How to Write About Coronavirus in a College Essay
Students can share how they navigated life during the coronavirus pandemic in a full-length essay or an optional supplement.
Writing About COVID-19 in College Essays
Experts say students should be honest and not limit themselves to merely their experiences with the pandemic. (Getty Images)
The global impact of COVID-19, the disease caused by the novel coronavirus, means colleges and prospective students alike are in for an admissions cycle like no other. Both face unprecedented challenges and questions as they grapple with their respective futures amid the ongoing fallout of the pandemic.
Colleges must examine applicants without the aid of standardized test scores for many – a factor that prompted many schools to go test-optional for now . Even grades, a significant component of a college application, may be hard to interpret with some high schools adopting pass-fail classes last spring due to the pandemic. Major college admissions factors are suddenly skewed.
"I can't help but think other (admissions) factors are going to matter more," says Ethan Sawyer, founder of the College Essay Guy, a website that offers free and paid essay-writing resources.
College essays and letters of recommendation , Sawyer says, are likely to carry more weight than ever in this admissions cycle. And many essays will likely focus on how the pandemic shaped students' lives throughout an often tumultuous 2020.
But before writing a college essay focused on the coronavirus, students should explore whether it's the best topic for them.
Writing About COVID-19 for a College Application
Much of daily life has been colored by the coronavirus. Virtual learning is the norm at many colleges and high schools, many extracurriculars have vanished and social lives have stalled for students complying with measures to stop the spread of COVID-19.
"For some young people, the pandemic took away what they envisioned as their senior year," says Robert Alexander, dean of admissions, financial aid and enrollment management at the University of Rochester in New York. "Maybe that's a spot on a varsity athletic team or the lead role in the fall play. And it's OK for them to mourn what should have been and what they feel like they lost, but more important is how are they making the most of the opportunities they do have?"
That question, Alexander says, is what colleges want answered if students choose to address COVID-19 in their college essay.
But the question of whether a student should write about the coronavirus is tricky. The answer depends largely on the student.
"In general, I don't think students should write about COVID-19 in their main personal statement for their application," Robin Miller, master college admissions counselor at IvyWise, a college counseling company, wrote in an email.
"Certainly, there may be exceptions to this based on a student's individual experience, but since the personal essay is the main place in the application where the student can really allow their voice to be heard and share insight into who they are as an individual, there are likely many other topics they can choose to write about that are more distinctive and unique than COVID-19," Miller says.
Opinions among admissions experts vary on whether to write about the likely popular topic of the pandemic.
"If your essay communicates something positive, unique, and compelling about you in an interesting and eloquent way, go for it," Carolyn Pippen, principal college admissions counselor at IvyWise, wrote in an email. She adds that students shouldn't be dissuaded from writing about a topic merely because it's common, noting that "topics are bound to repeat, no matter how hard we try to avoid it."
Above all, she urges honesty.
"If your experience within the context of the pandemic has been truly unique, then write about that experience, and the standing out will take care of itself," Pippen says. "If your experience has been generally the same as most other students in your context, then trying to find a unique angle can easily cross the line into exploiting a tragedy, or at least appearing as though you have."
But focusing entirely on the pandemic can limit a student to a single story and narrow who they are in an application, Sawyer says. "There are so many wonderful possibilities for what you can say about yourself outside of your experience within the pandemic."
He notes that passions, strengths, career interests and personal identity are among the multitude of essay topic options available to applicants and encourages them to probe their values to help determine the topic that matters most to them – and write about it.
That doesn't mean the pandemic experience has to be ignored if applicants feel the need to write about it.
Writing About Coronavirus in Main and Supplemental Essays
Students can choose to write a full-length college essay on the coronavirus or summarize their experience in a shorter form.
To help students explain how the pandemic affected them, The Common App has added an optional section to address this topic. Applicants have 250 words to describe their pandemic experience and the personal and academic impact of COVID-19.
"That's not a trick question, and there's no right or wrong answer," Alexander says. Colleges want to know, he adds, how students navigated the pandemic, how they prioritized their time, what responsibilities they took on and what they learned along the way.
If students can distill all of the above information into 250 words, there's likely no need to write about it in a full-length college essay, experts say. And applicants whose lives were not heavily altered by the pandemic may even choose to skip the optional COVID-19 question.
"This space is best used to discuss hardship and/or significant challenges that the student and/or the student's family experienced as a result of COVID-19 and how they have responded to those difficulties," Miller notes. Using the section to acknowledge a lack of impact, she adds, "could be perceived as trite and lacking insight, despite the good intentions of the applicant."
To guard against this lack of awareness, Sawyer encourages students to tap someone they trust to review their writing , whether it's the 250-word Common App response or the full-length essay.
Experts tend to agree that the short-form approach to this as an essay topic works better, but there are exceptions. And if a student does have a coronavirus story that he or she feels must be told, Alexander encourages the writer to be authentic in the essay.
"My advice for an essay about COVID-19 is the same as my advice about an essay for any topic – and that is, don't write what you think we want to read or hear," Alexander says. "Write what really changed you and that story that now is yours and yours alone to tell."
Sawyer urges students to ask themselves, "What's the sentence that only I can write?" He also encourages students to remember that the pandemic is only a chapter of their lives and not the whole book.
Miller, who cautions against writing a full-length essay on the coronavirus, says that if students choose to do so they should have a conversation with their high school counselor about whether that's the right move. And if students choose to proceed with COVID-19 as a topic, she says they need to be clear, detailed and insightful about what they learned and how they adapted along the way.
"Approaching the essay in this manner will provide important balance while demonstrating personal growth and vulnerability," Miller says.
Pippen encourages students to remember that they are in an unprecedented time for college admissions.
"It is important to keep in mind with all of these (admission) factors that no colleges have ever had to consider them this way in the selection process, if at all," Pippen says. "They have had very little time to calibrate their evaluations of different application components within their offices, let alone across institutions. This means that colleges will all be handling the admissions process a little bit differently, and their approaches may even evolve over the course of the admissions cycle."
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Essay on COVID-19 Pandemic
As a result of the COVID-19 (Coronavirus) outbreak, daily life has been negatively affected, impacting the worldwide economy. Thousands of individuals have been sickened or died as a result of the outbreak of this disease. When you have the flu or a viral infection, the most common symptoms include fever, cold, coughing up bone fragments, and difficulty breathing, which may progress to pneumonia. It’s important to take major steps like keeping a strict cleaning routine, keeping social distance, and wearing masks, among other things. This virus’s geographic spread is accelerating (Daniel Pg 93). Governments restricted public meetings during the start of the pandemic to prevent the disease from spreading and breaking the exponential distribution curve. In order to avoid the damage caused by this extremely contagious disease, several countries quarantined their citizens. However, this scenario had drastically altered with the discovery of the vaccinations. The research aims to investigate the effect of the Covid-19 epidemic and its impact on the population’s well-being.
There is growing interest in the relationship between social determinants of health and health outcomes. Still, many health care providers and academics have been hesitant to recognize racism as a contributing factor to racial health disparities. Only a few research have examined the health effects of institutional racism, with the majority focusing on interpersonal racial and ethnic prejudice Ciotti et al., Pg 370. The latter comprises historically and culturally connected institutions that are interconnected. Prejudice is being practiced in a variety of contexts as a result of the COVID-19 outbreak. In some ways, the outbreak has exposed pre-existing bias and inequity.
