Gamble,
Xing-Yong Jiang,
Xu-Dong Li,

Published: August 19, 2024
https://doi.org/10.1371/journal.pone.0305494
Reader Comments

The COVID-19 outbreak led to widespread school closures and the shift to remote teaching, potentially resulting in lasting negative impacts on teachers’ psychological well-being due to increased workloads and a perceived lack of administrative support. Despite the significance of these challenges, few studies have delved into the long-term effects of perceived instructional leadership on teachers’ psychological health. To bridge this research gap, we utilized longitudinal data from 927 primary and secondary school teachers surveyed in two phases: Time 1 in mid-November 2021 and Time 2 in early January 2022. Using hierarchical linear modeling (HLM), our findings revealed that perceptions of instructional leadership, especially the "perceived school neglect of teaching autonomy" at Time 1 were positively correlated with burnout levels at Time 2. Additionally, burnout at Time 2 was positively associated with psychological distress and acted as a mediator between the "perceived school neglect of teaching autonomy" and psychological distress. In light of these findings, we recommend that schools prioritize teachers’ teaching autonomy and take proactive measures to mitigate burnout and psychological distress, aiming for the sustainable well-being of both teachers and students in the post-pandemic era.

Citation: Chen X-M, Liao XL, Chen I-H, Gamble JH, Jiang X-Y, Li X-D, et al. (2024) The long-term effects of perceived instructional leadership on teachers’ psychological well-being during COVID-19. PLoS ONE 19(8): e0305494. https://doi.org/10.1371/journal.pone.0305494

Editor: Ali B. Mahmoud, St John’s University, UNITED STATES OF AMERICA

Received: April 29, 2023; Accepted: May 30, 2024; Published: August 19, 2024

Copyright: © 2024 Chen 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 relevant data are within the manuscript and its Supporting Information files.

Funding: This study was financially supported by the 2021 National Social Science Foundation of China (NSSFC) “Research on Mixed Ownership Model of Vocational Education” in the form of an award (BJA210105) received by I-HC. No additional external funding was received for this study. The funder 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.

1 Introduction

In response to the outbreak of COVID-19, countries worldwide implemented protective measures, such as physical distancing, to prevent the spread of the virus, resulting in the closure of schools globally [ 1 ]. The closure of schools has not only affected students’ psychological well-being [ 2 – 5 ], but has also caused a significant level of stress among teachers [ 6 , 7 ]. Studies indicate that teachers experienced pressure during the closure period due to mandatory teaching of online courses [ 8 ], increased teaching workloads [ 9 ], lack of support from administrators [ 10 , 11 ], and poor communication with students and parents [ 9 ]. Additionally, teachers suffered from symptoms such as anxiety, depression, and sleep disturbances [ 12 ]. As such, the literature has provided mounting evidence to suggest that COVID-19 has caused considerable psychological distress among teachers [ 13 – 15 ].

Recent studies have underscored the potential long-term consequences of pandemic-induced stress, which can erode protective factors such as teachers’ resilience. This erosion can lead to burnout [ 16 ] and adversely affect their psychological well-being [ 17 – 19 ]. The challenges are compounded by the fact that school closures and the shift to online teaching have heightened the risk of burnout among teachers [ 20 ]. This exacerbates their already significant levels of psychological distress [ 21 , 22 ], leading researchers to delve deeper into the factors contributing to job burnout and psychological distress among educators.

Building on this, individual-level factors during COVID-19 have been extensively studied. These include role conflict [ 23 ], professional experience (such as the number of years spent teaching) [ 24 ], teacher professional identity (which encompasses individual beliefs, values, and commitments related to the teaching profession) [ 25 ], and perceptions about one’s ability to control situations [ 26 ]. This also covers competence in online teaching tasks [ 27 ] and anxiety related to communicating with parents [ 28 ]. On the organizational front, Maslach et al. [ 29 ] posited that burnout stems from extended exposure to work-related stressors. Thompson et al. [ 30 ] introduced the Six Areas of Worklife model, pinpointing workload, control, reward, and values as organization-level factors linked to burnout, especially during the COVID-19 era. Other organization-level factors contributing to teacher burnout include work climate, work pressure, perceptions of collective exhaustion among peers, disruptions to conventional classroom teaching [ 31 ], diminished administrative support [ 28 , 32 ], and supervisory management styles [ 33 , 34 ]. Research has also highlighted the correlation between principals’ leadership styles and teacher burnout [ 35 – 37 ]. Moreover, numerous studies have identified teacher burnout as a significant predictor of psychological distress in educators [ 21 , 38 , 39 ].

While the significance of both individual-level and organization-level factors related to burnout has been assessed in the context of COVID-19, organization-level factors have not been sufficiently evaluated. Indeed, the education department should place greater emphasis on factors at the organizational level when implementing decisive measures to address them. Instructional leadership, a pivotal aspect of school leadership [ 40 , 41 ], has yet to be thoroughly explored in terms of its impact on teachers’ well-being during the pandemic. To date, there seems to be a gap in the literature regarding how teachers’ perceptions of instructional leadership influence their experiences of burnout and psychological distress, especially during school closures. This gap is particularly evident in studies focusing on the longitudinal effects of perceived instructional leadership on the mental health of Chinese teachers. Given this context, this study seeks to address the following research question: How do teachers’ perceptions of instructional leadership affect their subsequent experiences of burnout and psychological distress ?

To address the above gap, our study undertook two waves of data collection: the first wave was gathered during the period of online teaching when campuses were closed, aiming to gauge teachers’ perceptions of instructional leadership. The second wave was collected after the resumption of face-to-face classes to assess teacher burnout and psychological distress. The objective of this paper is to explore the relationship between perceived instructional leadership and subsequent burnout and psychological distress using hierarchical linear modeling (HLM). In this context, teachers’ perceptions of instructional leadership are considered at the school level, while burnout and psychological distress are evaluated at the individual (teacher) level. The subsequent section will present the model and research hypotheses.

2 Model and hypothesis

In the present research, we employed longitudinal data to systematically examine the influence of teachers’ perceptions of instructional leadership on subsequent manifestations of job burnout and psychological distress, as delineated in Fig 1 . To operationalize the construct of perceived instructional leadership, we grounded our categorization within the tenets of the Self-Determination Theory (SDT), segmenting it into three distinct categories. To elucidate the interrelationships among these variables, we anchored our investigation in the Stressor-Strain-Outcome (SSO) model, as proposed by Koeske and Koeske [ 42 ], subsequently formulating pertinent research hypotheses.

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The dotted line represents the indirect effect of perceived instructional leadership at Time 1 on psychological distress at Time 2.

https://doi.org/10.1371/journal.pone.0305494.g001

2.1 The SSO model

The Stressor-Strain-Outcome (SSO) model explains how work-related stressors negatively impact employee behavior through psychological strain, and conceptualizes strain as a mediating factor [ 42 ]. Stressors, in the SSO model, are environmental stimuli that employees perceive as bothersome and disruptive, such as excessive workload, a lack of support, and conflicting roles [ 42 – 44 ]. Strain, on the other hand, is a negative reaction to environmental stimuli that disrupts employees’ concentration, effecting their physiology and mood [ 42 , 45 ], with burnout as a common manifestation [ 42 , 43 ]. Outcome refers to the lasting behavioral or psychological effects of chronic stress and strain, such as physical or psychological symptoms (e.g., psychological distress in the workplace).

Based on the aforementioned concerns, three perceptions of school instructional leadership were evaluated by this study as disruptive environmental stimuli (i.e., stressors): perceived school neglect of teaching autonomy, perceived school neglect of teaching competence, and perceived school emphasis on competitive relationships during the COVID-19 pandemic.

Studies shown that burnout is often conceptualized as a strain in response to environmental stimuli in SSO model [ 42 , 43 ]. The construct of job-related burnout was proposed by Freudenberger [ 46 ] to describe the extreme physical and emotional exhaustion experienced by individuals due to excessive workloads. Maslach et al. [ 29 ] later defined burnout as "a prolonged response to chronic emotional and interpersonal stressors on the job," characterized by exhaustion, cynicism, and inefficacy. Emotional exhaustion, in particular, is considered the central component of burnout [ 42 , 47 ]. In the context of the COVID-19 pandemic, emotional exhaustion maybe a negative reaction to teachers’ perceived instructional leadership [ 48 , 49 ].

As per the SSO model, stressors produced by three perceptions of instructional leadership may result in psychological distress (outcome) in teachers, with burnout (strain) mediating the relationship between the two. In the following subsections, the hypothesized relationships between these variables are presented sequentially.

2.2 Operationalizing perceived instructional leadership during the COVID-19 pandemic: A tripartite categorization based on SDT

Instructional leadership is widely recognized as the cornerstone of school leadership [ 40 , 41 ]. Narrow conceptions of instructional leadership focus solely on teacher behaviors that augment student learning, whereas broader interpretations encompass issues related to both organizational and teacher culture [ 50 ]. According to Alig-Mielcarek and Hoy [ 51 ], instructional leadership comprises three primary components: (1) defining and communicating goals, (2) monitoring and providing feedback on the teaching and learning process, and (3) promoting and emphasizing the significance of professional development. Consequently, instructional leadership has emerged as an indispensable element of school reform and enhancement [ 51 ]. It influences a myriad of factors pivotal to the resilience of educational institutions, ranging from "organizational silence" (where crucial events or concerns remain unvoiced) to "organizational attractiveness" (reflecting positive sentiments towards an institution) [ 52 ].

The construct of instructional leadership in this study differs from the predominate perspective, which emphasizes leaders’ roles in stimulating teachers’ effectiveness in teaching and learning and improving students’ outcomes [ 53 ]. During the COVID-19 period, a more directive leadership style is indispensable to efficiently guide teachers in adapting to the unfamiliar task of online teaching [ 54 , 55 ], and it can be considered a special form of "instructional leadership" under pandemic conditions. It is uniquely adapted for the pandemic context and can reflect the teachers’ perceived instructional leadership in the context of epidemic. Specifically, drawing from the SDT, this study categorizes teachers’ perceptions of instructional leadership during school closures into three distinct categories: perceived school neglect of teaching autonomy, perceived school neglect of teaching competence, and perceived school emphasis on competitive relationships. As posited by SDT, every individual harbors three fundamental psychological needs: autonomy, competence, and relatedness [ 56 , 57 ]. The fulfillment of these needs is essential for an individual’s holistic development, and any deficiency can adversely impact their psychological well-being [ 57 ]. In this context, perceived school neglect of teaching autonomy denotes teachers’ sentiments that schools overlooked their online teaching autonomy, compelling them to adhere to specific teaching standards and methodologies, thereby affecting perceived autonomy. Perceived school neglect of teaching competence signifies teachers’ perceptions that schools disregarded their online teaching competence during the closure, marked by a lack of provision for necessary online teaching training and an apparent indifference to the challenges of online/distance teaching, thereby affecting perceived competence. The perception of the school emphasizing competitive relationships suggests environments where competition among teachers was unduly promoted, engendering a detrimental atmosphere concerning relatedness. These constructs, which pertain to the neglect of teacher autonomy and competence and the prioritization of competition over collaboration, can be considered stressors in pandemic context. They have largely remained unexplored empirically. In contrast, supportive instructional leadership styles, which have been linked with a sustainable sense of agency, teacher expertise, and positive peer relationships, are documented in sustainable education literature [ 58 , 59 ].

2.3 Perceived instructional leadership and burnout

In this study, we examine the impact of perceived instructional leadership on teachers’ job burnout during the school closure period. In the previous research, it was found that principals’ leadership was related with teacher burnout [ 35 – 37 ]. Eyal and Roth [ 35 ] found that while transactional leadership (which seeks efficiency through monitoring and ensuring compliance through rewards and punishments) was positively correlated with burnout, transformational leadership (characterized by empowering and fostering individuals’ sense of mission through encouragement of innovation based on individual needs) was negatively correlated with burnout. Collie’s findings [ 36 ] highlighted that autonomy-supportive leadership (which refers to practices that promote individuals’ self-initiation and empowerment) was associated with lower emotion exhaustion and autonomy-thwarting leadership (which refers to practices that exert external control and reduce individuals’ self-determination) was positively associated with emotional exhaustion. Based on instructional leadership has been accepted as the core of school leadership [ 40 , 41 ], our first hypothesis (Hypothesis 1) is that teachers’ perceived instructional leadership would be positively associated with teachers’ job burnout. Specifically, we propose three sub-hypotheses based on the dimensions of instructional leadership that have been suggested as significant stressors, based on the SSO.

H 1a : Perceived instructional leadership that neglects teaching autonomy will have a positive relationship with job burnout. Previous research has shown a strong relationship between burnout and autonomy [ 29 , 36 , 60 , 61 ]. Teachers who are unable to choose their own teaching methods during remote teaching may experience negative attitudes towards teaching activities, dissatisfaction with their work, and depression [ 62 ].

H 1b : Perceived instructional leadership that neglects teaching competence will have a positive relationship with burnout. During the school closure period, teachers were not provided with required training for online teaching, and some may feel that the school was not paying attention to their teaching abilities. This lack of support may result in increased teaching pressures and a sense of incompetence, leading to burnout [ 34 , 63 ].

H 1c : Perceived instructional leadership that emphasizes competitive relationships will have a positive relationship with burnout. Instructional leadership that emphasizes competition among teachers may lead to a lack of feedback from colleagues and leaders during online instruction, which has been shown to contribute to burnout [ 64 ].

2.4 Burnout and psychological distress

Job burnout is a persistent, negative, and work-related psychological condition that can lead to turnover intention [ 65 ] (for example, among Chinese high school teachers during the pandemic), reduced productivity [ 66 ] (for example, among primary and secondary school teachers in English), and psychological distress such as anxiety and depression both in the general population [ 29 , 67 ] and among schoolteachers [ 68 ]. Teachers belong to a profession that is more likely to experience work-related stressors and psychological distress than other occupations [ 69 ]. As a group at high risk of job burnout [ 70 ], teachers have drawn extensive attention from researchers [ 14 , 71 , 72 ]. Shin et al. [ 38 ] used a three-wave longitudinal data to show that burnout among Korean middle and high school teachers predicted subsequent depressive symptoms. Similarly, in a scoping review, Agyapong et al. [ 39 ] found that teacher burnout could provoke symptoms such as anxiety and depression.

Based on the above facts, we propose the second research hypothesis: teachers’ burnout will be positively associated with psychological distress (Hypothesis 2). This hypothesis suggests that the experience of burnout in teachers is likely to result in psychological distress, given the high prevalence of psychological distress among teachers and the evidence linking burnout to subsequent depressive symptoms and other negative mental health outcomes.

2.5 The mediation of burnout between perceived instructional leadership and psychological distress

According to the SSO model, job stress does not necessarily lead directly to specific outcomes but may act on outcomes through a mediating mechanism (in this case, burnout) [ 42 ]. This mediating effect of burnout has been documented in various studies. For instance, Koeske and Koeske [ 73 ] found that emotional exhaustion mediated stressful events experienced by students and their physical and mental health symptoms. In two other studies, Dhir et al. [ 74 ] and Pang [ 75 ] found that social media fatigue mediated excessive media use and anxiety and depression as well as perceived information overload and emotional stress and social anxiety.

The independent variables from the above literature [ 73 – 75 ], including stressful events experienced by students, excessive media use, perceived information overload, and the three types of teachers’ perceived instructional leadership assessed in this study, are all prominent stressors. The dependent variables, such as anxiety and depression, represent different forms of psychological distress. Therefore, we hypothesize that burnout may mediate the relationship between teachers’ perception of instructional leadership (neglect of teaching autonomy, neglect of teaching competence, and emphasis on competitive relationships) and psychological distress (Hypothesis 3).

3.1 Participants

In this study, participants were recruited from Shangrao City, Jiangxi Province, China. Due to the COVID-19 outbreak in the city during October 2021, face-to-face teaching was cancelled for the city’s primary and secondary schools by the municipal government, beginning on November 3, 2021. After a month of strict restrictions, the outbreak was brought under control, and the campus reopened for face-to-face instruction. During this period, we conducted an online survey, with the assistance of the city’s education department, comprised of two waves. The first wave was conducted to investigate teachers’ perceived instructional leadership during school closures (Time 1: mid-November 2021). The second wave of the study examined teachers’ burnout and psychological distress within 2 to 3 weeks of resuming face-to-face teaching (Time 2: early-January 2022).

A priori sample size estimation was conducted using the Optimal Design Software [ 76 , 77 ]. With the support of the city’s education department, we were able to involve more than 100 schools in this survey. For the intended HLM analysis, given a cluster number of 100, a desired power of 0.8, an expected effect size of 0.30, and a significance level set at 5% (0.05), the a priori estimation yielded a requirement of five subjects per cluster (refer to S1 Fig ). Based on this outcome, we deduced that for cluster numbers exceeding 100, having 5 subjects per cluster would be adequate. This conclusion aligns with findings from previous studies [ 78 , 79 ]. These studies emphasized that to achieve adequate power, it’s more beneficial to increase the number of sampled clusters. Typically, sample sizes of up to 60 at the highest level and k+2 at the lower level (when there are k independent variables) are required.

This study was approved by the Jiangxi Association of Psychological Counselors (IRB ref: JXSXL-2020-J013), and with the assistance of the local education authority, data was collected via a hyperlink via convenience sampling. As participation was voluntary, participants were asked to include their email addresses if they wished to participate in a follow-up survey. There were 1,642 teachers who provided their email addresses and completed the longitudinal survey. To ensure data quality, we eliminated participants whose reported age was less than 18 and whose response time to all questions was less than 150 seconds. Additionally, we decided to exclude schools with participants of less than 4, considering the issue of representativeness and the required sample size [ 78 , 79 ]. As a final sample, 103 schools and 927 primary and secondary teachers were included, with a minimum of five teachers per school.

3.2 Measures

Demographic variables such as gender, teaching experience, subject of instruction and school type (primary school or secondary school), were collected. At Time 1, participants were asked to rate their perception of instructional leadership in the context of mandatory online instruction. At Time 2, participants were asked to report their levels of burnout and psychological distress over the preceding two weeks. The following subsections provide a detailed description of the measurement tools used in this study, and the items of the questionnaires are listed (see S1 – S3 Tables) in appendix.

3.2.1 Perceived instructional leadership.

To our knowledge, there isn’t a tool specifically designed to measure teachers’ perceptions of instructional leadership during periods of mandatory online teaching, such as those experienced during the pandemic. In the context of epidemic, a more directive leadership style is essential to guide teachers in the face of online teaching [ 54 ]. For the purpose of assessing teachers’ perceptions of this special form of instructional leadership at Time 1, we utilized the Psychological Need Thwarting Scale of Online Teaching (PNTSOT) developed by Yi et al. [ 80 ]. The alignment between perceived instructional leadership and the PNTSOT is illustrated in S2 Fig .

The PNTSOT was initially developed to assess the extent of psychological need thwarting during online teaching. In accordance with the CFA results in [ 80 ] (CFI = 0.966, NNFI = 0.955, RMSEA = 0.09, and SRMR = 0.05) and revised results in [ 72 ] (CFI, NNFI ranged from 0.960 to 0.999; RMSEA and SRMR were both less than 0.09), these results indicate that PNTSOT has ideal factorial validity among primary and secondary schoolteachers.

In this study, the three subscales of the PNTSOT (autonomy, competence and relatedness thwarting) were considered as direct reflections of perceived instructional leadership (perceived school neglect of teaching autonomy, perceived school neglect of teaching competence and emphasis on competitive relationships) by teachers. For each question, a seven-item Likert-type scale was used, ranging from "strongly disagree" to "strongly agree". The three variables for psychological need thwarting were aggregated into school-level variables which corresponded to the three types of perceived instructional leadership. Through HLM, high-level data can be derived from the aggregation of low-level data. To establish the plausibility of the aggregation, the values of within-group agreement ( r wg ) were calculated and they were found to have adequate consistency ( r wg values for perceived school neglect of teaching autonomy, neglect of teaching competence, and emphasis on competitive relationships were 0.77, 0.74 and 0.82). Values of r wg between 0.70 and 0.79 indicated moderate agreement, and values of .80 and above indicated strong agreement [ 81 ]. As a result, it is was deemed reasonable to aggregate teacher-level data to school-level data and use them as independent variables for this study. The following will explain the correspondence between the three sub-dimensions of the PNTSOT and the three types of perceived instructional leadership.

Perceived school neglect of teaching autonomy refers to instructional leadership in which teachers felt that schools did not value their teaching autonomy and forced them to use specific teaching methods during online teaching. Perceived school neglect of teaching autonomy can be described by the autonomy thwarting subscale of the PNTSOT in terms of the following four items: “During online courses during the pandemic, I cannot decide for myself how I want to teach”, “During online teaching work during the pandemic, I feel there is pressure that affects my behavior and requires me to comply in a certain way”, “I have to follow a prescribed online teaching style during the pandemic” and “During the pandemic, I feel pressure from the external environment that limited me in choosing a particular online teaching style”. The higher the score, the more pronounced the perception of neglected teaching autonomy. Teachers perceptions of school neglecting teaching autonomy in this study demonstrated a high level of internal consistency (Cronbach’s α = 0.79, McDonald’s ω = 0.79).

Perceived school neglect of teaching competence means that teachers believed their schools did not provide necessary online teaching training. They also paid little attention to their online teaching during the school closure period. Teachers felt that they had few opportunities to acquire more online teaching experiences. This sense of neglect can be described through competence thwarting in PNTSOT. The four items of competence thwarting included “There are some online teaching situations that make me feel incapable in my daily work environment during the pandemic” and “Due to the lack of training opportunities in my environment, I feel that I am not capable of performing online teaching tasks”. As a result of these items, it appears that schools may be neglecting teachers’ online teaching ability. A higher score indicates a higher level of perceived neglect of teaching competence. There is an acceptable degree of internal consistency from our data (Cronbach’s alpha = 0.84, McDonald’s alpha = 0.86) for perceived school neglect of teaching competence.

Perceived school emphasis on competitive relationship refers to teachers’ belief that schools value teachers’ competition. This variable can be assessed using relatedness thwarting in the PNTSOT, in which the four items include “I feel disconnected from other colleagues and leaders when teaching online during the pandemic” and “I feel that my colleagues and leaders are jealous of me when I achieve good results in online teaching during the pandemic”. A higher score indicates a higher level of perception of school competitive relationships. Teachers perceptions of school competitive relationships in this study demonstrated good internal consistency (Cronbach’s α = 0.89, McDonald’s ω = 0.88).

3.2.2 Burnout.

Based on the fact that emotional exhaustion contributes most significantly to burnout [ 47 , 82 ], this study used the "Emotional Exhaustion Subscale" (8 items) of the Chinese version of the Primary and Secondary School Teachers’ Job Burnout Questionnaire (CTJBQ) [ 83 ] to assess teacher burnout at Time 2. A modified version of the CTJBQ scale was developed on the basis of the Maslach Burnout Inventory [ 82 ] to accommodate the cultural and linguistic background of mainland Chinese teachers. The CTJBQ scale includes subscales measuring emotional exhaustion, including "After a day at work, I feel exhausted" and "I feel that teaching has exhausted me emotionally and mentally." Based on a 7-point Likert-type scale, responses ranged from 1 (strongly disagree) to 7 (strongly agree). A higher score indicates a greater degree of job burnout. This study found that good internal consistency for burnout scores (Cronbach’s alpha = 0.95, McDonald’s ω = 0.95).

3.2.3 Psychological distress.

In order to assess psychological distress at Time 2, this research utilized the Chinese version of the Depression, Anxiety, and Stress Scale (DASS-21) developed by Chan et al. [ 84 ]. It has been demonstrated that the Chinese version of the DASS-21 scale has satisfactory psychometric properties [ 85 , 86 ]. In addition, recent studies have shown that DASS-21 scores are a valid indicator of general psychological distress [ 87 , 88 ]. A four-point scale was used to evaluate items on the DASS-21, with higher scores indicating more severe psychological distress. DASS-21 scores demonstrated excellent internal consistency in this study (Cronbach’s alpha = 0.96, McDonald’s alpha = 0.96).

3.3 Data analysis strategy

In terms of data analysis, a descriptive analysis was first conducted to analyze the background characteristics of the participants. This was followed by Pearson correlation analysis to determine the means of all variables and their correlations. As a next step, HLM 6.08 software was used to analyze the data to test the hypotheses H 1 (H 1a , H 1b , H 1c ) and H 2 . HLM applies when observations in a study grouped in some way and the groups are selected randomly; therefore, it is commonly used to analyze nested data [ 79 ]. Model testing proceeded in four phases: null model, random intercepts model, means-as-outcomes model, intercepts- and slopes-as-outcomes model [ 89 ]. In this research, an intercepts-as-outcomes model was implemented, as we intended to examine the impact of school-level perceived instructional leadership on job burnout and psychological distress, rather than focusing on the moderating effect of variables. Based on this model, all the demographic variables investigated were treated as control variables except for subject of instruction, which is a category variable. Thus, more dummy variables were generated. Also, the variable for subject of instruction did not have a significant impact on the dependent variables or mediator variables and different subject teachers did not differ significantly in the means of these variables. The specific formulae for HLM are as follows:

Teacher level:

To verify H 3 , a bootstrapping method was applied with 5000 random samples in order to test the indirect mediating effect of job burnout. Specifically, this path is labeled as a 2-1-1 model, with these three numbers representing the levels of the independent variable, mediator variable, and dependent variable. Specifically, the independent variable was at the school level (level 2) and both the mediator and dependent variable were both at the teacher level (level 1) (burnout and psychological distress). The indirect effect was tested using model 4 of Hayes’ PROCESS macro [ 90 ] by placing all variables at the teacher level, as in [ 91 ]. As a result of using the bootstrapping method, the path coefficient and confidence interval were obtained. It can be concluded that a mediation effect is established if the confidence interval does not contain 0 [ 92 ].

HLM essentially serves as an extension of regression analysis [ 79 ]. Before delving into the primary statistical analysis, we rigorously assessed key assumptions tied to regression, including linearity, multivariate normality, and the absence of autocorrelation and multicollinearity. We employed Quantile-Quantile (QQ) plots (refer to S3 and S4 Figs) to evaluate linearity and multivariate normality, with the plots closely following a straight line, indicating an approximately linear and normal distribution of residuals. For the dependent variable "burnout", the Goldfield-Quandt test (statistic = 1.08, p = 0.22) and the Durbin-Watson test (DW statistic = 1.93, p = 0.26) confirmed the absence of heteroskedasticity and significant autocorrelation, respectively. Similarly, for "psychological distress", the Goldfield-Quandt test (statistic = 0.83, p = 0.98) and the Durbin-Watson test (DW statistic = 2.03, p = 0.71) yielded consistent results. Additionally, all Variance Inflation Factor (VIF) values were below 1.7, indicating no multicollinearity issues.

4.1 Descriptive statistics and Pearson correlations

Before presenting the results of this study, a confirmatory factor analysis (CFA) was performed using diagonally weighted least squares estimation (DWLS) in light of the fact that DWLS is more suitable to the analysis of ordinal Likert-type scales [ 93 ]. The results of the CFA were presented in the appendix (see S4 and S5 Tables). Both the model fit (CFI = 0.985, NNFI = 0.984, RMSEA = 0.037, SRMR = 0.057) and the factor loadings (larger than 0.5) demonstrated satisfactory factorial validity in this study. Furthermore, the average variance extracted (AVE) values (see Table 1 ) are generally greater than 0.5, indicating acceptable convergent validity.

https://doi.org/10.1371/journal.pone.0305494.t001

Table 1 displays the demographic characteristics of the study participants, including their gender, teaching experience, subject of instruction, and school type (primary or secondary). It is estimated that 81.4% of participants are females. Regarding teaching experience, 24.2% of the participants had less than 5 years of experience, while 25.8%, 18.3%, 9.9%, and 21.8% had 6–10 years, 11–15 years, 16–20 years, and more than 20 years of experience, respectively. Among the participants, 35.8% taught Chinese, 33.1% taught mathematics, 12.7% taught English, 6.1% taught natural sciences (physics, chemistry, biology, geography), and 11.3% taught other subjects. Of the participants, 30.4% were from primary schools, and the remaining were from secondary schools.

Table 2 presents the means, standard deviations (SD), and Pearson correlation coefficients for the variables included in the study. The correlation coefficients show a significant positive association between perceived instructional leadership (perceived school neglect of teaching autonomy, school neglect of teaching competence, emphasis on competitive relationships) and burnout and psychological distress ( r = 0.15 to 0.59).

https://doi.org/10.1371/journal.pone.0305494.t002

Table 3 presents the results of HLM analysis. The null model with job burnout and psychological distress as outcome variables yielded ICC values of 0.035 and 0.005. Despite the small ICCs, HLM was not abandoned since additional dependence on higher-level grouping can arise after including explanatory variables into the models [ 94 ]. The use of multilevel analysis is not precluded by small ICCs [ 10 ]. Therefore, we continued to use HLM for our research objectives.

https://doi.org/10.1371/journal.pone.0305494.t003

The results of the intercepts-as-outcomes model, displayed in Eqs ( 1 ) and ( 2 ), reveal that, after controlling for relevant variables, perceived school neglect of teaching autonomy has a significant positive impact on teachers’ job burnout ( β = 0.38, SE = 0.17, p = 0.02), which supports H 1a . However, perceived school neglect of teaching competence and emphasis on competitive relationships did not significantly impact burnout negatively, indicating that H 1b and H 1c were not supported. Additionally, the model shows that job burnout significantly and positively impacted psychological distress ( β = 0.18, SE = 0.01, p <0.01), supporting H 2 .