Thousands of businesses are in danger of failure. Around 2.3 billion of the world’s 3.3 billion employees are out of work. These workers are especially susceptible since they lack access to social security and adequate health care, and they’ve also given up ownership of productive assets, which makes them highly vulnerable. Many individuals lose their employment as a result of lockdowns, leaving them unable to support their families. People strapped for cash are often forced to reduce their caloric intake while also eating less nutritiously (Fraser et al, Pg 3). The epidemic has had an impact on the whole food chain, revealing vulnerabilities that were previously hidden. Border closures, trade restrictions, and confinement measures have limited farmer access to markets, while agricultural workers have not gathered crops. As a result, the local and global food supply chain has been disrupted, and people now have less access to healthy foods. As a consequence of the epidemic, many individuals have lost their employment, and millions more are now in danger. When breadwinners lose their jobs, become sick, or die, the food and nutrition of millions of people are endangered. Particularly severely hit are the world’s poorest small farmers and indigenous peoples.
Infectious illness outbreaks and epidemics have become worldwide threats due to globalization, urbanization, and environmental change. In developed countries like Europe and North America, surveillance and health systems monitor and manage the spread of infectious illnesses in real-time. Both low- and high-income countries need to improve their public health capacities (Omer et al., Pg 1767). These improvements should be financed using a mix of national and foreign donor money. In order to speed up research and reaction for new illnesses with pandemic potential, a global collaborative effort including governments and commercial companies has been proposed. When working on a vaccine-like COVID-19, cooperation is critical.
The epidemic has had an impact on the whole food chain, revealing vulnerabilities that were previously hidden. Border closures, trade restrictions, and confinement measures have limited farmer access to markets, while agricultural workers have been unable to gather crops. As a result, the local and global food supply chain has been disrupted, and people now have less access to healthy foods (Daniel et al.,Pg 95) . As a consequence of the epidemic, many individuals have lost their employment, and millions more are now in danger. When breadwinners lose their jobs, the food and nutrition of millions of people are endangered. Particularly severely hit are the world’s poorest small farmers and indigenous peoples.
While helping to feed the world’s population, millions of paid and unpaid agricultural laborers suffer from high levels of poverty, hunger, and bad health, as well as a lack of safety and labor safeguards, as well as other kinds of abuse at work. Poor people, who have no recourse to social assistance, must work longer and harder, sometimes in hazardous occupations, endangering their families in the process (Daniel Pg 96). When faced with a lack of income, people may turn to hazardous financial activities, including asset liquidation, predatory lending, or child labor, to make ends meet. Because of the dangers they encounter while traveling, working, and living abroad; migrant agricultural laborers are especially vulnerable. They also have a difficult time taking advantage of government assistance programs.
The pandemic also has a significant impact on education. Although many educational institutions across the globe have already made the switch to online learning, the extent to which technology is utilized to improve the quality of distance or online learning varies. This level is dependent on several variables, including the different parties engaged in the execution of this learning format and the incorporation of technology into educational institutions before the time of school closure caused by the COVID-19 pandemic. For many years, researchers from all around the globe have worked to determine what variables contribute to effective technology integration in the classroom Ciotti et al., Pg 371. The amount of technology usage and the quality of learning when moving from a classroom to a distant or online format are presumed to be influenced by the same set of variables. Findings from previous research, which sought to determine what affects educational systems ability to integrate technology into teaching, suggest understanding how teachers, students, and technology interact positively in order to achieve positive results in the integration of teaching technology (Honey et al., 2000). Teachers’ views on teaching may affect the chances of successfully incorporating technology into the classroom and making it a part of the learning process.
In conclusion, indeed, Covid 19 pandemic have affected the well being of the people in a significant manner. The economy operation across the globe have been destabilized as most of the people have been rendered jobless while the job operation has been stopped. As most of the people have been rendered jobless the living conditions of the people have also been significantly affected. Besides, the education sector has also been affected as most of the learning institutions prefer the use of online learning which is not effective as compared to the traditional method. With the invention of the vaccines, most of the developed countries have been noted to stabilize slowly, while the developing countries have not been able to vaccinate most of its citizens. However, despite the challenge caused by the pandemic, organizations have been able to adapt the new mode of online trading to be promoted.
Ciotti, Marco, et al. “The COVID-19 pandemic.” Critical reviews in clinical laboratory sciences 57.6 (2020): 365-388.
Daniel, John. “Education and the COVID-19 pandemic.” Prospects 49.1 (2020): 91-96.
Fraser, Nicholas, et al. “Preprinting the COVID-19 pandemic.” BioRxiv (2021): 2020-05.
Omer, Saad B., Preeti Malani, and Carlos Del Rio. “The COVID-19 pandemic in the US: a clinical update.” Jama 323.18 (2020): 1767-1768.
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Volume 26, Number 7—July 2020
Another Dimension
A critique of coronavirus.
Cite This Article
Why did the quiet descend?
Does this plague not know
that apocalypses come with fanfare,
wails of lamentation,
howls of wayward dogs,
explosive blasts?
Or, maybe, silence.
Just shop-window glass crunching underfoot
puncturing the eerie nothing.
Never quiet.
Why does the sun still shine?
Can it not see what transpires
from its lofty throne
above the Earth?
Read the room, sun.
Now’s the time for greyscale filter.
Or, maybe, an eclipse.
One last blinding ray of blazing flare
to scorch the land,
to boil the sea,
to serve up des hommes brûlés
to whichever vengeful deity
dines with us tonight .
Not sunshine.
Never sunshine.
Why can I smell the tulips?
I thought the virus
wiped olfaction from our
paltry list of powers?
Or, maybe, smoke.
You know, from voracious flames
feasting on our foliage and flesh,
the smog of industry,
of mushroom clouds.
Why does that not sting my nostrils?
Not flowers.
Never flowers.
Why does life go on inexorably?
Is Ragnarök not supposed to happen
around now?
Where are the horsemen?
Where are the double gates of Paradise?
What a lame apocalypse:
we’ve been sold a lemon.
Or, maybe, pop culture eschatology
isn’t all it is cracked up to be.
I thought the zombies would be roaming
all my haunts
Never life.
Miss Osen is a Specialty Registrar in the ENT Department at St George’s University Hospitals NHS Foundation Trust, London. Her professional interests include ENT and history of medicine; extracurricular interests include composing bleak poetry and flash/sudden fiction.
DOI: 10.3201/eid2607.201426
Original Publication Date: May 26, 2020
Related Links
- More Another Dimension Articles
Table of Contents – Volume 26, Number 7—July 2020
Please use the form below to submit correspondence to the authors or contact them at the following address:
Elana R. Osen, ENT Department, St George’s University Hospitals NHS Foundation Trust, Blackshaw Rd, Tooting, London, SW17 0QT, UK
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A critique of clinical economy: reassessing value and care during covid-19—an essay by Eric Reinhart and Daniel Brauner
Read our latest coverage of the coronavirus outbreak.
- Related content
- Peer review
- Eric Reinhart , MD-PhD candidate and candidate in adult psychoanalysis 1 2 3 ,
- Daniel Brauner , professor of medicine, chief, Division of Geriatrics 4 4
- 1 University of Chicago Pritzker School of Medicine, Chicago, IL, USA
- 2 Harvard University Department of Anthropology, Cambridge, MA, USA
- 3 The Chicago Center for Psychoanalysis, Evanston, IL, USA
- 4 Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA
- reinhar{at}fas.harvard.edu
For decades, American medical practice has been organised around billing codes, with severe consequences for patient care and physician morale. The interruption of routine clinic visits owing to covid-19 presents an opportunity to reconsider the guiding principles of clinical care, write Eric Reinhart and Daniel Brauner
The United States is host to more documented covid-19 cases and deaths than any other country. Under pandemic conditions, deficiencies in the organisation of the American healthcare system have become more visible and their consequences—particularly racial and class disparities in care—intensified.
The routine clinic visit is one feature of this system that has attracted attention by its sudden obsolescence. As is the case across broad swathes of the US, the clinics in which we work and train have been closed or drastically curtailed because of infection risks. Concerns about face-to-face interactions have led some states to prohibit non-urgent appointments in physical clinics during covid-19, provoking a surge in telemedicine. Such interruptions to standard practices are now prompting critical questions: How necessary is the clinic? What functions does it serve? Could its essential medical roles be fulfilled otherwise?