To test the third hypothesis, the mediating effect of job burnout between perceived school neglect of teaching autonomy and teachers’ psychological distress was examined based on the results of the first hypothesis. The bootstrapping method was applied with 5000 random samples, and the indirect effect was found to be significant [indirect effect = 0.046, 95% CI (0.031, 0.061)], which supports the proposed model wherein perceived school neglecting: teaching autonomy had a significant indirect effect on teachers’ psychological distress through job burnout. Therefore, it can be concluded that perceived school neglecting: teaching autonomy has a significant impact not only on teachers’ job burnout but also on their psychological distress, highlighting the importance of addressing this issue in schools.

5 Discussion

The educational landscape has been profoundly affected by the COVID-19 pandemic, with the closure of schools presenting a myriad of challenges for educators. A plethora of studies have underscored the multifaceted challenges teachers faced, ranging from the rapid adaptation to novel teaching technologies [ 95 ] to an escalation in workload [ 9 , 96 ]. Furthermore, a palpable lack of administrative support [ 10 , 28 , 32 ] has exacerbated the psychological distress experienced by educators. This research augments the existing body of knowledge by elucidating the ramifications of instructional leadership that overlooks the essence of teaching autonomy. Such neglect has been identified as a salient precursor to psychological distress, with burnout serving as a mediating factor. Notably, the study did not discern any significant effects stemming from the perceived neglect of teaching competence or the emphasis on competitive relationships within educational settings.

A pivotal revelation of this investigation is the detrimental impact of perceived institutional disregard for teaching autonomy during school closures. This adverse effect manifested prominently in the form of burnout and persisted even as educators transitioned back to traditional, in-person teaching modalities. This aligns with prior research which posits that diminished autonomy can be a catalyst for protracted burnout [ 27 , 36 , 60 , 61 ]. Conversely, some studies [ 36 , 97 ] have championed the protective role of perceived autonomy against burnout, particularly during the pandemic. These studies have enumerated several avenues to bolster teacher autonomy, encompassing flexibility in curriculum delivery, platform selection, and scheduling. Empirical evidence has consistently shown a positive correlation between teacher autonomy and pivotal outcomes such as motivation, instructional quality [ 98 ], empowerment [ 99 ] and job satisfaction [ 100 ], while inversely correlating with burnout [ 62 ]. The significance of autonomy in pedagogical settings cannot be overstated, especially given its pivotal role in teacher retention [ 100 ]. The deprivation of such autonomy, particularly in online pedagogical settings, can precipitate a cascade of negative outcomes, including diminished motivation, dissatisfaction, and pronounced burnout [ 62 ]. It’s noteworthy that the autonomy under scrutiny pertains to the latitude teachers had during online instruction, encompassing their discretion in pedagogical methodologies. The enduring impact of this neglect on educators’ mental well-being resonates with findings from Besser et al. [ 8 ] and Wakui et al. [ 101 ].

Contrastingly, this study’s findings diverge from the anticipated outcomes regarding the neglect of teaching competence and the emphasis on competitive relationships among educators. Such factors did not emerge as significant contributors to burnout. This observation is buttressed by findings from Huang et al. [ 102 ] and Yang and Huang [ 103 ], which highlight the plethora of resources available to educators during the pandemic, enabling continuous pedagogical skill enhancement. Consequently, it can be inferred that perceived school neglect of teaching competence might not be a salient determinant of burnout. Moreover, while competitive relationships can undoubtedly engender a less collegial environment, the virtual nature of instruction during the pandemic might have attenuated the impact of such competition on burnout. However, as educational institutions gravitate back to traditional teaching modalities, fostering a collaborative ethos among educators, underscored by mutual support and feedback, is paramount. This collaborative approach, coupled with the evident significance of autonomy, is pivotal for the holistic well-being of educators [ 104 ].

Further buttressing the findings of this study is the established linkage between educators’ burnout and psychological distress [ 38 , 39 , 71 , 72 ]. Burnout, typified by sustained negative affect related to pedagogical duties, can culminate in enduring psychological distress among educators [ 105 ]. This study’s findings also corroborate the mediating role of burnout between the perceived neglect of teaching autonomy and psychological distress, aligning with the conceptualization of burnout as a strain in SSO models [ 42 , 43 , 74 , 75 ]. Specifically, the study spotlighted the neglect of teaching autonomy by instructional leadership during school closures as a prominent stressor, culminating in protracted burnout and psychological distress.

Furthermore, the results derived from hierarchical linear modeling (HLM) underscored that perceived instructional leadership (perceived school neglect of teaching autonomy and competence, and emphasis on competitive relationships) did not have a direct bearing on psychological distress. Thus, this investigation substantiates the mediating role of burnout between perceived instructional leadership and educators’ psychological distress, aligning seamlessly with the SSO model.

Despite the valuable insights this study offers, there are several limitations to consider. Firstly, our sample was not randomly selected, which might constrain the generalizability of the findings to all middle and high school teachers in mainland China. Moreover, we did not include other teacher categories, such as kindergarten or university educators. Secondly, in order to efficiently access teachers’ perceived instructional leadership under pandemic conditions, we used a directive leadership as the special form of instructional leadership, which lead that our measurement of perceived instructional leadership is limited by epidemic. Future research would benefit from the development of a dedicated scale to assess perceived instructional leadership.

6 Conclusions

This study underscores the significant role that instructional leadership can play as a stressor for teachers over the long term in the pandemic, especially when it overlooks teaching autonomy. The findings indicate that when teachers perceive instructional leadership as neglecting their autonomy, it can have a profound and lasting impact on their job burnout. This, in turn, can detrimentally affect their mental well-being.

While strategies such as bolstering teacher resilience and ensuring more robust support from colleagues and managers are essential, our study also emphasizes the importance of enhancing teaching autonomy. Schools should prioritize giving teachers more ownership over their teaching methods, facilitated by sustainable leadership practices that emphasize life-long learning. Given the intricate nature of teaching, sustainability in the profession undoubtedly requires the autonomy that allows teachers to adaptively address students’ needs. This is especially true considering the challenges posed by the pandemic on teachers’ motivation and job satisfaction. As schools transition back to in-person teaching in the post-pandemic era, it becomes imperative to respect teachers’ pedagogical choices, grant them increased autonomy in the classroom, and nurture their self-efficacy and innovative capabilities. Such measures are crucial for the long-term mental health and overall well-being of teachers.

Supporting information

S1 checklist. strobe-checklist..

https://doi.org/10.1371/journal.pone.0305494.s001

S1 Fig. The result of optimal design.

https://doi.org/10.1371/journal.pone.0305494.s002

S2 Fig. The corresponding relationship between perceived instructional leadership and PNTSIOT.

https://doi.org/10.1371/journal.pone.0305494.s003

S3 Fig. Q-Q Plot of residuals as burnout dependent variable.

https://doi.org/10.1371/journal.pone.0305494.s004

S4 Fig. Q-Q Plot of residuals as psychological distress dependent variable.

https://doi.org/10.1371/journal.pone.0305494.s005

S1 Table. Items of psychological need thwarting of online teaching scale.

https://doi.org/10.1371/journal.pone.0305494.s006

S2 Table. Items of emotional exhaustion subscale.

https://doi.org/10.1371/journal.pone.0305494.s007

S3 Table. Items of DASS-21.

https://doi.org/10.1371/journal.pone.0305494.s008

S4 Table. Model fit.

https://doi.org/10.1371/journal.pone.0305494.s009

S5 Table. Factor loadings of CFA.

https://doi.org/10.1371/journal.pone.0305494.s010

S1 File. Data source.

https://doi.org/10.1371/journal.pone.0305494.s011

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

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

November 17, 2020

13 min read

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The way forward

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

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

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

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

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

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

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

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

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

8 Lessons We Can Learn From the COVID-19 Pandemic

BY KATHY KATELLA May 14, 2021

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

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

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

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

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

Lesson 1: Masks are useful tools

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

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

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

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

Lesson 2: Telehealth might become the new normal

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

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

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

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

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

Lesson 3: Vaccines are powerful tools

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

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

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

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

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

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

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

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

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

Lesson 5: We need to take mental health seriously

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

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

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

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

Lesson 6: We have the capacity for resilience

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

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

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

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

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

Lesson 7: Community is essential—and technology is too

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

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

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

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

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

Lesson 8: Sometimes you need a dose of humility

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

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

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

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

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WATCH: 5 ways to manage your time during a pandemic

The novel coronavirus has infected nearly 2 million people and killed more than 130,000 worldwide, according to the World Health Organization. As countries around the world, including the United States, grapple with how to contain COVID-19, school closings, stay-at-home orders and other restrictions have upended daily life for many.

Watch the livestream in the player above.

Kamini Wood, a certified life coach, and the PBS NewsHour’s Amna Nawaz answered your questions about time management in a shifting world of working-from-home, unemployment and school closings.

What’s the best way to structure your day?

This pandemic has forced many to face a new normal and find a new routine. That often includes working with the rest of your family or roommates.

Wood emphasizes giving yourself “an element of grace” when going through your day-to-day life. That means giving yourself time to relax or find an activity you enjoy, and keep things in perspective.

She said it’s helpful to maintain at least a broader plan for your days, which means not staying in your pajamas — in an effort to feel like you are really starting your day — but not making things so structured “where every hour is planned out.”

Finding that happy medium means you don’t overstress yourself in an already stressful moment in history, and gives you the leeway to focus on your accomplishments, rather than the things you missed during the day.

“Things may have to change, and it’s going to be okay,” Wood said.

Wood also recommends setting short-term daily schedules, rather than long-term schedules since “it’s a fluid time for us.”

Things may shift from day-to-day so it’s important to stay flexible when things need to change. Wood mentioned, as an example, that teachers are trying to figure out how to maintain classes and adapt to the changing circumstances.

Ultimately, she recommends taking things day-by-day to help prevent feeling overwhelmed.

How do I manage time with kids at home?

Just as adults are feeling stressed out by this change, kids are also feeling stressed about their regular routines being upended.

Wood said it’s important to give your children a safe space to talk about their feelings.

“They understand more than we necessarily think they do,” she said.

Children will likely not have the same stressors as you, and the best way to figure out what’s stressing them out is to communicate. That way, it’s easier to find ways to alleviate their anxiety.

For younger children in particular, they may not even know how to process the emotions they’re feeling. Wood said it’s important to acknowledge their frustrations and find a way to help them work through it.

Wood also emphasized that there’s no single right answer to this, and that the best thing to do is figure out what works for your particular family.

“There’s not a right way to do it,” she said. “But there is going to be our way of doing it.”

When working around family members in general, Wood said to practice forgiveness and to try to practice joy.

Remembering to be forgiving and to find moments of joy helps to “bring that happiness back into our lives.”

Is it a good time to start something new?

Many of us may suddenly have a lot of time to explore new skills or projects, but Wood emphasizes that it’s not necessarily the most important thing to do right now.

“We have to honor ourselves and where we’re at,” she said.

She reminds everyone not to give yourself more stress than you can manage, so while it may be a good time to learn something new, you shouldn’t start it if you don’t have the passion or energy to try it out.

“Remember you’re doing your best,” she said.

How do I maintain certain habits if I’ve lost my job?

Since the outbreak, millions of Americans have filed for unemployment, which means for so many, the routines attached to work schedules have been severely affected.

Wood said the thing to remember is that none of this was in your control.

“You did not have control over this pandemic, or this uncertainty that has happened,” she said. “What you do have control over is how you choose to move forward.”

She also said to remember that “it’s okay to be vulnerable” and to ask for help from your support group, whether that’s family or friends.

Most importantly, she said, practice self compassion.

“One of the things you can do is really evaluate and appreciate who you are as a person, what your values and your core gifts are, and when you anchor into those things, you’ll remember how valuable you are,” she said.

After reminding yourself of your support base and your self worth, then you can earnestly plan your next steps.

When it’s difficult to even get up in the morning, Wood suggests practicing self-care once you wake up, perhaps some exercise or meditation, to help you get motivated for the day. After that, laying out a plan can help keep you on track.

How should I deal with stress?

Wood said the first thing to do when you’re feeling stressed or overwhelmed is to accept that those thoughts are there, but they don’t have to drive the rest of your day.

She recommends having a “brain dump” by writing your thoughts in a journal, with no particular structure. That way, the feelings have a place to go. She also said it can be helpful to rip the page up when you’re done.

“Emotions are meant to be in motion,” she said.

Wood also suggests, at the end of the day, to make a list of all your accomplishments, no matter how small. This helps with the feeling of being “stuck” or feeling like you did not accomplish enough that day.

When dealing with more immediate stress, Wood recommends acknowledging the feelings and to have a way to “get present.”

“If you’re having a sad day, recognize that it’s okay to be sad,” she said.

To stay present in the moment, it helps to tune into your five senses, thinking about what you can hear, or taste, or touch. That way, your mind focuses on that rather than all the racing thoughts and emotions swirling around.

Wood also suggests finding an anchoring thought or word that helps you settle down. Her personal anchoring word is “grace,” which she admits she repeats to herself a lot.

“It’s a reminder that you’re okay,” she said.

Justin Stabley is a digital editor at the PBS NewsHour.

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medical leadership
healthcare planning

The COVID-19 pandemic, even as we are in its early phase, invites reflection on best leadership practices. As hospitals and providers pivot to respond, the pandemic spotlights leadership in healthcare. What is working as we all collectively combat this global viral scourge? The impetus to analyse leadership practices especially now comes from the adage that ‘a crisis is a terrible thing to waste’. 1 The danger of COVID-19 is self-evident and is already all too apparent around the world. At this writing today (1 April 2020), 873 008 individuals have been infected worldwide and 43 275 have died. 2 In addition to the scientific opportunities to better understand the virus, its epidemiology, and strategies to prevent and cure COVID-19 disease, there is a clear opportunity to reflect on how to lead in healthcare through a crisis, to catalogue best practices, and to cascade these leadership practices broadly.

Even as we are in approaching the surge of the pandemic—in my community, on day 10 of a modelled course that predicts a surge approximately 40 days from now, there are already many lessons on leadership—extraordinary actions from ‘big L’ leaders—those with titled organisational responsibility as well as from ‘little l’ leaders—individuals without formal leadership titles whose leadership emerges organically. Indeed, a crisis such as this tests available models and hypotheses about leadership.

In cataloguing some best practices that I have witnessed at my institution—the Cleveland Clinic, I will try to articulate these practices and frame them through the lens of extant leadership models. The model by Kouzes and Posner 3 of five leadership commitments—challenging the process, inspiring a shared vision, enabling others to act, modelling the way and encouraging the heart—provides an especially opportune taxonomy. What follows, then, is a catalogue of leadership practices, an annotation of each with specific examples, and a reflection of how these specific behaviours invoke or challenge existing leadership concepts.

Be proactive

Proactivity—anticipating events with contingency plans—has been a critical leadership competency in the coronavirus pandemic. Two kinds of proactivity seem evident—proactivity before the crisis hits and proactivity once the crisis is under way. Indeed, the critical relevance of proactivity has been evident both in its presence and in it is absence. The urgent need to catch up on testing capability in the USA and the potential insufficiency of the supply of personal protective equipment provide examples of the consequences of inaction.

Proactivity during the crisis regards real-time, dynamic modelling. Based on the expected events, what is the challenge that will materialise tomorrow, next week and next month? From the earliest signal of disease, laboratory medicine colleagues at my institution were developing testing capability for COVID-19. The result is that as of 20 March 2020, roughly two-thirds of all the positive tests in the US state of Ohio were performed at my institution, where local testing capability was developed early. As another example, medical students, respiratory therapists, intensivists and biomedical engineering colleagues at the Cleveland Clinic are currently advancing designs for a rapid production ventilator in anticipation of a need for ventilators that will exceed supply should a surge occur. Also, in the spirit of ‘little l’ leadership that can be so impactful, medical students in the Cleveland Clinic Lerner College of Medicine have launched an online repository to identify volunteer activities to help busy interns, residents and fellows. Proactivity abounds. Leadership is occurring diffusely, both by those with leadership titles and those without.

Proactivity is captured in the Kouzes and Posner leadership commitment of ‘challenging the process’. The centrality of seeing the current state—a projected shortage of equipment and personal protective equipment, developing models with contingencies and, most importantly, using these predictions to drive action has been underscored by the coronavirus pandemic.

Clarify governance for the crisis

Crises test the adequacy of existing governance structures and also require deployment of new ad hoc roles. For example, in the coronavirus crisis, the primacy of supply chain and sourcing personal protective equipment from novel sources, like the paint and construction industries, has become evident as we plan for and ready ourselves for the surge of affected patients. Development of an ‘incident command’ centre which convenes key leaders regularly, makes real-time decisions based on harvesting the group’s wisdom, and cascades awareness of these decisions broadly is a critical step. Communicating the structure and membership of this incident command team has been an institutional priority. The emphasis on how to organise the institutional response and how to cascade information bespeaks a commitment to ‘inspiring a shared vision’ and to ‘enabling others to act’. The governance structure gives people the latitude to innovate locally and the mandate to share their activities and ideas with the critical incident team.

Act…quickly

Quick implementation during a crisis is paramount. Forming an incident command centre reflects awareness that decisions will need to be made quickly and provides organisational infrastructure to do so. Also, the aforementioned example of developing COVID-19 test capability locally at a time when national capacity to test was stalled underscores the importance and value of acting quickly.

Of course, quick action is underpinned by a sense of urgency, which underlies Kouzes and Posner’s emphasis on ‘challenging the process’. In the case of coronavirus, there has generally been very little need to communicate urgency, as urgency is widely evident in the daily worldwide tally of affected individuals and associated deaths. 2 At the same time, the fact that college students were still actively convening on beaches to party during spring break on 20 March 2020 reminds us that one can never overcommunicate urgency and that communication must be tailored to the audience. New emphasis is being given to data that young people are not exempt from the risks of serious illness due to COVID-19.

Similarly, an ineluctable consequence of acting quickly is making mistakes. Wisdom from Voltaire that ‘The perfect is the enemy of the good’ and from Confucius that ‘Better a diamond with a flaw than a pebble without’ 4 is central to being able to act quickly. Leaders must (and, at the Cleveland Clinic) have amply acknowledged fallibility and the inevitability of making mistakes in our response to coronavirus. At the same time, these leaders have reaffirmed that any mistakes will be made in service of the organisation’s mission—‘better care of the sick, investigation of their problems, and more teaching of those who serve’ and in the current coronavirus crisis, caring for our patients and protecting our fellow caregivers. Furthermore, creating psychological safety 5 is paramount in a crisis because the event calls on harvesting wisdom from every part of the organisation and, indeed, the world. Leaders’ acknowledging their own fallibility in this effort helps create psychological safety, as does leaders’ acknowledging others’ efforts, even if incompletely successful. As has happened at my institution, when leaders acknowledge that in moving quickly, we will naturally make some mistakes, change course repeatedly and revise our thinking, they create space for colleagues to ‘experiment, take risks, and learn from the accompanying mistakes’. 3 Again, this validates the centrality of having psychological safety and of ‘challenging the process’. Also embedded in acting quickly is the leadership commitment of ‘enabling others to act’.

Communicate actively

A successful response to a crisis is the ultimate team effort because all members of the team must be aligned in service of a common goal. Communication is a critical part of achieving the needed alignment. In the context of George Bernard Shaw’s admonition that ‘the single biggest problem in communication is the illusion that it has taken place’, 6 communication must be frequent, iterative, and must use multiple dissemination media. Virtual meetings to assure communication have ramped up quickly at my institution, with twice daily calls for the command centre, among institute chairpersons, and the executive team. In addition, information is being cascaded to all stakeholder audiences through daily podcasts, emails, and so on. Videos of the CEO, Dr Mihaljevic, communicating with all 66 000 caregivers are regularly posted. Indeed, communication since the very beginning of our planning (on 21 January 2020) has been an absolute priority in service of aligning caregivers and, through forthrightness and compulsive and thorough planning, assuaging anxiety by providing direction about how we will cope and prevail together. The primacy of acting in a synchronised, aligned fashion reflects the very origins of the Cleveland Clinic, which was forged in 1921 in the aftermath of World War I around the concept of ‘acting as a unit’. In communicating today, leaders are able to connect our current efforts with our deep-seated culture and the organisational DNA.

Indeed, communication is needed to ‘inspire a shared vision’.

Be both realistic and optimistic

F Scott Fitzgerald’s quote that ‘The test of a first-rate intelligence is the ability to hold two opposed ideas in the mind at the same time and still retain the ability to function’ 7 is especially germane here. Leadership in a crisis requires both framing the challenge ahead while profusely acknowledging the contributions that have been made to date and optimistically capturing the reality that we will ultimately emerge from the crisis back to a state of normality. As an example, consider Winston Churchill’s famous ‘we shall fight on the beaches’ speech to the British people in the throes of World War II and London bombings. Churchill amply acknowledged the formidable current challenge while articulating the resolve that ultimately allowed the UK and the allies to prevail. Churchill was truly ‘encouraging the heart’.

Leadership communications at the Cleveland Clinic are anchored in realism that coronavirus poses an existential challenge while coupled with optimism—exemplified by sharing specific stories—that our talent, commitment and organisational culture will assure ultimate success. Even when, as now, we are just approaching the eye of the storm, optimism and acknowledgement of colleagues’ contributions to date galvanises people’s commitment and provides stamina for the long haul.

That leaders demonstrate optimism in their demeanour and behaviours is also key. Embodying the principle of ‘modelling the way’, colleagues look to leaders’ affect to guide their responses. As they see clinician leaders on the front line of clinical care, their resolve to pitch in increases. This opportunity underscores a major advantage of a physician leadership model in which leaders engage in active clinical practice, perhaps especially in times of pressing need as now. 8

Overall, a crisis heightens the need for great leadership and underscores needed leadership competencies, both through success in their presence and through failure in their absence. Along with specific leadership practices that may hold value to others as they navigate the current coronavirus pandemic or the next challenge, this reflection invokes the five leadership competencies articulated by Kouzes and Posner 3 as well as the primacy of creating psychological safety. 5

↵ . Available: www.Worldometers.info/coronavirus/ [Accessed 20 Mar 2020 ].
↵ . Available: https://www.entrepreneur.cpm/article/249676 [Accessed 20 Mar 2020 ].
Edmondson AC
↵ . Available: https://www.visualworkplace.com/2016/06/01/the-single-biggest-problem-in-communication-is-the-illusion-that-it-has-taken-place [Accessed 20 Mar 2020 ].
Scott Fitzgerald F

Contributors This is an original commentary of which JKS is the sole author. The paper is being exclusively submitted for consideration to publish in BMJ Leadership.

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 consent for publication Not required.

Provenance and peer review Not commissioned; externally peer reviewed.

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Productivity Center

9 Ways to Manage Your Time During a Pandemic

Albert Costill

Time Management

Wednesday, May 27th, 2020

As you are entirely aware, pandemics, such as COVID-19, can completely turn your world upside down. What’s more, the uncertainty and break in normalcy can wreck all of the strides you made in managing your time . Here are nine ways to manage your time during a pandemic.

Thankfully, you can get back on track. It’s not going to happen overnight. But, with a little trial and error, as well as patience, you can once again master the art of time management. And, here are nine ways to help you get there.

1. Prioritize your health and well-being with mico-practices.

Right now, the most important thing for you to do is to take care of your health and well-being . After all, how can you stay focused and energized when you’re not feeling 100% physically, emotionally, and mentally?

I don’t want to bore you with the same advice you’ve been told a million times. Exercise. Eat healthily. Get plenty of sleep. And, if you need to talk to some, please reach out to someone who trusts or a professional mental health professional.

All of the above are known as “macro-practices.” But, research has found that just as effective are “micro-practices.”

These are practices that only take a few seconds or minutes to do. They can also be anchored to existing activities. And, they’ve been found to promote calmness and relaxation. For instance, when washing your hands, conduct a self-wellness check-in. Another example would be doing breathing exercises when taking a break from work or writing in a gratitude journal during your evening routine.

2. What’s the best way to structure your day?

When a pandemic strikes, it’s going to disrupt our routines . Even if you were already working from home, COVID-19, as an example, you now have to manage your time homeschooling your kids or sharing a workplace with your spouse or roommate.

In short, while you should have a broad plan on how you’re going to spend your days, it also shouldn’t be too rigid that you don’t have any wiggle room. Remember, during uncertain times, things can change daily. And, since this is already a stressful time, you don’t want to add the pressure of following a strict schedule.

So, how can you achieve this? To be honest, that depends on what exactly is going on in your life. For instance, you may have to be a “teacher” for your kids between 9 am and 11 am. Or, maybe your significant other has a virtual meeting at 1 pm that forces you to hang out in the backyard for its duration.

If you’re in these types of situations, then you need to construct your schedule around them. Perhaps block time for uninterrupted work before you have to homeschool your children. If you have an invite at the same time as your better half, consider an alternative time.

Most importantly, try to work during your personal production peaks . During lulls, leave your calendar open. And forgive yourself if your day didn’t go exactly as planned. Despite what it may seem like, tomorrow is a new beginning to get back on track.

3. Designate a workplace.

A calm, clean, and dedicated workspace is essential. No matter how much you plan or motivated you are, it’s impossible to stay focused when you’re sitting on the couch with the TV on and your family chatting in the background. Moreover, how can you remain productive when you have a messy desk that’s stealing your attention from your work?

In a perfect world, you would have your own home office where you could shut the door and work in silence. But, that’s not possible for everyone . At the least, try to find a quiet area in your home and set up shop there. Make sure that you have everything you need to get your work done. And, make sure that you keep it clean and clutter-free.

Don’t be afraid to experiment or get creative. Is there a closet that you could place a desk in? Could you purchase a small folding table and move it around as needed? Would a wall unit work? Is there a shed or garage that could be converted into a home office?

4. Pay attention to fragmented time.

What exactly is fragmented time? Well, H.V. MacArthur describes this as occurs those “small pockets of 15 to 30-minute blocks of time that exist between scheduled meetings.” I call these time buffers. But, whatever terminology you want to use, the concept is the same.

Having gaps in your schedule gives you a chance to breathe and take a break . It can even be used to help you prepare for your next meeting or to-do-list. And, it ensures that if that Zoom call went into overtime, you aren’t to run late into your next appointment.

Despite these benefits, “most of us are very passive with our calendars,” writes MacArthur. “Clockwise saw a 17% increase in the amount of fragmented time per person per week (blocks of time less than 2 hours) and a 1.27-hour (8%) decrease in the amount of focus time per person per week (blocks of time longer than 2 hours).”

The reason? “People tend to schedule us for meetings based on what works for them and the open space they spot in our calendars,” MacArthur states. “But that may leave you very little time to actually get work done and the fragmented time ends up sucked up in busy but unproductive activities.”

The solution? Bome more “intentional about the ratio of fragmented to focused time you allow in your schedule.”

5. Find a healthier balance with your screens.

Before the coronavirus, we were already dependent on our gadgets. In fact, it’s been found that we tap, click, and swipe our phones a whopping 2,617 times a day. I can’t imagine what that’s up to now, what with the latest news updates, virtual activities , and staying connected to your work.

Sure. It’s of the utmost importance to remain informed and in-touch. But, it can also be distracting. Even worse, being glued to your screen for too long can be exhausting.

How can you create a healthier relationship with your phone? Well, Catherine Price, author of How To Break Up With Your Phone: The 30-Day Plan To Take Back Your Life, suggests trying “to gently get into the habit of cultivating moment-to-moment awareness.” It gives you a chance to see see how you feel while on your screens.

“I also recommend reducing ‘ease of access,’” adds Price. “If you’ve got that device in your pocket, it’s very easy to access every news app in the universe.” A quick fix would be to “create a charging station for your phone somewhere nearby, but not within arm’s reach.”

“If you’re having issues with compulsively checking before bed, maybe get your phone out of your bedroom and put a book on your bedside table instead,” states Price. “Put some kind of craft project or a puzzle out on your table so that when you do have a down moment, you have some option that’s easy to get to that’s not your phone.”

Price also recommends being more selective with your apps. That means only keeping those that are beneficial and uninstalling those that aren’t. You may also want to remove social media apps fro your Home screen. And, instead of imposing more things on yourself, reduce the amount of Zoom meeting or conference calls you have on your schedule.

6. Put first things first in your calendar.

“Putting first things first means organizing and executing around your most important priorities,” Stephen Covey famously wrote. “It is living and being driven by the principles you value most, not by the agendas and forces surrounding you.”

In other words, identify your priorities and add them to your calendar. If not, something of less importance will take precedence. Best of all, because you should only a handful of priorities, you can maintain a healthy balance of structure and malleability.

7. Don’t put yourself in calendar debt.

“Lots of people spend time coming up with budgets so they can improve their finances,” writes Kayla Sloan in another Calendar article . “Then they spend additional time tracking their finances and comparing everything to their budget. After that, they may tweak one or the other, and sometimes both, as they balance their spending and income.”

“Sticking to a budget and doing financial planning goes a long way toward reaching your money goals,” adds Kayla. However, “have you ever thought about time in a similar way?” After all, “you can always make more money.”

But, as for time? Well, “once spent, you can’t make more“ of it. “That’s why you should budget your time like you budget money,” suggests Kayla.

Creating a budget for the first time may seem overwhelming. In reality, though, it’s not all that complicated. The key is to know exactly how you want to spend your most valuable asset.

To help you get started, here are some recommendations from Kayla:

Find and use a calendar app .
Put your most important tasks in a list.
Create healthy routines like planning ahead and exercise.
Block out time for tasks like email.
Determine what can be automated, delegated, and eliminated from your schedule.
Learn shortcuts, such as keyboard shortcuts.
Schedule downtime.
Keep motivated by setting personal and work goals.

And, as Dave Ramsey explains, when you have a time budget, you gain a sense of traction. As a result, you’ll be more efficient and won’t waste your time on activities that leave you feeling drained.