This ongoing disruption has led many to argue that the high volume of clinic visits in the US has been neither medically necessary nor beneficial. Such observations alone, however, are not sufficient to allow us to change and improve our existing practice standards. To do so effectively, we must also re-examine the structural economic pressures by which clinical care has been shaped over the last half century.
In American healthcare, the organisation of care remains determined by disconnected institutions that bill private and government sponsored insurance on a fee-for-service basis. This system is conditioned by mundane, taken-for-granted billing codes that supply the overarching economic incentives for the delivery of care. This essay traces the rise of the contemporary American clinic to illuminate forces shaping this billing structure and how it has arranged relationships between government, medical care, doctors, and patients—relationships largely orchestrated by the American Medical Association (AMA) and its invention of a list.
A strategy for protecting fee-for-service
Historically, the AMA has opposed government involvement in healthcare, fearing that what it called “socialised medicine” would mean layers of bureaucracy and paperwork, loss of physician autonomy, and decreased financial compensation. This fear intensified in the 1960s as proposals for Medicare and Medicaid gained momentum.
AMA leadership had two options: continue with plan A—a losing battle against government participation and financing of medical care—or generate a plan B. Under the direction of Francis Cox, the AMA developed and implemented plan B: stop resisting government involvement in healthcare and instead co-opt and control it.
The first step in this strategy was to conduct Relative Value Studies, surveys of physicians that catalogued various procedures and charges, initially in California and then nationally. Cox and the AMA used these data to create a list of billable procedures with relative values expressed as “relative value units” (RVUs). In speeches to physicians to advocate for restructuring clinical visits around this list, Cox explained his philosophy: that the adoption of the list was necessary to enable “the private practice of medicine, as we know it, to continue.” 1 He saw RVUs as a means of maintaining the fee-for-service, private practice model under government sponsorship.
The AMA’s Current Procedural Terminology, or CPT manual, came out of the RVU index and consists of a system of billing codes for different services, each corresponding with a particular level of billable charges. A look at the early RVU studies reveals nearly verbatim adoption of these studies in the CPT manual, which was first published by the AMA in 1966, just in time to bill the newly established Medicare and Medicaid national insurance programmes, treating them like large insurance companies. This model continues in its latest iteration, CPT 2020.
With CPT, the AMA had not only found a way effectively to control government involvement in healthcare, it had also developed a way to directly profit from it. In the contracts the AMA established with the Health Care Financing Administration (HCFA)—the government agency that administers Medicare and Medicaid—the AMA made licensing of the CPT to the government conditional on the HCFA’s commitment to publicly endorse the CPT, require its use by physicians, and encourage its use by others. 2 The CPT codes provided the HCFA with a short term solution to the need for a billing system, even as this arrangement would soon prove to have long term unintended consequences. Licensing the CPT codes from the AMA allowed the government to avoid the laborious tasks of producing a new set of original billing codes and generating physician acceptance of them.
The contracts prohibited the HCFA from subsequently developing or considering a competing system. According to a unanimous federal appeals court decision in 1998, which revealed elements of an AMA contract with the HCFA, “the AMA misused its copyright by licensing the CPT to HCFA in exchange for HCFA’s agreement not to use a competing coding system.” 3 This arrangement has effectively hamstrung the HCFA, leaving it dependent on the AMA.
The licensing and sale of the CPT system to the government and billing industry has provided a substantial source of AMA revenue for many years. 4 Although the exact figure gathered from the sale of CPT codes is not disclosed in public documents, the AMA reports that $208m (£166m; €182m) of its $390m total revenue in 2019 was derived from “royalties and credentials”; CPT related sales appear to comprise the most significant component of this revenue category. 5 6 This annual income has allowed the AMA lobby to maintain outsized influence over American healthcare.
The new specialty: partitioning care
The origins of the American clinic today are inextricably tied to the CPT codes. The first CPT manual listed few non-surgical procedures and a clinic visit itself became the main “procedure” of non-surgical doctors. One set of visit codes for “consultation” rewarded specialists with higher RVUs for their expertise; another set of codes was introduced for “primary physicians,” giving rise to a new, distinct specialty.
This billing structure, in which CPT codes dictate levels of RVU reimbursement, has had far ranging consequences for medical training. It has provided financial incentives for rapid increases in specialisation and continues to be a major determinant of deficiencies of investment, quality, and physician numbers in primary care.
The CPT dictated system reformed the doctor-patient relationship. Previously, many specialists cared for patients whose predominant condition fell within their specialty while also addressing a patient’s additional medical needs. 7 Following the adoption of the CPT manual, specialists were disincentivised from treating conditions outside their specialty or providing “continuing care” if they wanted to bill at higher levels. The CPT system thus effectively installed specialisation and billing as the ordering principles of the American medical system. Although increasing specialisation is necessary in light of advancements in medical knowledge, financially incentivised partitioning of patients’ conditions at the expense of continuity and coherence in patient experience is not an inevitable consequence of specialisation.
The CPT system at first formalised a new model of care that was, in theory, to be managed by a single physician, consigning responsibility for continuity exclusively to the newly conceived “primary physician”—a category defined from its outset by inadequate physician numbers. In 1966, the same year of the first CPT manual, the AMA created the Citizens Commission on Graduate Medical Education and assigned it the task of establishing a clinic based specialty to address an ostensible lack of general practitioners. Recommending the creation of residency programmes to train primary physicians, the commission defined the new specialty “in the first contact sense” and tasked it with “continuing and comprehensive patient responsibility,” which became especially important as other specialists relinquished this role. 8
Primary physicians’ mandate to provide continuing and comprehensive patient care was stymied, however, by several CPT related influences. When patients became sick, they were often sent to specialists who applied specialty directed guidelines: algorithms for a particular organ or disease to recommend covered procedures. Primary physicians familiar with the patient were largely excluded from decision making processes in favour of specialists’ recommendations, which tended towards polypharmacy and additional procedures. Furthermore, when patients were admitted to hospital, the primary doctor was increasingly side lined in the clinic, such that specialists took over short term care of their patients.
One indicator of the harmful health consequences of this system was the 30 day hospital re-admission rate, which skyrocketed following the associated establishment of “hospitalist” physicians—those responsible only for in-hospital care—in the late 1990s. This reality, which was partly a result of billing incentives for short term hospitalisation and rapid discharge, later led to regulations in the Affordable Care Act that penalise hospitals for high rates of 30 day re-admissions. These regulations do not, however, address the underlying billing system that perpetuates perverse incentives in clinical care and shapes its troubling discontinuities.
The clinic of paperwork
As the partitioning of hospital care reconfigured the role of the clinic, basic screening and vaccinations—tasks better performed by large scale public health initiatives rather than by physicians—became an essential part of the primary doctor’s daily routine and revenue. Primary doctors became increasingly financially dependent on the routine clinic visit, and these visits became standard practice, regardless of whether they were justified by a patient’s condition.
Revenue from routine visits has become so central to primary care that some training programmes now expressly incorporate maximally profitable coding practices (the choice of documented billing codes for services rendered) into residency curriculums, where “accuracy” in coding is measured by whether a trainee has coded for the most and highest possible billable items for a given visit. 9 Under this organisation of the clinic, when an urgent medical issue does arise, a patient’s own primary doctor is often fully booked with routine visits such that the urgent visit falls to another doctor unfamiliar with that patient’s history. Even in clinics designed to avoid this particular problem, the minutiae of billing requirements frequently threaten to overwhelm attention given to actual care.
Further frustrating the ideal of the clinic was a push by Medicare regulators to enact cost cutting measures. Beginning in the 1990s, multimillion dollar fines were levelled against many large medical centres for billing clinic visits at higher CPT levels without sufficient documentation. 10 Regulators accused doctors of fraud and instituted complex reporting requirements to justify CPT levels, intending to encourage doctors to bill at lower levels and be more prudent in their administration of procedures. Instead, doctors became expert at providing the key terms needed to justify procedures and billed at higher CPT levels, rendering the fines impotent. In 1980 physician and writer Howard Spiro offered this critique: “We are all encouraged to do more in the way of technological activities today than 10 or 30 years ago simply because the third party payers pay for technology and not for thinking… it is easy to assess the costs of the procedures but difficult to assess the cost of a thought.” 11
The adoption of electronic medical records further de-emphasised critical clinical thought by enabling the construction of the patient chart with pre-set, generic qualifying language. The medical record, which had previously served many functions, including tracking the clinical narrative of the patient, became first and foremost a documentary exercise to justify billing. The focus was shifted from patient wellbeing—a difficult concept on which to assign itemised, billable value—to filling out encounter forms, which became increasingly onerous because of efforts to prevent fraud that was defined as inadequate documentation. In this medical chart-cum-bill, the patient as billable customer became most relevant. Furthermore, this system has only compounded the paperwork requirements for physicians, which are noted today as the leading drivers of high rates of physician burnout and dissatisfaction. 12
The AMA’s fear that government involvement in healthcare would result in increased bureaucracy and reduced physician autonomy and satisfaction have been realised; ironically, this reality is largely the consequence of the AMA’s own designs.
After covid-19
The current suspension of the clinic as we have known it offers an opportunity to reassess its organisation and structural determinants. 13 Organisation of medicine around the CPT system rather than patient care bears much responsibility for the broken system from which we are now suffering. As we reopen the clinic, we must disrupt its walls such that patients can be cared for across sites—telephone, video, hospital, patients’ homes, nursing homes, and, when necessary, the physical clinic—using electronic charting compiled to enable an understanding of patients’ circumstances, not records constructed around key terms to justify billing. Freeing the clinic from a billing centric system, rather than just updating CPT codes and documentation requirements for telemedicine, is necessary for structural changes to advance effective, equitable care as an actionable ethos.
The fee-for-service American healthcare system produces profound inefficiencies and inequities in care. Efforts to address this reality—such as calls for a single payer national system—must confront the specific mechanisms by which this has come to be the case. To do so, historical-economic analyses of the bureaucratic structures embedded in current practices are vital to enable genuine improvements in clinical care, morale, and public health.
Biographies
Eric Reinhart is an MD-PhD candidate at the University of Chicago Pritzker School of Medicine and the Harvard University Department of Anthropology. He has conducted four years of historical and ethnographic research in American clinical contexts, evaluating patient-doctor relationships and their structuring bureaucratic determinants. He is also a candidate in adult psychoanalysis at The Chicago Center for Psychoanalysis. Daniel Brauner is board certified by the American Board of Internal Medicine in general internal medicine, rheumatology, and geriatric medicine, and has been in clinical practice for nearly 40 years. He is a professor in the Department of Medicine, chief of the Division of Geriatrics, and also appointed in the Department of Family and Community Medicine and the Program in Medical Ethics, Humanities, and Law at Western Michigan University Homer Stryker MD School of Medicine. Until 2020, he was an associate professor at the University of Chicago, where he had an active clinical practice and was programme director of the Geriatrics Fellowship and assistant director of the MacLean Center for Clinical Medical Ethics for more than 20 years. He has published on the history of resuscitation and ‘do-not-resuscitate’ orders, language, and medicine, cognitive impairment and dementia, and other issues in the care of older patients in the US.
Conflicts of interest: Neither Eric Reinhart nor Daniel Brauner have any competing interests or conflicts of interest relevant to this article. Neither author has received any funding for this research.
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The case for critical thinking: the covid-19 pandemic and an urgent call to close the critical thinking gap in education.
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When critical thinking is literally a matter of life or death, we can no longer afford to keep ... [+] treating it like a luxury good.
The world’s greatest health crisis in 100 years has forced educators to rapidly transform learning spaces from brick and mortar settings to distance learning settings. The most discussed aspect of this transition is the vast number of students lacking access to the devices and connectivity they need to engage in distance learning .
This is not really news. Before this crisis, it was already known that although 70% of teachers in United States assigned homework that requires internet access , 15% of student households lack high-speed internet. For families earning under $30,000 annually, this rate jumps to 33%. Despite the awe-inspiring efforts of school systems and communities rallying to get devices and connectivity sorted out for hundreds of thousands of students, initial data suggests that nationwide, vast numbers of students are not logging in . With public schools shut down in every state and 15 states deciding to not reopen for the remainder of the school year, meaningful access to technology will play a crucial role in distance learning.
Technology, however, is far from the be-all, end-all to educational success. Prior to this crisis, schools serving high numbers of students from low income families would often celebrate when they reached a 1:1 student-to-technology device ratio. This speaks to a surprisingly different type of digital divide than the one we typically worry about. While these students rely heavily on screens for learning, some students in more affluent communities attend schools that ban screen time altogether , relying more on human interaction and play-based learning.
Why is it that Steve Jobs did not let his children near iPads when they were young? How could it be that Tim Cook refused to let his nephew be on social media networks? Does it make sense that Bill Gates banned his children from having cell phones until they were teens? Clearly, a device and a wifi hotspot is not a cure-all. If we are truly concerned about issues of access, t here is a larger, more inequitable issue that is even more critical than access to technology: access to critical thinking instruction.
The Critical Thinking Gap
Nanotechnology. Automation. Artificial intelligence. Big data. It is impossible to hear an expert pontificate on the future of work without pointing out all the ways basic knowledge and skills alone are no longer sufficient. Futurist Alvin Toffler explained that “the illiterate of the 21st century will not be those who cannot read and write. It will be those who can not learn, unlearn, and relearn.” Bill Daggett often shares the dire prediction that if “you can write an algorithm for a task, the job is gone.” If we are sincere in our goal to prepare young people to solve problems the likes of which we have never seen, using technologies that have not been created, in career fields that do not exist, education systems should obsess over critical thinking.
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Yet, critical thinking is still a luxury good . This crucial set of skills and dispositions, including reasoning, analyzing multiple perspectives, and displaying the healthy sense of skepticism needed to seek evidence to support or refute claims is notoriously hard to teach . Complicating manners further, critical thinking is even harder to teach across different contexts. The critical thinking required to ponder complex questions in medicine, for instance, requires insight into subject-specific expertise and contexts vastly different questions a social media marketer or agricultural expert would explore. But difficulty alone cannot explain the cognitive dissonance that exists when we claim critical thinking is such a crucial aspect of future-readiness for all students, but face a reality where only 1 in 10 educators teach critical thinking.
The critical thinking gap is one of the most significant, yet overlooked equity challenges in education today. Right now, systems leaders are going full throttle to figure out the access challenges related to distance learning at a time when most states are cancelling standardized tests until things get back to normal. From an equity perspective, however, “normal” means returning to a system where poor students of color disproportionately fail these exams. For those who lament the idea of “ teaching to a test ,” it helps to understand that these tests are typically not the simple fill-in-the-blank or easy multiple choice questions of yesteryear, but complex, multi-step questions that require critical thinking to succeed.
With critical thinking embedded into the main tool states use for accountability, one would presume this would be another reason critical thinking should be prioritized. But if you walked into most classrooms where critical thinking is taught, you would immediately recognize a separate and unequal education , even within the same school building. You would likely see critical thinking in gifted and talented programs that are consistently far less racially and socioeconomically diverse than the school system’s demographics. Critical thinking is often a focus of selective magnet schools and specialized high schools that face similar diversity challenges, particularly in New York City . T NTP’s Opportunity Myth report dived even further into these inequities, finding that “classrooms that served predominantly students from higher-income backgrounds spent twice as much time on grade-appropriate assignments and five times as much time with strong instruction, compared to classrooms with predominantly students from low-income backgrounds.” If critical thinking is so important, why is it still treated like a luxury good?