8. Keep your values in sight.

Think of your values as a compass. Even if you’ve hiked in the same forest hundreds of times, it’s easy to turn yourself around and get lost. Thankfully, you have your trusty compass to guide you out of the woods safely.

When you know the value of your work, by alining it with your mission and values, it’s much easier to stay on track — especially during these unprecedented times. Instead of wasting your time on meaningless activities, you’re only focusing on the things that are bringing you closer to your goals.

9. Look after your peeps.

In this day in age, I highly doubt that you’re working entirely by yourself. I mean, even freelancers and solopreneurs may outsource tasks to others.

Regardless of how many people you’re collaborating with, it’s imperative that you check-in on them. We’re living in strange times right now. And, it’s undoubtedly affecting or mental health, which in turn will impact our performance.

Even just saying “hi” to others can make them feel connected and less isolated. More importantly, you can also make sure that they’re aware of their purpose and help them address any possible issues.

For example, if they’re struggling with time management, make sure that they’re only focusing on their top priorities. If not, and they’re wasting time on something else, then that can bottleneck your own productivity.

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My name is Albert Costill and I'm a content marketer at Calendar. If I can help people become more productive in my journey, even better. If you ever have a question about your Calendar or how you can use it - - don't hesitate to reach out. I'm a Calendar Pro.

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How to Write About the Impact of the Coronavirus in a College Essay

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.

[ Read: How to Write a College Essay. ]

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.

[ Read: What Colleges Look for: 6 Ways to Stand Out. ]

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.

[ Read: The Common App: Everything You Need to Know. ]

"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."

Searching for a college? Get our complete rankings of Best Colleges.

Writing about COVID-19 in a college admission essay

by: Venkates Swaminathan | Updated: September 14, 2020

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Writing about COVID-19 in your college admission essay

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

The CommonApp COVID-19 question

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

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

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

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

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

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

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

Counselor recommendations and school profiles

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

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

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

Writing about COVID-19 in your main essay

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

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

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

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

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Research Roundup: How the Pandemic Changed Management

Mark C. Bolino,
Jacob M. Whitney,
Sarah E. Henry

Lessons from 69 articles published in top management and applied psychology journals.

Researchers recently reviewed 69 articles focused on the management implications of the Covid-19 pandemic that were published between March 2020 and July 2023 in top journals in management and applied psychology. The review highlights the numerous ways in which employees, teams, leaders, organizations, and societies were impacted and offers lessons for managing through future pandemics or other events of mass disruption.

The recent pandemic disrupted life as we know it, including for employees and organizations around the world. To understand such changes, we recently reviewed 69 articles focused on the management implications of the Covid-19 pandemic. These papers were published between March 2020 and July 2023 in top journals in management and applied psychology.

Mark C. Bolino is the David L. Boren Professor and the Michael F. Price Chair in International Business at the University of Oklahoma’s Price College of Business. His research focuses on understanding how an organization can inspire its employees to go the extra mile without compromising their personal well-being.
JW Jacob M. Whitney is a doctoral candidate in management at the University of Oklahoma’s Price College of Business and an incoming assistant professor at Kennesaw State University. His research interests include leadership, teams, and organizational citizenship behavior.
SH Sarah E. Henry is a doctoral candidate in management at the University of Oklahoma’s Price College of Business and an incoming assistant professor at the University of South Florida. Her research interests include organizational citizenship behaviors, workplace interpersonal dynamics, and international management.

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

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

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

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

More from TIME

Read More: The Family Time the Pandemic Stole

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Read these 12 moving essays about life during coronavirus

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

by Alissa Wilkinson

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

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

The Vox guide to navigating the coronavirus crisis

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

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

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

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

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

A syllabus for the end of the world

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

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

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

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

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

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

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

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

What day is it today?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Management of the COVID-19 pandemic: challenges, practices, and organizational support

Eman kamel hossny.

1 Nursing Administration, Faculty of Nursing, Assiut University, Assiut, Egypt

Sahar Mohamed Morsy

Asmaa mohamed ahmed.

2 Nursing Administration, Faculty of Nursing, South Valley University, Qena, Egypt

Manal Saleh Moustafa Saleh

3 Nursing Administration, Faculty of Nursing, Zagazig University, Sharkia, Egypt

4 Nursing Department, College of Applied Medical Sciences, Shaqra University, Shaqra, Saudi Arabia

Atallah Alenezi

Marwa samir sorour.

5 Nursing Administration, Faculty of Nursing, Tanta University, Tanta, Egypt

Associated Data

All data generated or analyzed during this research are included within this manuscript.

The authors confirm that all methods were performed in accordance with the relevant guidelines and regulations.

Health organizations currently face tremendous challenges in the management of the COVID-19 pandemic. To do this, successful and proven scientific practices and support are needed.

This study aimed to explore the challenges, practices, and organizational support dealt with by nursing managers in the management of the COVID-19 pandemic.

A qualitative content analysis study evaluated 35 nursing managers in five university hospitals through a semi-structured interview. The Consolidated Criteria for Reporting Qualitative Research were used for this qualitative study.

Three main themes emerged: Challenges include the development of a COVID-19 crisis management plan, a shortage in nursing staff, and psychological problems. Practices include; changes in work schedules for nursing staff, the exchange process, hospital preparation, and training and education. And organizational support includes both support at an organizational level and support at an individual level.

This study revealed that nursing managers are faced with many challenges in the management of COVID-19, requiring good practices and organizational support. This study offers evidence for nursing managers to expect problems that may arise during the pandemic.

Recommendations

The COVID-19 pandemic started in Wuhan, China, in December 2019 and has spread intensely around the world since then, despite quarantine and containment measures [ 1 ].Sometimes crises are beyond human control and usually lead to death and affect people's lives in different ways. The crisis is a complex phenomenon that requires multi-directional corrective actions and, above all, preventive measures. There is no best way out of the crisis. Based on the facts of an absence of preparedness plans in hospitals, nursing managers face difficulties in managing the crisis during the outbreak of COVID-19, so studying the reality is the main target [ 2 ].

According to the World Health Organization (WHO), on April 13, 2019, more than 1.7 million people were infected, and nearly 85,000 people lost their lives. In addition, as of September 26, 2020, about 213 countries all around the world have been affected by this disease, resulting in 32,700,000 confirmed cases and more than 993,000 deaths.

In Egypt, the first positive case of COVID-19 was confirmed on February 14, 2020 [ 3 ]. Then there was a rise in the total number of cases and deaths. In parallel, there was a growing rise in the number of infected nurses and physicians [ 4 ]. In October 2020, Egypt was the 46 th country in the entire world and the 8 th Arab country affected by this virus. The number of cases has reached more than 106,707, and the number of deaths has reached more than 6,211. Moreover, this statistic is changing every day.

The COVID-19 pandemic is an extraordinary international health “war” in which the arena is the hospitals and our fighters are the health workers on the front lines. COVID-19 has presented nurses with unprecedented professional, social, and psychological challenges [ 5 , 6 ]. Therefore, proper preparation of nurses is essential, as they are the greatest providers of health information and services for people [ 7 ]. The responsibility of this preparation falls on the nursing managers. Managers must be prepared to respond to the effects of this pandemic on themselves and their staff. Even with advances in healthcare and virus control technology, real success is not possible without effective leadership.

Nursing managers in health organizations currently face huge challenges related to dealing with pandemic operations. Therefore, managing the coronavirus crisis requires successful and proven scientific practices implemented through effective institutional work. Effective institutional work refers to the complete disappearance of vision and personal effort; the existence of institutions and entities that integrate with one another according to an interlocking system and a clear vision; the existence of methodologies and scientific foundations; the presence of a working group of people competent in the three levels of crisis management (strategic, executive, and operational); coordination among institutions, the optimal use of resources through a professional operating system that applies best practices; and the presence of many capabilities and local enablers that can be managed and built quickly and efficiently [ 8 ].

The scenarios for facing each pandemic wave need greater preparation and considerable experience in identifying the challenges, scientific practices, and organizational support. Since the beginning of the pandemic, the Egyptian Ministry of Health (MOH) has been using hotlines and sponsored advertisements on Facebook to teach people about the disease as a way to use such powerful tools to its advantage [ 9 ].

Also, leaders and nursing managers can provide specific support to their healthcare organizations and develop programs to cope with the coronavirus pandemic. This study can guide nursing managers in this regard [ 10 , 11 ]. A coordinated global response is needed to prepare healthcare systems to face these challenges [ 12 ]. The World Bank emphasizes that global readiness for pandemics is crucial for global security and should be considered part of a program for strengthening healthcare systems [ 13 ]. Therefore, the researchers in this study sought to explore nursing managers’ experiences of the challenges, practices, and organizational support during the management of the COVID-19 pandemic. The study's findings would be useful to public health administrators and policymakers in determining how to manage crisis waves effectively.

Significance of the study

This study was conducted in Egypt after the first pandemic wave in March 2020, for which more than 194 million COVID-19 cases have been reported in over 188 countries. Egypt was no exception and recorded the highest rate of coronavirus infections at 1,774 cases in June. The Ministry of Health recorded the highest death rate from COVID-19 with 97 deaths on June 15, 2020. At the beginning of the second wave in November 2020, the daily infection rate reached 365 recorded cases, but it jumped to 911 cases within days, with 42 deaths. As the world faces an unprecedented threat, an opportunity to achieve stronger healthcare systems and improve global cooperation is presented to confront the next health threat and enhance future pandemic preparedness [ 14 ].

Crisis management is the biggest challenge facing healthcare organizations. A good manager should consider the latest knowledge and practices, not only official ones, but also practical skills and experience in developing and implementing corrective agendas for crisis situation management. Significant knowledge gaps still need to be filled through ongoing monitoring and research activities. In the management of the coronavirus crisis, officials are exposed to many challenges that require serious consideration and solidarity among all responsible authorities to overcome obstacles traditionally inherent between nurses and doctors [ 15 ], and in healthcare and social sciences [ 16 ]. Determine the appropriate practices and support needed to reach and achieve the desired COVID-19 pandemic management goals. To this end, a qualitative approach was adopted because it is based on the participants’ first-hand experiences and yields more realistic results [ 17 ].

Aims of the study

To explore the challenges, practices, and organizational support facing nursing in the management of the COVID-19 pandemic.

Research objectives

Determine the challenges faced by nursing managers in the management of the COVID-19 pandemic.
Determine which common practices are being used in managing the COVID-19 pandemic.
Determine the types of organizational support provided in managing the COVID-19 pandemic.

Study questions

What are the challenges nursing managers face in managing the COVID-19 pandemic?
What are the practices being used to face the challenges of managing the COVID-19 pandemic?
What are the types of organizational support provided?

Subject and methods

Study design and setting.

This qualitative study design was conducted in 2020 in five university hospitals in Egypt. This design was considered suitable for exploring the challenges, practices, and organizational support facing nursing managers in the management of the COVID-19 pandemic. It could also provide the participants with time and an opportunity to speak openly and reflect deeply on their personal experiences. All of these hospitals offer scientific learning and exercise to upcoming and existing physicians, nurses, and other healthcare personnel while providing therapeutic care to patients. These hospitals are collectively referred to in this study as universities.

Study subject and data collection

The participants were enrolled (35 nurse managers), including five nursing directors, five assistant nursing directors, 10 supervisors, and 15 head nurses at five university hospitals in Egypt. All participants were female, with a mean age of 41.36 ± 6.66 years and a mean work experience of 19.10 ± 5.57 years. Among all the participants, three had PhDs, 18 had master’s degrees, and 14 individuals had bachelor’s degrees in nursing.

Sampling was based on a purposive sampling technique to get an in-depth understanding of the situation during the pandemic and was also used to select diverse participants from the five hospitals. This ensured that the participants with diverse experiences clarified different aspects related to the aim of the study. The following inclusion criteria were applied: being at one of the nursing management levels, having worked in it for a period of no less than two years, and having more than five years of experience.

The researchers communicated directly with the nursing directors by phone and also sent an e-mail to inform them about the study. The researchers conducted semi-structured face-to-face and telephone interviews to collect data [ 18 ]. This study was conducted after the first wave of the COVID-19 pandemic, which began in September 2020 and was completed in November 2020, (total time frame for data collection of about 5 weeks).

The researchers used open-ended questions to encourage discussion with the interviewees and obtain more in-depth information. The interview encompassed nursing managers’ challenges, practices, and organizational support in managing the COVID-19 pandemic. The researchers used the following questions as a guide in the interview: What challenges have nursing managers faced during the COVID-19 pandemic? Is there any pre-preparation for this crisis? What practices are used to overcome the problems raised? Can nursing managers elaborate on these practices? What types of organizational support were provided during the COVID-19 pandemic? The researchers conducted interviews until sufficient data for analysis was obtained. The 30-to 90-min interviews were conducted at the times and places selected by the contributors.

Operational definition for nurse manager: in the current study, nurse manager means one of those at the administrative level, either director/ assistant director, or supervisor, or head nurse.

Data analysis

Two authors conducted semi-structured interviews to collect data. They are faculty members of the faculty of nursing and have previous experience as nursing managers in different hospitals. They do not work at either of the hospitals where participants were enrolled, which ensured that what the participants said in the interviews was not affected by personal relations with the two authors. All authors agreed on the final categories. During the interviews, the two authors’ interpretations of what the participants shared were validated by summarizing and asking questions about what they said to ensure that there were no misunderstandings. Credibility was enhanced by purposeful sampling from five different university hospitals.

The researchers used a traditional (conventional) content analysis approach, using Graneheim and Lundman’s method [ 19 ]. In this method, each entire interview was considered an analysis unit. The unit of analysis refers to the notes that must be analyzed and coded. The recorded interviews were replayed several times and transcribed accurately by the researchers. Paragraphs, phrases, and words that are linked to each other in terms of content are considered meaning units. They are classified according to their content and background. Written transcripts were revised numerous times to highlight words covering units of meaning and extract initial symbols. The codes were then reviewed numerous times in a continuous process from code drawing to classification. The same symbols were combined, classified, and named, and subdivisions were obtained. Finally, the extracted subcategories were compared and combined to form the major categories or themes. The researchers evaluated the data using the Consolidated Criteria for Reporting Qualitative Research (COREQ) [ 20 ].

Assessment of data stability and accuracy

The stability and accuracy of data were checked using Lincoln and Guba’s criteria [ 21 ]. The believability of the data was evaluated using the triangulation method, member-checking, prolonged engagement techniques, and an external checking process (external researcher). The external evaluator is a member of the nursing administration with more than 20 years of experience, who reviewed the data after the semi-structured interview to ensure credibility.

Built on the outcomes of the interviews with nursing managers, the following three main themes and eight subthemes were related to “challenges,” “practices,” and “organizational support.” Challenges include development of a COVID-19 crisis management plan; shortage of nursing staff; and psychological problems. Practices included changes in work schedules for nursing staff, the exchange process (deal between university hospitals), hospital preparation, and training and education. Organizational support includes support at the organizational level and support at the individual level (Tables (Tables1, 1 , ,2, 2 , and and3 3 ).