The COVID-19 Pandemic and the Case for Critical Thinking
There is a clear case for critical thinking now, more than ever before. With the mass shutdowns across the country and throughout the world, this is a live example of the type of thinking young people need to navigate the uncertainties they will undoubtedly face when they come of age. This pandemic, and our reactions to this once-in-a-century health crisis, drive home the need to equip all young people with critical thinking skills and dispositions. Our challenges reveal an urgent need to emphasize several key aspects of critical thinking.
The world watched as Wuhan, China, the city of 11 million people where the COVID-19 pandemic originated, struggled mightily to contain this outbreak. The first reported case occurred on November 17, 2019, and Wuhan’s recently-ended strict quarantine measures started on January, 23, 2020.
The United States reported its first patient infected with the novel coronavirus on January 20, 2020. On January 31, the Trump administration suspended travel into the United States from any foreign nationals from China (with a consequential exception for the immediate family members of permanent residents and United States citizens).
This is a prime example where the mere ability to observe, assess, and adjust is not enough. Leaders tasked with solving complex challenges must also be willing to engage in these thinking processes. For instance, the limited travel ban from China on January 23, 2020 ignored the reality that over 5 million people left the Wuhan province in the days prior to their strict quarantine. This ban also overlooked the nearly 400,000 travelers from China who entered after the outbreak’s origination, but prior to the ban’s enactment. And it is unclear whether the ban accounted for the 40,000 people who would later travel from China under the ban’s exceptions with inconsistent screening practices upon entry.
Without a willingness to observe, assess, and adjust, warnings like this January 29, 2020 excerpt from a memo written by Peter Navarro, President Trump’s trade advisor, had no chance of being impactful: “The lack of immune protection or an existing cure or vaccine would leave Americans defenseless in the case of a full-blown coronavirus outbreak on U.S. soil,” Mr. Navarro’s memo said. “This lack of protection elevates the risk of the coronavirus evolving into a full-blown pandemic, imperiling the lives of millions of Americans.”
Adopting this willingness requires a fundamental shift of leadership values. Decisive, bold actions may conform with stereotypes of what strong leaders should do. But in complex, rapidly changing situations where risk is high and information is limited, this style is far inferior than one based on thoughtful decisions made carefully with humility and constant awareness of the unknown. All students would benefit from instructional models that help them develop a strong sense of inquisitiveness and the ability to collect and make sense of information.
Speaking of information, even though technology makes it possible to have much of the world’s information at your fingertips, information alone is insufficient for critical thinking. This information is meaningless without the desire and ability to ask the right questions, identify conflicting information, assess the credibility and accuracy of that information, and determine what actions ought to be taken in response.
For instance, in late January 2020 , China’s National Health Commission director offical Ma Xiaowei noted that infected, asymptomatic people may still be able infect others. This would make the disease much more challenging to manage and control. However, the Centers for Disease Control and Prevention did not have “any clear evidence patients’ being infectious before symptom onset” but was “actively investigating that possibility” during this same time period.
This is where another important critical thinking dispositions comes into play that contradicts another traditional leadership hierarchy. Being right is often the goal in traditional leadership models. But when the critical thinking disposition is involved that values doing right over being right, it necessitates a much more careful and people-centered analysis. Weighing these two conflicting statements requires an understanding of the potential risks. This information came out at a time when the United States’ novel coronavirus cases were in the single digits. This was also around two months after China acknowledged receiving its first case, giving the United States clear insight into the exponential growth model of this disease and the drastic impact of a massive lockdown to stop the spread of the virus.
A public health official from China spoke freely about the risks of virus transmission posed by patients who are infected, but do not show any symptoms yet. This is from a country with an unfavorable history of imposing harsh consequences on those who spoke out against the risks of this disease. In late January, Chinese health officials also had two more months of experience dealing with this disease than the United States did. Imagine leaders involved in this decision making were trained as early as kindergarten to ask questions why “what are the hardships of being a blind mouse, and why might these three blind mice be running after the farmer’s wife?” This might lead to a mindset shift resulting in a very different set of questions for these real-world challenges.
When faced with prospect of millions of people dying in the case of a viral outbreak, would you prefer to act on research that found that infected, asymptomatic patients can transmit the virus before symptoms occur? Or would you prefer to rely on your country’s finding that they did not find “any clear evidence,” but were still looking to confirm that reality? If it is more important to be right, then you will always want to rely on your people over others. But if the focus is doing right, instead, then your analysis must go to the merits of the conflicting information and evaluate the vastly different costs of being wrong. If United States health officials mistakenly “played it safe” by taking earlier, strong actions on testing and social distancing guidance, then they made an expensive overreaction. We now know that China’s health official was correct about how the virus worked for patients without symptoms. The cost of getting this wrong is likely part of why, at time of publication of this article, the United States has seen 468,895 novel coronavirus cases, over 30,000 new cases a day, and over 16,697 deaths.
When critical thinking is literally a matter of life or death, we can no longer afford to keep treating it like a luxury good.
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COVID-19 Coronavirus Essay
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COVID-19 Coronavirus Abstract First appearing in China in late 2019, the novel Coronavirus COVID-19 has become the most significant global pandemic event in a century. As of October 28, 2020 the total number of cases worldwide was 44 million with 1.17 million deaths. The United States has had an extremely politicized response to the virus, and despite having less than five percent of the world’s population, the U.S. has had more than 20 percent of the world’s COVID-19 cases with 8.85 million cases and 227 thousand deaths. Currently, it seems unlikely that COVID-19 will be under control and people able to resume their normal lives until late 2021. In this essay, we discuss what Coronavirus is, what COVID-19 is, where it originated, the health impact of the disease, risk factors , efforts to contain the spread of the disease, the economic impact of the disease, and how COVID-19 may be impacting the 2020 United States Presidential election. COVID-19 Coronavirus Essay Titles Global Pandemic or Global Panic? The Facts About the Coronavirus Mask Not What You Can Do for Your Country Preventing Coronavirus Is Easy, Treating It Can Be Hard Mask Mandates: Constitutional Violation or Appropriate Government Intervention? How Government Leaders Have Responded to the Coronavirus Pandemic COVID-19 Coronavirus Essay Topics Are mask mandates to prevent the spread of the coronavirus constitutional? Many people suggest that mask mandates are a violation of their constitutional rights. Has the Supreme Court previously considered the question in other pandemics or addressed similar questions in other contexts? What have the results been? Would those results support a claim that mask mandates are constitutional? Is Coronavirus really as deadly as they say it is? With variations in fatality rates depending on the country and pre-existing conditions, is the Coronavirus as dangerous as people initially thought it was? How President Trump’s successful treatment for COVID-19 highlights the interrelationship between wealth, access to healthcare , and treatment outcomes for people infected with the Coronavirus. Current best practices to prevent the spread of COVID-19 as people head into cold and flu season. Discuss the steps people should take to prevent transmission of the virus, whether any early steps have proven unhelpful, and whether people need to get their Flu shots since people are already taking precautions to prevent COVID-19 transmission. Is COVID-19 likely to be only the first global pandemic of the coming century? Many prominent people have been predicting a pandemic event for several years; is COVID-19 an indicator of things to come, or a once-in-a-century type event? COVID-19 Coronavirus Essay Outline I. Introduction A. Define COVID-19 B. Where COVID-19 originated C. Health Impact of COVID-19 D. Risk Factors E. Efforts to Contain the Spread F. Economic Impact of COVID-19 G. COVID-19 and the 2020 Presidential Election H. Thesis: Although it is easy to see the immediate real-life impact of COVID-19 on global health, welfare, and economy, it is more difficult to predict the lasting effects of the pandemic, which could continue to impact people for the next several decades. II. Define COVID-19 A. Coronavirus B. Novel C. 19 III. Origination A. Wuhan wet-market B. European strain C. Other theories IV. Health Impact of COVID-19 A. Symptoms B. Prognosis C. Mortality V. Risk Factors A. Health B. Demographics C. Wealth VI. Economic Impact of COVID-19 A. US B. Global C. Projections VII. COVID-19 and the 2020 U.S. Presidential Election A. Americans upset with Trump’s response to coronavirus. B. Some Americans upset with more restrictive measures. C. Trump does not support restrictive measures. D. Biden supports restrictive measures. VIII. New Coronavirus Wave in U.S. IX. Conclusion Essay Title: The Coronavirus Is Real and It Kills Economies as Well as People Hook Sentence: Almost a year ago, COVID-19, a novel coronavirus, first emerged as a major health epidemic in China; now, it has spread around the globe, not only killing people but also bringing economies to a halt. Introduction While most people are aware that there is a global COVID-19 pandemic currently impacting people, there has been a sufficient amount of intentional and unintentional misinformation about this strain of the coronavirus that many people do not understand the extent of the problem. The COVID-19 pandemic is the most significant epidemic or pandemic event to hit the world since the Spanish Flu in the 1918 and 1919. By the end of that pandemic, between three and five percent of the world’s population had died as a result of a particularly virulent strain of influenza (Roos, 2020). It also led to a massive economic struggle for people around the globe, including thrusting the United States into a two-year depression. This pandemic event shares many similarities, but also some significant differences with the Spanish Flu including. Ways that it is similar include the health impacts of the disease, some of the risk factors, and containment efforts. Ways that it is different include overall mortality rates , the economic impact of the disease, and how COVID-19 influences politics . Thesis Statement Although a smaller percentage of people around the globe are likely to die from COVID-19 than died from the Spanish flu, it is likely that COVID-19 will have a more dramatic and long-lasting economy on global politics, economy, and long-term health than the Spanish Flu pandemic. Body The coronavirus known as COVID-19 is one of many coronaviruses. It is often called a novel virus because it was first identified in humans in 2019. The term coronavirus refers to zoonotic viruses that cause illnesses in animals and can be transmitted from animals to humans. There are several types of coronaviruses, but most of them cause mild illnesses in people. However, there have been some other significant coronaviruses that have caused local epidemics and had pandemic potential, such as the Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV). Although the term refers to a range of illnesses, they generally seem to target the respiratory system and produce symptoms that range from mild to pneumonia and death. COVID-19 has a more dramatic impact on many people’s health than prior coronavirus infections. It also has a wider range of impact. In some people, it can be asymptomatic. In others it can cause respiratory and gastrointestinal problems. For those most severely impacted by the disease, it can impair breathing and cause organ failure, resulting in death. COVID-19 is believed to have originated in Wuhan-China and that the initial point of animal-to-human transmission occurred in a market selling both live and dead animals for human consumption. The genetics of the virus suggests that it originally began in a bat, but it may have passed through other types of animals before landing in humans. The disease appears to have the ability to evolve rapidly, with different strands impacting different areas of the globe. The World Health Organization (WHO) declared COVID-19 to be a global pandemic on March 11, 2020 (Cucinotta & Vanelli, 2020). The health impact of COVID-19 depends on a number of factors. For many people, the symptoms of COVID-19 may, indeed, by similar to a regular seasonal flu. In fact, many people have the disease and are asymptomatic. This had led to dangerous statements that COVID-19 is no more dangerous than the flu, which …capacity have caused businesses, especially small businesses, to shut down around the world. While countries with more robust social welfare programs may not have seen the same extent of impact, no countries that have had active pandemic infections have been spared economic consequences. In addition, because the economy is global, even those countries that have been successful at reducing the impact of COVID-19 on their population have experienced economic problems. COVID-19 is currently causing recession conditions in many countries, and, if it follows the same pattern as the Spanish Flu, it will lead to at least short periods of economic depression in most countries, worldwide. Another way that the COVID-19 pandemic has impacted the world is through politics. The response by political leaders has led to very different reactions in different parts of the world. In the United States, President Trump intentionally downplayed the risks of the disease and his administration gave misleading information to the public, such as initially suggesting that masks made one more susceptible to the disease. These efforts, which appear to have been motivated by a desire to avoid financial panic, may have contributed to rapid transmission rates in the country. They also seem to have helped bolster people who believe mask mandates are unconstitutional. Trump’s coronavirus response is expected to play a major role in the 2020 election, which may be impacted by the fact that Trump and several key Republicans contracted COVID-19 in September. The number of super-spreader events over the summer and a lax approach by some state and federal officials seems to have had an impact on the spread of COVID-19. While it was under control in many areas, it is now surging throughout most of the United States. In fact, virus numbers are rising in all but nine states (Meyer, 2020). What seems to make this newest wave of coronavirus different from the first two major waves to impact the U.S. is that there does not appear to be an epicenter of infection; instead, it is widespread making containment efforts more difficult. At this point in time, approximately 1 in every 1,000 Americans has tested positive for the virus, without about 2 in every 100,000 Americans having died from hit (Meyer, 2020). The country is experiencing extremely high single-day totals, and spread seems likely as voters head out to the polls for the elections, which places them at risk of contracting and spreading the disease, especially in areas that are not following safety protocols. In one week, the nation added over half a million cases and because many states are not taking any type of lockdown steps, these numbers can be expected to rise. Despite these rising numbers, the White House was reporting ending the pandemic as one of President Trump’s accomplishments on October 28, 2020 (Kelly, 2020). Conclusion While it may be true that the Coronavirus will probably kill a smaller percentage of the world’s population than the Spanish Flu killed, it would be a mistake to call it a less severe pandemic. The modern world is much more global than the world was a century in the past. Therefore, any problem significantly impacting health and the economy in a single region has a much broader impact. This global economy and easy and rapid transport helped the pandemic spread far more quickly than it could have in a less global environment. It also means that the economic impact of the pandemic on areas that have been hit the hardest has spread to areas across the globe. As a result, it seems likely that the extent of COVID-19’s full impact on the…
Sources Used in Documents:
References Association for Professionals in Infection Control and Epidemiology (APIC). “Herd Immunity. APIC.org. 3 September 2020. https://apic.org/monthly_alerts/herd-immunity/ . Accessed 17 October 2020. Centers for Disease Control and Prevention. “People at Increased Risk.” CDC. 11 September 2020. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fneed-extra-precautions%2Fpeople-at-increased-risk.html . Accessed 17 October 2020. Cucinotta, D. and Vanelli, M. “WHO Declares COVID-19 a Pandemic.” Acta Biomed, 91(1):157-160. 19 March 2020. doi 10.23750/abm.v91i1.9397. https://www.mattioli1885journals.com/index.php/actabiomedica/article/view/9397 . Accessed 17 October 2020. DeMarco, C. “COVID-19 and the Flu Vaccine: What You Need to Know.” MD Anderson Cancer Center. 20 August 2020. https://www.mdanderson.org/cancerwise/should-you-get-the-flu-vaccine-during-coronavirus-covid-19-pandemic.h00-159384312.html . Accessed 17 October 2020. Kelly, C. “White House Listing Ending COVID-19 Pandemic as an Accomplishment Despite Cases Spiking to Record Levels.” CNN. 28 October 2020. https://www.cnn.com/2020/10/27/politics/white-house-ending-covid-19-pandemic-accomplishment-record-cases-spike/index.html . Accessed 28 October 2020. Meyer, R. “The Coronavirus Surge that Will Define the Next Four Years.” The Atlantic. 22 October 2020. https://www.theatlantic.com/health/archive/2020/10/coronavirus-election-day-surge/616822/ . Accessed 28 October 2020. Rods, D. “When WWI, Pandemic, and Slump Ended, Americans Sprung into the Roaring Twenties.” History. 24 April 2020. https://www.history.com/news/pandemic-world-war-i-roaring-twenties . Accessed 17 October 2020. Viglione, G. “How Many People Has the Coronavirus Killed?” Nature. 1 September 2020. https://www.nature.com/articles/d41586-020-02497-w . Accessed 17 October 2020.