Categories, subcategories, and codes related to challenges in the management of the COVID-19 pandemic

Categories	Subcategories	Open codes
	Ad hoc committee	- (100%) of top-level nursing managers asserted that no preparedness plan had been in place - An Ad hoc committee was formed at the university hospitals’ level - A committee was assigned with the tasks and responsibilities to establish a preparedness plan for confronting the COVID-19 pandemic - A committee was composed of different department managers of the university hospitals
	Use the plan of another isolation hospitals (	Use the plan of another isolated hospital as a benchmark on how the plan will respond to the crisis
	Absenteeism among nurses	- Fear of infection makes nurses use their vacation leaves to be absent - Curfew makes (night transportation difficult for remote villages during curfew, reflecting negatively on night shift nurses)
	Infections among nurses	- Exposure - Work with suspected and positive cases
	-Panic emotions, fear, anxiety, and depression -Emotional motivation through good relationships between nursing managers and their nurses -Physically self-existence of nursing managers with nurses -Provision of psychological cession to nurses	-Related to the nature of the coronavirus and fear of infection, dealing with suspected cases, and caring for COVID-19 patients -Insufficient nursing knowledge about the coronavirus -Refuse to deal with nurses from the community -Cut family ties with nurses

Categories, subcategories, and codes related to practices in the management of the COVID-19 pandemic

Categories	Subcategories	Open codes
	In regular work places In isolation places	-Day and night shift only instead of three shifts, from 7AM–4 PM and from 4 PM–7 AM -Nurses stay 24 h; each nurse works 12 h a day and swaps shifts every 6 h
	The deal in regular work places	- Elderly nurses, nurses who support their families, nurses who have children, as well as nurses who have chronic diseases, work in regular places
	The deal in isolation places	- young nurses who do not have spouses or children and are free from chronic diseases to work in isolation hospitals (one university hospital) and partial isolation places in each university hospital with many facilities, such as: - Full accommodation in university cities for 14 days - Provision of transportation - Transferring of signature to isolation facilities - Granting exceptional leave to workers in isolation - Exemption from signing for infected staff
	Equipping the hospital	- The rapid-response team is appointed to deal with suspected and positive cases - Allocate rooms to sort the cases - Allocate rooms to isolate positive cases - Equipping ambulances by providing hand sanitizers, pumps for spraying chlorine, and personal coasters for the driver and paramedic - The morgue; training of workers on PPE use, disinfection, and sterilization, and posters on how to deal with COVID-19 deaths and mortuary refrigerators
	Infection control team	-Liaison between the Supreme Council of Universities and hospital managers -Monitoring to ensure medical and nursing teams and workers are wearing the personal protective equipment (PPE) correctly and in the appropriate places -Preparing reports about suspected cases and infected cases and the whole plan related to their role - The allocation of a tripartite committee to monitor the disbursement of personal protective equipment - Provide temperature detection reagents
	Training	- Conducting intensive training for the medical team - Training for doctors on performing swabs - Training on how to wear and remove PPE - Training on how to deal with suspected and infected cases
	Education	- Small lectures - Small education teams were assembled to teach doctors, nurses, and workers how to deal with each other and with suspected and infected cases

Categories, subcategories, and codes related to organizational support in the management of the COVID-19 pandemic

Categories	Subcategories	Open codes
	Determining the paths and places of isolation in each hospital	-A separator was put between isolation rooms and administrative offices -The allocation of triage and isolation rooms for suspected patients in the general reception (no = 21)
	Allocate Assiut university isolation hospital	1-Isolation hospitals serve faculty members and employees at the university 2- It was divided into three zones according to the condition of the patients; - Green zone, it receives positive cases that have no symptoms or have simple symptoms - Yellow zone, it receives positive cases that have severe symptoms, but do not need respirators - Red zone, it receives positive cases that have severe symptoms, and need respirators 3-It was divided into two areas according to the possibility of contamination; -The clean area includes restrooms, an elevator and a staircase -The contaminated area includes patient rooms and patient ward elevator, where transportation of patients, samples, and contaminated laundry were done 4-Separations have been made to isolate between the clean area where contaminated area
	Communication and collaboration	- Nurses and physicians collaborate in providing care to patients during hospitalization, - Physicians provided medical information to nurses when needed, which was facilitated by what Sapp group to facilitate communication between health care teams - Open phones for in charge personnel 24 h a day for both medical and nursing teams
	Material support	-The Supreme Council of Universities provided the university hospitals with antiseptics and preventive supplies - Provision of financial rewards to all medical staff -Provision of antiseptics and preventive materials to the hospital medical team -Transportation provision -Provision of cameras in isolation facilities -Transferring of signatures in isolation facilities, granting exceptional leave to workers in isolation and those with chronic diseases, and exemption from signing for infected staff -Transferring of signatures to isolation facilities, granting exceptional leave to workers in isolation and those with chronic diseases, and exemption from signing for infected staff

Theme 1: Challenges (Table (Table1 1 )

Nursing managers while managing the COVID-19 pandemic face many challenges that need creative thinking to solve. Semi-structured interviews revealed three sub-themes: development of a COVID-19 crisis management plan; shortage of nursing staff; and psychological problems.

Development of a Covid-19 crisis management plan

Most nursing managers confirmed that preparation for a COVID-19 crisis management plan was the biggest challenge they faced. The coordination, planning, and successful implementation of adaptable COVID-19 preparedness and response strategies will depend on all hospitals’ being engaged in the plan, as well as constant coordination. The factors related to this subtheme are discussed subsequently.

Ad hoc committee

All five (100%) top-level nursing managers asserted that no preparedness plan had been in place. A committee was formed at the university hospitals level and composed of different department managers of the university hospitals, and was assigned the tasks and responsibilities of establishing a preparedness plan for confronting the COVID-19 pandemic. Nursing director no. 1 said, “The committee was formed at the university hospitals level. The committee was composed of different department managers of the university hospitals (nursing, medical, pharmacist, laboratories, engineering, physicians with different specialists, and infection control).”

Use the plan of another isolation hospitals ( use Aboteage Hospital’s and Esna Hospital’s).

Hospital managers used the plan of another isolated hospital as a benchmark, to see if they were going in the right direction, in addition to different suggestions, if available. Nursing director No. 5 said, “We use Aboteage Hospital’s and Esna Hospital’s plans to determine whether we are in the right direction.”

Shortage in nursing staff

All nursing managers agreed that the shortage of nursing staff was the second biggest challenge faced by all hospitals. Without a sufficient number of nurses, the healthcare sector cannot provide adequate care to patients. The factors related to this subtheme are described herein.

Absenteeism and presenteeism among nurses

The absenteeism rate among nurses increased because of many factors, such as fear of infection, curfew, psychological problems, remote villages, and difficult transportation. According to interviewees, curfew was considered the main cause of nurse absenteeism aside from fear of infection. Nursing managers in the main hospital said, “Curfew started at 5:00 pm in all counties, so night shift nurses can’t go to their workplace, especially since about 55% of them live in rural areas (remote villages). Besides the difficulty in getting transportation during curfew, nurse absenteeism from work is also due to vacation leaves.

Head nurse No.1 said, “Three nurses in one unit were found positive for the coronavirus, which led to all the other nurses in the unit being absent and eventually causing this unit to be closed. In other words, fear of infection makes nurses use vacation leaves to be absent.”

Infection among nurses

The coronavirus started to spread among nurses in different hospitals and units. Contact with infected people and work with suspected and infection cases were the main causes of this spread. More than half of first-line nursing managers said, that “most nurses use university buses for transportation, which contributes to the spread of infection among them.”

Supervisors’ No. 1, 2, 3, and 4 said, “Nurses became infected from contact with other nurses in hospital transportation and from lending personal items, all of which contributed to the high number of infections among nurses.”

Psychological problems

Nurses’ experienced psychological problems during COVID-19 and fear of infection were the main factors related to this challenge.

Panic emotions, fear, anxiety, and depression

At the height of the pandemic, all healthcare personnel were distressed, and some of them became panicked about infection. Nursing directors asserted that nurses’ fears are legitimate. Also, related to the nature of the coronavirus, and fear of infection, dealing with suspected cases, and caring for COVID-19 patients, insufficient nursing knowledge about the coronavirus contributed to nurses’ fear of exposure to infection, making them susceptible to anxiety and worry. Moreover, bad interactions with family members, neighbors, and their community contribute to nurses’ psychological problems and depression.

Nursing directors’ No. 1, 2, 3, 4, and 5 said, “Nurses are afraid of infection. One of the nurses said, I will not come to work; I fear becoming infected.”

All the head nurses (no = 15) said, “Nurses ask about the virus and how to protect themselves from infection.” They are also afraid for their children and family members.

One head nurse said, “Some nurses in my unit cry due to bad dealings with their husbands or their neighbors.”

Theme 2: Practices ( Table Table 2 2 )

Nursing managers provided creative practices in crisis management throughout the COVID-19 pandemic. These practices included changes in nursing staff work schedules, the exchange process (a deal between university hospitals), hospital preparation, and training and education.

Changes in work schedules of nursing staff

In regular workplaces.

Nursing managers had to match nurses’ work hours with curfew hours. They had to change the work schedule to two shifts a day (morning and night), instead of three shifts (morning, evening, and night) which started from 7:00AM to 4:00 PM and from 4:00 PM to 7:00 AM, as attested by the directors of the hospitals.

Nursing director No. 1 said, “We had to change the work schedules to cope with the curfew conditions in the country.”

In isolation places

The isolation facilities also needed their work hours to change to allow nurses on duty to work 6 h per shift, have a break in the next 6 h before working again in the next 6 h to work exactly 12 out of 24 h a day for 14 consecutive days. However, the nurses in isolation facilities have full accommodation, whereas the other nurses who are working in the usual work settings do not.

All assistant nursing directors under study (no = 5) said, “In isolation facilities, nurses stay 24 h for 14 days with full accommodation, which necessitates an appropriate work schedule to cope with such conditions.”

Exchange process (deal between university hospitals)

One of the most important practices that were used to solve many problems during the COVID-19 pandemic crisis was the exchange process. This process took place at the level of the five university hospitals to meet the shortages of staff nurses. The deal provides for taking young nurses who do not have spouses or children to work in an isolation hospital (one university hospital) and partial isolation places in each university hospital, in exchange for giving elderly nurses, nurses who support their families, nurses who have children, as well as who have chronic diseases the opportunity to work in regular workplaces.

"Deal between the university hospitals solves the problem of nursing shortage as well as the creativity in applying it in isolated places and regular places," said Nursing Director No. 5.

Hospital preparation

Hospitals must be prepared and well furnished with various equipment and supplies to face the coronavirus pandemic. The factors related to this theme include equipping the hospital and infection control team.

Equipping the hospital

Equipping the hospital with a trained rapid-response team to deal with suspected cases, and separate sorting rooms for suspected and positive cases. Moreover, equipping ambulances and morgues with hand sanitizers, pumps for spraying chlorine, personal coasters for the driver and paramedic, and training on dealing with patients. The morgue was prepared as well, with staff training, posters on how to deal with the dead and mortuary refrigerators, and instructions on properly wearing PPE to prevent infection.

Supervisors’ No. 1, 3, and 4 said, “Equipping hospitals well will help them deal with the pandemic and better organize the work flow through a trained rapid-response team to deal with suspected cases and separate sorting rooms for suspected and positive cases, as well as equip ambulances and morgues with needed supplies.”

Head nurses No. 1, 2, and 3 said, “We supervise infection control nurses and ensure that each car has enough protective measures and that the morgues are equipped and adequately sterilized.”

Infection control team

All of the nursing managers interviewed asserted the significant role of an infection control team during the COVID-19 pandemic, in which they have a pioneering role in the liaison role between the Supreme Council of Universities and hospital managers for providing any instruction or information. They are also preparing reports about suspected cases and infected cases and the whole plan related to their role, in addition to monitoring medical and nursing teams to monitor their commitment to wear personal protective equipment (PPE) as well as monitoring the worker. Moreover, the appointment of a tripartite committee to monitor the disbursement of personal protective equipment (PPE) in addition to providing temperature detection reagents.

The nursing directors in each hospital said, “The infection control unit plays a vital role in providing PPE and daily monitoring reports on all nurses, physicians, and hospital workers.” They constitute a liaison between the Supreme Council of Universities and hospital managers.

Training and education

Training and education are the backbones of the management of this pandemic. Adequate training and information on how to deal with COVID-19 need to be disseminated to all healthcare teams.

Intensive training should be provided to the medical team (physicians, nurses, and other healthcare workers), such as on conducting swab tests for suspected cases. Furthermore, training on how to wear and remove PPE should be conducted in sorting and isolation areas.

One assistant nurse director said, “Training started in March 2019 to equip the nurses, physicians, and workers to face the ongoing pandemic.”

Small education teams were prepared to educate all doctors, nurses, and other healthcare workers about COVID-19. Nurses in isolation rooms were also taught how to deal with infected patients without exposure to infection.

One director said, “Education for all medical staff was conducted in addition to small lectures in all hospitals to teach nurses in isolation areas.”

Theme 3: Organizational support (Table (Table3 3 )

In the management of the coronavirus crisis, support required to reach and achieve the desired goals in successful COVID-19 pandemic management. Themes related to this them were; support at organizational level and support at individual level.

Support at organizational level

Determining the paths and places of isolation in each hospital.

At the level of all university hospitals, a separator was made between isolation rooms and administrative offices. The allocation of triage and isolation rooms for suspected patients in each hospital.

One supervisor said that the general reception in the main hospital has triage and isolation rooms that reach to (no = 21)

Allocate assiut university’ isolation hospital.

One of the organizational supports that helped nursing managers and medical managers manage the COVID-19 pandemic was the Allocate Assiut university isolation hospital. It was divided into three zones according to the condition of the patients (COVID-9 triage). Green zone, it receives positive cases that have no symptoms or have simple symptoms, yellow zone, it receives positive cases that have severe symptoms, but do not need respirators, and red zone, it receives positive cases that have severe symptoms, and need respirators. The hospital was divided into two sections based on the risk of contamination: the clean area, which includes restrooms, an elevator, and a staircase, and the contaminated area, which includes patient rooms and a patient ward elevator that transports patients, samples, contaminated laundry, and so on. Separations have been made to separate the clean and contaminated areas.

Nursing Director No. 5 said , “Faculty and university employees are served by the isolation hospital. It was divided into three zones according to the condition of the patients (green zone, yellow zone, and red zone). It was also divided into two areas according to the possibility of contamination (clean area and contaminated areas). Moreover, Separations have been made between the clean area and the contaminated area.”

Support at an individual level

Managerial support for health care providers was inevitable, especially at a time of crisis. Subcategories related to support at an individual level included communication and collaboration, and material support.

Communication and collaboration

Communication and collaboration among the five hospitals are also counted as organizational support at an individual level between healthcare professionals. The main features include: nurses and physicians collaborate in providing care to patients during hospitalization; physicians provide medical information to nurses when needed; what Sapp group to facilitate communication between health care teams; and open phones for in-charge personnel 24 h a day for both medical and nursing teams.

One director said, “The communication and collaboration between medical staff and nursing staff on all managerial levels has been unprecedented in the history of nursing, with nurses and physicians working together as one team in regular and isolated places.”

One supervisor said , “What Sapp group was initiated to facilitate communication between us, staff nurses, medical staff, as well as nursing and medical managers, in addition to open phones 24 h a day for those in managerial positions.

Material support

The Supreme Council of Universities provided antiseptics and preventive supplies to university hospitals; financial rewards to all nurses and doctors who work in isolation facilities; cameras in isolation hospitals; signature transfer to isolation facilities; exceptional leave for workers in isolation and those with chronic diseases; and exemption from signing for infected staff.

All five nursing directors reported that “ The Supreme Council of Universities provided the university hospitals with antiseptics and preventive supplies needed during the pandemic. In addition to the provision of financial rewards to all medical staff (nurses and physicians who work at isolation places), and the provision of nutrition and treatment. Furthermore, all floors in the isolation hospital have been installed with cameras to follow up work, monitor nurses and doctors, and support actions for healthcare personnel and patients, transferring signatures to isolation facilities, granting exceptional leave to workers in isolation and those with chronic diseases, and exempting infected staff from signing.”

This study was conducted through interviews with a total of 35 female nursing managers with a mean age of 41.36 ± 6.66 years and a mean work experience of 19.10 ± 5.57 years, including five nursing directors, five assistant nursing directors, 10 supervisors, and 15 head nurses, aiming to explore the challenges, practices, and organizational support dealt with by nursing managers in the management of the COVID-19 pandemic.

In this study, in Table Table1, 1 , managers reported that the biggest challenge they faced at the start of the pandemic was the development of a plan to deal with the COVID-19 pandemic. According to those interviewed in his study, there might have been no plan that helped deal with the COVID-19 pandemic had been in place, but hospitals are usually required to have a crisis management or emergency response plan. The study conducted by Mathew et al., [ 22 ] found that lack of pandemic preparedness plan was one of the challenges faced by frontline health and social care workers during COVID-19 pandemic.

So as revealed from the interviews all activities related to the preparation were internally initiated. An Ad hoc committee was formed at the university hospitals level, composed of different department managers from nursing, medical, pharmacy, laboratories, engineering, physicians with different specialists, and infection control, assigned with the tasks and responsibilities to establish a preparedness plan for confronting the COVID-19 pandemic. These coordinated activities, what made the plan evolve in time. In many countries, strong coordination techniques were needed, as the fragmentation of health services resulted in inadequate responses and timely interventions to health emergencies [ 23 ].

The second biggest challenge facing nursing managers in this study was the shortage of nursing staff and figuring out how to work with 30% of hospital personnel. The research study by Matthew et al., [ 22 ] found several challenges faced by health and social care workers on the front lines during the COVID-19 pandemic, staff shortages, lack of personal protective equipment (PPE), and anxiety and fear among professionals. According to the result of the interviewees, the main reason for this shortage was absenteeism and fear of infection due to the lack of a clear plan and strategies for deal with the COVID-19 pandemic [ 24 ]. The WHO [ 25 ] recommends that staff shortages should be anticipated due to absenteeism and increased demand for services, and a plan should be put in place to address this shortage.

Regarding absenteeism, fear of infection was the main cause that make nurses use their vacation for absence. In addition, curfew makes transportation difficult especially in the night and in the remote villages, resulting in increase absenteeism in the night shift, putting nursing managers in a challenge. According to Adamczyk et al., [ 26 ] restrictions on movement and travel one of the challenges of the pandemic, In this study, nursing managers have been obliged to change the work schedules of the nursing staff to adapt to the curfew in Egypt (5:00 PM to 6:00 AM). The study by Partzick et al., [ 27 ] in Germany revealed that the COVID-19 pandemic has rapidly changed the working conditions of nurses and their working lives.

This change was imperative because, without the nurses, adequate care could not be provided to patients. In regular workplaces, the usual three-shift system (day, evening, and night) was revised to two shifts (9 h. a day and 15 h. a night), 7 AM–4 PM and 4 PM–7 AM. However, in isolation facilities, the changes in the work schedule involved implementing a four-shift day, with work for 6 h per shift and each nurse working two alternate shifts, and full accommodation provided (Table (Table2). 2 ). This finding came in line with the policies applied in the region to overcome nurses’ shortage, as about 17 countries increased working hours and vacation time, in addition to implementing full-time work hours [ 28 ].

Moreover, to deal with the crisis, new and creative ideas were needed to solve the upcoming challenges innovatively. So, creativity and innovative solutions were needed to develop new working procedures and practices [ 29 ]. One of the most important and creative practices that were used to overcome shortages during the COVID-19 pandemic crisis was the exchange process (a deal between the university hospitals). The deal provides for taking young nurses who do not have spouses or children to work in isolated places, in return for giving elderly nurses, nurses who support their families, nurses who have children, and nurses who have chronic diseases the opportunity to work in regular workplaces (Table (Table2 2 ).

The third challenge facing nursing managers during the pandemic was psychological problems such as panic, fear, anxiety, and depression facing staff nurses. In many reported studies, staff nurses’ doubts regarding practices for carefulness with COVID-19 patients caused anxiety and fear. Furthermore, studies conducted in many countries related to caring for COVID-19 patients reported negative psychological consequences, such as anxiety, sadness, and stress, for nurses [ 30 – 33 ]. According to the study conducted in Egypt on health care workers (HCW) exposed to COVID -19, an extensive number of them had symptoms of anxiety, insomnia, depression, and stress [ 34 ]. Another study conducted on nurses in Egypt reveals that about three-quarters (75.2%) of nurses working in fever hospitals had high-stress levels versus 60.5% of nurses working in general hospitals [ 35 ].

From another prospective, the findings of a recent quantitative study on frontline nurses’ experiences showed that fear and unwillingness were mitigated through increased knowledge about the virus [ 36 ]. According to Adamczyk et al., [ 26 ] uncertainty about the future and there was a lot of contradictory information in the media caused a sense of confusion and heightened the feeling of anxiety. Dealing with the situation was not facilitated by the phenomenon of global misinformation, called by some experts as the “infodemic”, which may be defined as an overabundance of information that makes it difficult for people to find trustworthy sources and reliable guidance [ 37 ].

Both nursing managers and nursing staff also faced psychological problems. The COVID-19 outbreak causes panic emotions among nurses, and a lack of preparation to deal with these emotions puts them under great tension. However, nursing managers in our study, having a strong presence in their departments, being a good role models the staff, and acting as both leaders and administrator, have the authority to generate a more positive impact on their staff during this pandemic [ 38 ].

A study conducted by Gao et al. [ 39 ] found that a close relationship between nursing managers and their staff nurses was a vital factor in increasing motivation. However, perspectives on the significance of the psychological well-being of nurses during the COVID-19 pandemic should be emphasized [ 40 ]. Emotional motivation to relieve nurses from the stress they experience at work was demanded.

In addition to the role, that hospital preparations plays in fighting a COVID-19 pandemic, through equipping the hospital with a rapid-response team who are prepared to deal with suspected and positive cases, allocating rooms to sort the cases and others to isolate positive cases, and equipping ambulances and the morgue.

Furthermore, the role played by the infection control team at the level of all the studied hospitals is not neglected. From the researchers’ viewpoints, the infection control team was the backbones of each hospital which its team act as the Liaison between the Supreme Council of Universities and hospital managers, according to the WHO [ 5 ], in the face of an unknown disease, sharing and collaboration are the best means of finding solutions. According recent policy paper developed by Ghannam & Sebae [ 41 ] itemized amongst its commendations the need for improved infection control in health services in their attempt to study the effect of the pandemic on the new health insurance system that is being piloted in Egypt. The infection control team prepares reports about suspected cases and infected cases and the whole plan relato ted their role, a tripartite committee was created to monitor PPE disbursement [ 42 ]. PPE is one of the most important requirements for fighting an infectious pandemic like COVID-19. This is in addition to providing temperature detection reagents.

Furthermore, education and training play an important role in preparing nursing and medical staff to proficiently face this pandemic. According to the study conducted to assess the nurses' knowledge, concerns, perceived impact, and preparedness toward the COVID-19 pandemic, around half (51.2%) of the studied nurses said that the main sources of knowledge were from the Ministry of Health and World Health Organization's websites and formal pages [ 43 ]. It should be provided to all nursing and medical teams and healthcare workers. According to Chimenya [ 44 ], hospitals should conduct training and education sessions to bridge the knowledge gap and educate workers about their fear of infection.

In line with the overall findings of the practices presented in this study, several protective and preventive policies were emerged to overcome the negative effect of the pandemic, these policies included: management and communication, training and education, wellbeing drop-in sessions, peer support, team support, availability of personal protective equipment, and proper planning [ 45 ].

The third theme that will be discussed in this study is organizational support (Table (Table3). 3 ). Organizational support is carried out at two levels, one of which is at the organizational level to determine the paths and places of isolation in each hospital and to allocate the isolation hospital at Assiut University to serve the university’s faculty and staff members, and which has been divided into three zones according to the condition of the patients (green, yellow, and red).

Another at the individual level was the evidence of communication and collaboration between nursing and medical management teams during the COVID-19 pandemic. Nurses and physicians need to know the importance of communication in healthcare [ 46 ]. Nurses and physicians collaborate in providing care to patients during hospitalization; regarding Hossny [ 47 , 48 ], when nurses and physicians have the increased opportunity to work in a civil environment, they will collaborate more. Also, the establishment of information and communication channels was required during crisis management. Communication and collaboration in this study were demonstrated by the creation of WhatsApp groups and open phones for in-charge personnel 24 h a day for both medical and nursing teams.

Other ways of organizational support provided include material support, for instance, the Supreme Council of Universities provided disinfectants (antiseptics) and preventive supplies to all university hospitals, The university also provided transportation and full accommodation, financial rewards, transferring of signature in the isolation facilities, free swabs for all employees, and the granting of exceptional leaves to workers in isolation and those with chronic conditions, as well as the exemption from signature for infected staff, were implemented.

According to Hossny, [ 49 ] it is the responsibility of hospital managers to develop the weaker services inside their hospitals. This helps ourselves and our institutions prepare for this complex and fast economy, which is essential for support. Accordingly, many procedures related to obtaining signatures and facilities performed in the healthcare setting make work during the pandemic easier. Regarding signatures, all nursing managers reported that granting exceptional leave to workers in isolation and those with chronic diseases, as well as an exemption for infected staff from signing, was implemented. Regarding facilities, Open University cities for medical staff who want to stay in isolation and the provision of buses for nurses to facilitate transportation were established.

Limitations of the work

About generalizing the results of this study, there are some restrictions, as the qualitative research is primary subjective in approach, which could carry some bias. This study was conducted in five university hospitals, while the university compound includes seven hospitals, also there are many hospitals affiliated with the Ministry of Health in Assiut city, in addition to health insurance hospitals. Furthermore, this study was restricted to nursing managers. Therefore, study various sectors of hospitals including all segments of staff nurses, will provide preferred informations.

Nursing managers have gained much experience in crisis management throughout the COVID-19 pandemic. Nursing managers faced many challenges in the management of the COVID-19 pandemic. These challenges include developing a crisis preparedness plan, shortage of nursing staff, and psychological problems. Useful practices include adapting schedules, equipping and preparing hospitals, and training and education. In addition, organizational support is carried out at two levels, one of which is at organizational level to determine the paths and places of isolation in each hospital and to allocate the isolation hospital. Another at the individual level include establishing communication and cooperation, and material support such as providing disinfectants, financial rewards, and transferring the signature to the isolation facilities.

The COVID-19 pandemic requires the development of an integrated plan, and this plan must be disseminated to the hospital’s nursing and medical teams to better equip them for the current and future crises. The importance of cooperation and effective communication should also be emphasized. Accurate implementation of instructions also helps overcome these crises and succeed in establishing and maintaining safety. More studies are required on how to manage the COVID-19 pandemic in hospitals.

Acknowledgements

Not applicable.

Author contributions

The idea put out was conceived by H.EK and M.SM. The introduction sections were written by A.AM and A. A. The methods part was written by H.EK, S. MS, and M. MS. H.EK and M.SM were responsible for collecting data, analysis, and writing of the results part. All authors have worked together on the discussion section. The final manuscript and writing of the article was contributed to by all authors (H.EK, M.SM, A. AM, M. MS, A. and S. MS), who also discussed the results. All authors replied to reviewers' comments. The manuscript's English language editing was done by S. MS. After going over the reviewers' comments, H.EK and M.SM read the entire text. The final revised manuscript was read and approved by all authors.

Availability of data and materials

Declarations.

Approval to conduct this study was obtained from the Assiut University Hospitals Board and the Faculty of Nursing Ethics Committee (9–2020). A written informed consent was obtained from participants before the interview and data gathering. Justifications were provided to contributors about privacy, concealment of data, the aims of the study, and study methods.

“All authors declare that they have no competing interests”.

Publisher's Note

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

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

Updated on
Apr 30, 2024

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

Table of Contents

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

Essay On COVID-19 in English 100 Words

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

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

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

Also Read: National Safe Motherhood Day 2023

Essay On COVID-19 in 200 Words

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

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

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

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

Essay On COVID-19 in 300 Words

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

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

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

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

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

Also Read: Essay on Abortion in English in 650 Words

Short Essay on Covid-19

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

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

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

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

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

Simran Popli

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

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Coronavirus disease 2019 (COVID-19): A literature review

Affiliations.

1 Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia; Tropical Disease Centre, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia; Department of Microbiology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia. Electronic address: [email protected].
2 Division of Infectious Diseases, AichiCancer Center Hospital, Chikusa-ku Nagoya, Japan. Electronic address: [email protected].
3 Department of Family Medicine, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia. Electronic address: [email protected].
4 Department of Pulmonology and Respiratory Medicine, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia. Electronic address: [email protected].
5 School of Medicine, The University of Western Australia, Perth, Australia. Electronic address: [email protected].
6 Siem Reap Provincial Health Department, Ministry of Health, Siem Reap, Cambodia. Electronic address: [email protected].
7 Department of Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Warmadewa University, Denpasar, Indonesia; Department of Medical Microbiology and Immunology, University of California, Davis, CA, USA. Electronic address: [email protected].
8 Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia; Tropical Disease Centre, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia; Department of Microbiology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia; Department of Clinical Microbiology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia. Electronic address: [email protected].
9 Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, MI 48109, USA. Electronic address: [email protected].
10 Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia; Tropical Disease Centre, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia; Department of Microbiology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia. Electronic address: [email protected].
PMID: 32340833
PMCID: PMC7142680
DOI: 10.1016/j.jiph.2020.03.019

In early December 2019, an outbreak of coronavirus disease 2019 (COVID-19), caused by a novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), occurred in Wuhan City, Hubei Province, China. On January 30, 2020 the World Health Organization declared the outbreak as a Public Health Emergency of International Concern. As of February 14, 2020, 49,053 laboratory-confirmed and 1,381 deaths have been reported globally. Perceived risk of acquiring disease has led many governments to institute a variety of control measures. We conducted a literature review of publicly available information to summarize knowledge about the pathogen and the current epidemic. In this literature review, the causative agent, pathogenesis and immune responses, epidemiology, diagnosis, treatment and management of the disease, control and preventions strategies are all reviewed.