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Essay on the Pandemic — An epidemic occurring over a very wide area, crossing international borders and usually affecting a large number of people is known as a pandemic. The last time a pandemic occurred was in 2009, with the outbreak of Swine Flu, which killed thousands of people. In December 2019, a Novel Coronavirus , known as Covid 19, resulted in the outbreak of a respiratory illness.
Since its discovery, the virus has spread globally, causing thousands of deaths. It had a wide impact on the lives of people around the world. The virus was first identified in an outbreak of the respiratory disease in Wuhan city of China. On January 30, 2020, the World Health Organization (WHO) declared Covid 19 a global health emergency, and as of March 11, 2020, it was officially an epidemic. The term Covid 19 is an abbreviated form, derived from “ novel coronavirus disease 2019 ”.
The outbreak of the disease has a profound impact on the way we perceive the world, our interactions with others, and the way we live our daily lives. The rate of contagion and the pattern of transmission have endangered the existence of human life.
Security measures required to prevent the spread of the virus include social distancing, lockdown, isolation, and quarantine of those exposed to it. On March 24, 2020, a nationwide lockdown for 21 days was announced by the government, affecting India’s entire 1.3 billion population. As a result, in India, all educational institutions and almost every business establishment had to be shut down.
International, as well as intra-state travel, was banned. India suspended all tourist visas, as most of the confirmed cases were related to other countries. The lockout was increased in phases in those 21 days. This forced people to remain confined within their homes and led to a deadlock in almost all professional, personal, and economic activities. Restrictive measures aimed at curbing the new Coronavirus pandemic drastically changed lives.
Parents working at home with children, trapped indoors for weeks, found the experience overwhelming and exhausting. The sudden change caused a high amount of stress to everyone. Many migrant workers deprived of their work and daily income, had difficulties in returning to their places of origin. It had terrible consequences on the economy and widened the socio-economic disparities that divided the country.
Normal life came to a standstill; everyone was feeling lost and dreaded. In this unprecedented scenario, front-line workers emerged as heroes, with doctors, nurses, paramedics, police, transport officers, essential service providers, and cleaners coming to the forefront to stop the spread of the disease and join them. Breaking great barriers every day, many of them contracted the disease and perished.
The epidemic had some unexpected positive results. In the midst of the entire crisis, with the spread of the virus, all industrial activity and human exploitation of natural resources came to a complete halt. Due to this, the level of pollution declined and nature rejuvenated itself. Even at home, the lockdown had its fair share of advantages.
Families found it grace to spend quality time together and rediscover the love and care that had been lost over time. With the world facing the coronavirus crisis , the epidemic has wreaked havoc and changed human lives forever. After the virus subsides, its effects and unpleasant consequences will be felt for a long time. Nevertheless, in such times, hope is a powerful healer. The pandemic is united in its struggle against the pandemic and life will surely prevail.
The COVID-19 Pandemic caused a lot of damage to the world. Working with Covid 19 , the world learned many lessons. And it is important to learn a lesson to prepare yourself for the next pandemic and prevent possible pandemics.
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Coronavirus Disease (COVID-19): The Impact and Role of Mass Media During the Pandemic
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The outbreak of coronavirus disease 2019 (COVID-19) has created a global health crisis that has had a deep impact on the way we perceive our world and our everyday lives. Not only the rate of contagion and patterns of transmission threatens our sense of agency, but the safety measures put in place to contain ...
Keywords : COVID-19, coronavirus disease, mass media, health communication, prevention, intervention, social behavioral changes
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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.
Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.
- 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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As the year 2020 started a new pandemic took a toll on the lives of many people. The full damage of this newly discovered virus is still unclear. The Coronavirus recently named COVID- 19 started in Wuhan, China but has created panic among people around the world. According to the World Health Organization the Coronavirus can cause sickness that extend from a regular cold to more critical diseases
According to Centers for Disease Control and Prevention (CDC) who is observing the pandemic, the COVID-19 can be transmitted from one person to another.
The virus comes from a greater family of Coronaviruses which are known to be carried by many animals like bats, camels, and cats to name a few. Not many of the viruses are able to spread from animals to human. Many of the people who contracted the virus at the beginning had some contact with Huanan Seafood Wholesale Market in China, which indicated that the virus was passed from animal to human.
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Soon After, it was known that some of the people who had the virus, did not have contact with the live animal markets which only meant that they got it from another person who was infected.
With no vaccine to prevent the virus many recommendations have been stablished to diminish the spread. Some of the recommendation given by the CDC include not touching you nose, mouth, and eyes without washing your hands. Staying away from sick people or staying home if you are sick. Wearing a mask whenever diagnosed with the virus is also instructed.
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As the rate mortality and infected people has continual to rise scientist and researchers have been gathering at the World Health Organization’s Geneva headquarters to give urgency to research about COVID-19 and ways to prevent further outbreaks. Along with researching the health professionals are looking for ways to come up with vaccines and medication before other epidemics occur. The discussion of more than three-hundred experts of health will create the foundation necessary to start the research and speed up for answer.
- Centers for Disease Control and Prevention. “Coronavirus Disease 2019 (COVID-19) Situation Summary.” Coronavirus Disease 2019 (COVID-19). CDC, 13 February 2020. https://www.cdc.gov/coronavirus/2019-nCoV/summary.html
- World Health Organization. “World experts and funders set priorities for COVID-19 research.” Coronavirus disease (COVID-19) outbreak. 12 February 2020. https://www.who.int/news-room/detail/12-02-2020-world-experts-and-funders-set-priorities-for-covid-19-research
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A critical analysis of the impacts of COVID-19 on the global economy and ecosystems and opportunities for circular economy strategies
T. ibn-mohammed.
a Warwick Manufacturing Group (WMG), The University of Warwick, Coventry CV4 7AL, United Kingdom
K.B. Mustapha
b Faculty of Engineering and Science, University of Nottingham (Malaysia Campus), Semenyih, Selangor43500, Malaysia
c School of The Built Environment and Architecture, London South Bank University, London SE1 0AA, United Kingdom
K.A. Babatunde
d Faculty of Economics and Management, Universiti Kebangsaan Malaysia, Bangi, Selangor43600, Malaysia
e Department of Economics, Faculty of Management Sciences, Al-Hikmah University, Ilorin, Nigeria
D.D. Akintade
f School of Life Sciences, University of Nottingham, Nottingham NG7 2UH United Kingdom
g Kent Business School, University of Kent, Canterbury CT2 7PE, United Kingdom
h Faculty of Economics, Kyushu University, 744 Motooka, Nishi-ku, Fukuoka 819-0395, Japan
M.M. Ndiaye
i Department of Industrial Engineering, College of Engineering, American University of Sharjah, Sharjah, UAE
F.A. Yamoah
j Department of Management, Birkbeck University of London, London WC1E 7JL United Kingdom
k Sheffield University Management School (SUMS), The University of Sheffield, Sheffield S10 1FL, United Kingdom
The World Health Organization declared COVID-19 a global pandemic on the 11th of March 2020, but the world is still reeling from its aftermath. Originating from China, cases quickly spread across the globe, prompting the implementation of stringent measures by world governments in efforts to isolate cases and limit the transmission rate of the virus. These measures have however shattered the core sustaining pillars of the modern world economies as global trade and cooperation succumbed to nationalist focus and competition for scarce supplies. Against this backdrop, this paper presents a critical review of the catalogue of negative and positive impacts of the pandemic and proffers perspectives on how it can be leveraged to steer towards a better, more resilient low-carbon economy. The paper diagnosed the danger of relying on pandemic-driven benefits to achieving sustainable development goals and emphasizes a need for a decisive, fundamental structural change to the dynamics of how we live. It argues for a rethink of the present global economic growth model, shaped by a linear economy system and sustained by profiteering and energy-gulping manufacturing processes, in favour of a more sustainable model recalibrated on circular economy (CE) framework. Building on evidence in support of CE as a vehicle for balancing the complex equation of accomplishing profit with minimal environmental harms, the paper outlines concrete sector-specific recommendations on CE-related solutions as a catalyst for the global economic growth and development in a resilient post-COVID-19 world.