Keywords: 2019-nCoV; COVID-19; Novel coronavirus; Outbreak; SARS-CoV-2.

PubMed Disclaimer

COVID-19 pandemic and Internal Medicine Units in Italy: a precious effort on the front line. Montagnani A, Pieralli F, Gnerre P, Vertulli C, Manfellotto D; FADOI COVID-19 Observatory Group. Montagnani A, et al. Intern Emerg Med. 2020 Nov;15(8):1595-1597. doi: 10.1007/s11739-020-02454-5. Epub 2020 Jul 31. Intern Emerg Med. 2020. PMID: 32737837 Free PMC article. No abstract available.

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DOI: 10.1590/1413-81232024298.05052024
Corpus ID: 271831639

Qualitative analysis of nurses' performance and experiences in hospital management in the face of COVID-19.

Patzy Dias Rebello , Sabrina da Costa Machado Duarte , +3 authors Marcelle Miranda da Silva
Published in Ciência & Saúde Coletiva 1 August 2024

18 References

Análise qualitativa: teoria, passos e fidedignidade, organizational learning during covid‐19: a qualitative study of nurses' experiences, double working hours in nursing : difficulties faced in the labor market and daily worka, nursing experience during covid-19 pandemic in korea: a qualitative analysis based on critical components of the professional practice models, indonesian hospital’s preparedness for handling covid-19 in the early onset of an outbreak: a qualitative study of nurse managers, psychopathological symptoms and work status of southeastern brazilian nursing in the context of covid-19, the nurse's work in the context of covid-19 pandemic., evaluation of nursing service management model applied in hospitals managed by social health organization., poor knowledge of covid-19 and unfavourable perception of the response to the pandemic by healthcare workers at the bafoussam regional hospital (west region-cameroon), challenges facing nurse managers during and beyond covid‐19 pandemic in relation to perceived organizational support, related papers.

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Exclusive: Publisher to retract article for excessively citing one researcher after Retraction Watch inquiry
Authors retract quantum physics paper from Science after finding mistakes
A scientist peer-reviewed an article that plagiarized his work. Then he saw it published elsewhere.

Our list of retracted or withdrawn COVID-19 papers is up past 400 . There are more than 50,000 retractions in The Retraction Watch Database — which is now part of Crossref . The Retraction Watch Hijacked Journal Checker now contains more than 250 titles . And have you seen our leaderboard of authors with the most retractions lately — or our list of top 10 most highly cited retracted papers ? What about The Retraction Watch Mass Resignations List — or our list of nearly 100 papers with evidence they were written by ChatGPT ?

Here’s what was happening elsewhere (some of these items may be paywalled, metered access, or require free registration to read):

“Three MDMA therapy papers retracted over data integrity concerns .”
A study claiming to link COVID-19 vaccines to deaths based on autopsy findings has been retracted for a second time . First time . More from the last author here .
“Junior researchers ‘cited more if PhD supervisor is well known ,’” a study finds .
Researchers find “‘Surname strategies’ help authors beat citation alphabet bias .”
“Making Sense of the 2024 Journal Citation Reports,” from a Wolters Kluwer director .
“Should We Publish Fewer Papers ?”
“My experience as a reviewer for MDPI .”
“The UK launched a metascience unit. Will other countries follow suit ?”
“Why I’ve removed journal titles from the papers on my CV .”
“Flood Of ‘Junk’: How AI Is Changing Scientific Publishing .”
A look into “a thesis riddled with plagiarism” by “the media’s favorite philosopher of science .”
“How paper mills are undermining scientific publishing “: a video interview.
“ Superconductivity paper spurs dispute as field reels from earlier scandal.” A link to our coverage of one retraction.
“Nonsense correlations and how to avoid them .”
“Has your paper been used to train an AI model? Almost certainly .”
“Peer review will only do its job if referees are named and rated .”
“Detecting Scientific Fraud Using Argument Mining .”
30% of medical postgraduates surveyed “had resorted to plagiarism at some point during their academic pursuits .”
Researcher steps down from university position after having a second article removed .
“The Rat Race for Research Funding Delays Scientific Progress .”
“Trouble and strife deepen at famed U.S. particle physics lab .”

Like Retraction Watch? You can make a tax-deductible contribution to support our work , follow us on Twitter , like us on Facebook , add us to your RSS reader , or subscribe to our daily digest . If you find a retraction that’s not in our database , you can let us know here . For comments or feedback, email us at [email protected] .

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Nation & World

Too many people, not enough management: A look at ‘overtourism’ chaos this summer

This is a story of what it means to be visited in 2024, the first year in which global tourism is expected to set records after the pandemic.

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Tourists visit the old center of Sintra, Portugal, earlier this month. Ana Brigida/Associated Press

SINTRA, Portugal — The doorbell to Martinho de Almada Pimentel’s house is hard to find, and he likes it that way. It’s a long rope that, when pulled, rings a literal bell on the roof that lets him know someone is outside the mountainside mansion that his great-grandfather built in 1914 as a monument to privacy.

There’s precious little of that for Pimentel during this summer of “overtourism.”

Travelers idling in standstill traffic outside the sunwashed walls of Casa do Cipreste sometimes spot the bell and pull the string “because it’s funny,” he says. With the windows open, he can smell the car exhaust and hear the “tuk-tuk” of outsized scooters named for the sound they make. And he can sense the frustration of 5,000 visitors a day who are forced to queue around the house on the crawl up single-lane switchbacks to Pena Palace, the onetime retreat of King Ferdinand II.

“Now I’m more isolated than during COVID,” the soft-spoken Pimentel, who lives alone, said during an interview this month on the veranda. “Now I try to (not) go out. What I feel is: angry.”

This is a story of what it means to be visited in 2024, the first year in which global tourism is expected to set records since the coronavirus pandemic brought much of life on Earth to a halt. Wandering is surging, rather than leveling off, driven by lingering revenge travel, digital nomad campaigns and so-called golden visas blamed in part for skyrocketing housing prices.

Anyone paying attention during this summer of “overtourism” is familiar with the escalating consequences around the world: traffic jams in paradise. Reports of hospitality workers living in tents. And “anti-tourism” protests intended to shame visitors as they dine – or, as in Barcelona in July, douse them with water pistols. Advertisement

The demonstrations are an example of locals using the power of their numbers and social media to issue destination leaders an ultimatum: Manage this issue better, or we’ll scare away the tourists – who could spend their $11.1 trillion a year elsewhere. Housing prices, traffic and water management are on all of the checklists.

Cue the violins, you might grouse, for people like Pimentel who are well-off enough to live in places worth visiting. But it’s more than a problem for rich people.

“Not to be able to get an ambulance or to not be able to get my groceries is a rich people problem?” said Matthew Bedell, another resident of Sintra, which has no pharmacy or grocery store in the center of the UNESCO-designated district. “Those don’t feel like rich people problems to me.”

A vendor holds up an eagle as he waits for tourists to take photos with near the Terejl National Park outside Ulaanbaatar, Mongolia, in July. Ng Han Guan/Associated Press

WHAT IS OVERTOURISM ANYWAY?

The phrase itself generally describes the tipping point at which visitors and their cash stop benefitting residents and instead cause harm by degrading historic sites, overwhelming infrastructure and making life markedly more difficult for those who live there.

It’s a hashtag that gives a name to the protests and hostility that you’ve seen all summer. But look a little deeper and you’ll find knottier issues for locals and their leaders, none more universal than housing prices driven up by short-term rentals like Airbnb, from Spain to South Africa. Some locales are encouraging “quality tourism,” generally defined as more consideration by visitors toward residents and less drunken behavior, disruptive selfie-taking and other questionable choices. Advertisement

“Overtourism is arguably a social phenomenon, too,” according to an analysis for the World Trade Organization written by Joseph Martin Cheer of Western Sydney University and Marina Novelli of the University of Nottingham. In China and India, for example, they wrote, crowded places are more socially accepted. “This suggests that cultural expectations of personal space and expectations of exclusivity differ.”

The summer of 2023 was defined by the chaos of the journey itself – airports and airlines overwhelmed, passports a nightmare for travelers from the U.S. Yet by the end of the year, signs abounded that the COVID-19 rush of revenge travel was accelerating.

In January, the United Nations’ tourism agency predicted that worldwide tourism would exceed the records set in 2019 by 2%. By the end of March, the agency reported, more than 285 million tourists had traveled internationally, about 20% more than the first quarter of 2023. Europe remained the most-visited destination. The World Travel & Tourism Council projected in April that 142 of 185 countries it analyzed would set records for tourism, set to generate $11.1 trillion globally and account for 330 million jobs.

Aside from the money, there’s been trouble in paradise this year, with Spain playing a starring role in everything from water management problems to skyrocketing housing prices and drunken tourist drama. Protests erupted across the country as early as March, when graffiti in Malaga reportedly urged tourists to “go (expletive) home.” Thousands of protesters demonstrated in Spain’s Canary Islands against visitors and construction that was overwhelming water services and jacking up housing prices. In Barcelona, protesters shamed and squirted water at people presumed to be visitors as they dined al fresco in touristy Las Ramblas.

In Japan, where tourist arrivals fueled by the weak yen were expected to set a new record in 2024, Kyoto banned tourists from certain alleys. The government set limits on people climbing Mount Fuji. And in Fujikawaguchiko, a town that offers some of the best views of the mountain’s perfect cone, leaders erected a large black screen in a parking lot to deter tourists from overcrowding the site. The tourists apparently struck back by cutting holes in the screen at eye level.

Air travel, meanwhile, only got more miserable, the U.S. government reported in July. UNESCO has warned of potential damage to protected areas. And Fodor’s “No List 2024” urged people to reconsider visiting suffering hotspots, including sites in Greece and Vietnam, as well as areas with water management problems in California, India and Thailand. Advertisement

Not-yet-hot spots looked to capitalize on “de-touristing” drives such as Amsterdam’s “Stay Away” campaign aimed at partying young men. The “Welcome to MonGOlia” camapaign, for example, beckoned from the land of Genghis Khan. Visits to that country by foreign tourists jumped 25% the first seven months of 2024 over last year.

Tourism is surging and shifting so quickly, in fact, that some experts say the very term “overtourism” is outdated.

Michael O’Regan, a lecturer on tourism and events at Glasgow Caledonian University, argues that “overtourism” has become a buzzword that doesn’t reflect the fact that the experience depends largely on the success or failure of crowd management. It’s true that many of the demonstrations aren’t aimed at the tourists themselves, but at the leaders who allow the locals who should benefit to become the ones who pay.

“There’s been backlash against the business models on which modern tourism has been built and the lack of response by politicians,” he said in an interview. Tourism “came back quicker than we expected,” he allows, but tourists aren’t the problem. “There’s a global fight for tourists. We can’t ignore that. … So what happens when we get too many tourists? Destinations need to do more research.”

OF VISITORS VS. BEING VISITED

Virpi Makela can describe exactly what happens in her corner of Sintra. Advertisement

Incoming guests at Casa do Valle, her hillside bed-and-breakfast near the village center, call Makela in anguish because they cannot figure out how to find her property amid Sintra’s “disorganized” traffic rules that seem to change without notice.

“There’s a pillar in the middle of the road that goes up and down and you can’t go forward because you ruin your car. So you have to somehow come down but you can’t turn around, so you have to back down the road,” says Makela, a resident of Portugal for 36 years. “And then people get so frustrated they come to our road, which also has a sign that says ‘authorized vehicles only.’ And they block everything.”

Nobody disputes the idea that the tourism boom in Portugal needs better management. The WTTC predicted in April that the country’s tourism sector will grow this year by 24% over 2019 levels, create 126,000 more jobs since then and account for about 20% of the national economy. Housing prices already were pushing an increasing number of people out of the property market, driven upward in part by a growing influx of foreign investors and tourists seeking short-term rentals.

To respond, Lisbon announced plans to halve the number of tuk-tuks allowed to ferry tourists though the city and built more parking spaces for them after residents complained that they are blocking traffic.

A 40-minute train ride to the west, Sintra’s municipality has invested in more parking lots outside town and youth housing at lower prices near the center, the mayor’s office said.

More than 3 million people every year visit the mountains and castles of Sintra, long one of Portugal’s wealthiest regions for its cool microclimate and scenery. Sintra City Hall also said via email that fewer tickets are now sold to the nearby historic sites. Pena Palace, for example, began this year to permit less than half the 12,000 tickets per day sold there in the past.

It’s not enough, say residents, who have organized into QSintra, an association that’s challenging City Hall to “put residents first” with better communication, to start. They also want to know the government’s plan for managing guests at a new hotel being constructed to increase the number of overnight stays, and more limits on the number of cars and visitors allowed.

“We’re not against tourists,” reads the group’s manifesto. “We’re against the pandemonium that (local leaders) cannot resolve.”

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W.H.O. Declares Global Emergency Over New Mpox Outbreak

The epidemic is concentrated in the Democratic Republic of Congo, but the virus has now appeared in a dozen other African countries.

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A health worker in a yellow gown, a white mask and a blue hairnet holds a sealed plastic bag containing samples in a makeshift laboratory space in a tent.

By Apoorva Mandavilli

The rapid spread of mpox, formerly called monkeypox, in African countries constitutes a global health emergency, the World Health Organization declared on Wednesday.

This is the second time in three years that the W.H.O. has designated an mpox epidemic as a global emergency. It previously did so in July 2022. That outbreak went on to affect nearly 100,000 people , primarily gay and bisexual men, in 116 countries, and killed about 200 people.

The threat this time is deadlier. Since the beginning of this year, the Democratic Republic of Congo alone has reported 15,600 mpox cases and 537 deaths. Those most at risk include women and children under 15.

“The detection and rapid spread of a new clade of mpox in eastern D.R.C., its detection in neighboring countries that had not previously reported mpox, and the potential for further spread within Africa and beyond is very worrying,” said Dr. Tedros Adhanom Ghebreyesus, the W.H.O.’s director general.

The outbreak has spread through 13 countries in Africa, including a few that had never reported mpox cases before. On Tuesday, the Africa Centers for Disease Control and Prevention declared a “public health emergency of continental security,” the first time the organization has taken that step since the African Union granted it the power to do so last year.

“It’s in the interests of the countries, of the continent and of the world to get our arms around this and stop transmission as soon as we can,” said Dr. Nicole Lurie, the executive director for preparedness and response at the Coalition for Epidemic Preparedness Innovations, a nonprofit that finances vaccine development.

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