1. Introduction
The world woke up to a perilous reality on the 11th of March, 2020 when the World Health Organization (WHO) declared novel coronavirus (COVID-19) a pandemic ( Sohrabi et al., 2020 ; WHO, 2020a ). Originating from Wuhan, China, cases rapidly spread to Japan, South Korea, Europe and the United States as it reached global proportions. Towards the formal pandemic declaration, substantive economic signals from different channels, weeks earlier, indicated the world was leaning towards an unprecedented watershed in our lifetime, if not in human history ( Gopinath, 2020 ). In series of revelatory reports ( Daszak, 2012 ; Ford et al., 2009 ; Webster, 1997 ), experts across professional cadres had long predicted a worldwide pandemic would strain the elements of the global supply chains and demands, thereby igniting a cross-border economic disaster because of the highly interconnected world we now live in. By all accounts, the emerging havoc wrought by the pandemic exceeded the predictions in those commentaries. At the time of writing, the virus has killed over 800,000 people worldwide ( JHU, 2020 ), disrupted means of livelihoods, cost trillions of dollars while global recession looms ( Naidoo and Fisher, 2020 ). In efforts to isolate cases and limit the transmission rate of the virus, while mitigating the pandemic, countries across the globe implemented stringent measures such as mandatory national lockdown and border closures.
These measures have shattered the core sustaining pillars of modern world economies. Currently, the economic shock arising from this pandemic is still being weighed. Data remains in flux, government policies oscillate, and the killer virus seeps through nations, affecting production, disrupting supply chains and unsettling the financial markets ( Bachman, 2020 ; Sarkis et al., 2020 ). Viewed holistically, the emerging pieces of evidence indicate we are at a most consequential moment in history where a rethink of sustainable pathways for the planet has become pertinent. Despite this, the measures imposed by governments have also led to some “accidental” positive effects on the environment and natural ecosystems. As a result, going forward, a fundamental change to human bio-physical activities on earth now appears on the spectrum of possibility ( Anderson et al., 2020 ). However, as highlighted by Naidoo and Fisher (2020) , our reliance on globalization and economic growth as drivers of green investment and sustainable development is no longer realistic. The adoption of circular economy (CE) – an industrial economic model that satisfies the multiple roles of decoupling of economic growth from resource consumption, waste management and wealth creation – has been touted to be a viable solution.
No doubt, addressing the public health consequences of COVID-19 is the top priority, but the nature of the equally crucial economic recovery efforts necessitates some key questions as governments around the world introduce stimulus packages to aid such recovery endeavours: Should these packages focus on avenues to economic recovery and growth by thrusting business as usual into overdrive or could they be targeted towards constructing a more resilient low-carbon CE? To answer this question, this paper builds on the extant literature on public health, socio-economic and environmental dimensions of COVID-19 impacts ( Gates, 2020b ; Guerrieri et al., 2020 ; Piguillem and Shi, 2020 ; Sohrabi et al., 2020 ), and examines its interplay with CE approaches. It argues for the recalibration and a rethink of the present global economic growth model, shaped by a linear economy system and sustained by profit-before-planet and energy-intensive manufacturing processes, in favour of CE. Building on evidence in support of CE as a vehicle for optimizing the complex equation of accomplishing profit while minimizing environmental damage, the paper outlines tangible sector-specific recommendations on CE-related solutions as a catalyst for the global economic boom in a resilient post-COVID-19 world. It is conceived that the “accidental” or the pandemic-induced CE strategies and behavioural changes that ensued during coronavirus crisis can be leveraged or locked in, to provide opportunities for both future resilience and competitiveness.
In light of the above, the paper is structured as follows. In Section 2 , the methodological framework, which informed the critical literature review is presented. A brief overview of the historical context of previous epidemics and pandemics is presented in Section 3 as a requisite background on how pandemics have shaped human history and economies and why COVID-19 is different. In Section 4 , an overview of the impacts (both negative and positive) of COVID-19 in terms of policy frameworks, global economy, ecosystems and sustainability are presented. The role of the CE as a constructive change driver is detailed in Section 5 . In Section 6 , opportunities for CE after COVID-19 as well as sector-based recommendations on strategies and measures for advancing CE are presented, leading to the summary and concluding remarks in Section 7.
A literature review exemplifies a conundrum because an effective one cannot be conducted unless a problem statement is established ( Ibn-Mohammed, 2017 ). Yet, a literature search plays an integral role in establishing many research problems. In this paper, the approach taken to overcome this conundrum involves searching and reviewing the existing literature in the specific area of study (i.e. impacts of COVID-19 on global economy and ecosystems in the context of CE). This was used to develop the theoretical framework from which the current study emerges and adopting this to establish a conceptual framework which then becomes the basis of the current review. The paper adopts the critical literature review (CLR) approach given that it entails the assessment, critique and synthetisation of relevant literature regarding the topic under investigation in a manner that facilitates the emergence of new theoretical frameworks and perspectives from a wide array of different fields ( Snyder, 2019 ). CLR suffers from an inherent weakness in terms of subjectivity towards literature selection ( Snyder, 2019 ), prompting Grant and Booth (2009) to submit that systematic literature review (SLR) could mitigate this bias given its strict criteria in literature selection that facilitates a detailed analysis of a specific line of investigation. However, a number of authors ( Morrison et al., 2012 ; Paez, 2017 ) have reported that SLR does not allow for effective synthesis of academic and grey literature which are not indexed in popular academic search engines like Google Scholar, Web-of-Science and Scopus. The current review explores the impacts of COVID-19 on the global economy and ecosystems and opportunities for circular economy strategies, rather than investigating a specific aspect of the pandemic. As such, adopting a CLR approach is favoured in realising the goal of the paper as it allows for the inclusion of a wide range of perspectives and theoretical underpinnings from different sources ( Greenhalgh et al., 2018 ; Snyder, 2019 ).
Considering the above, this paper employed archival data consisting of journal articles, documented news in the media, expert reports, government and relevant stakeholders’ policy documents, published expert interviews and policy feedback literature that are relevant to COVID-19 and the concept of CE. To identify the relevant archival data, we focused on several practical ways of literature searching using appropriate keywords that are relevant to this work including impact (positive and negative) of COVID-19, circular economy, economic resilience, sustainability, supply chain resilience, climate change, etc. After identifying articles and relevant documents, their contents were examined to determine inclusions and exclusions based on their relevance to the topic under investigation. Ideas generated from reading the resulting papers from the search were then used to develop a theoretical framework and a research problem statement, which forms the basis for the CLR. The impact analysis for the study was informed by the I = P × A × T model whereby the “impact” (I) of any group or country on the environment is a function of the interaction of its population size (P), per capita affluence (A), expressed in terms of real per capita GDP, as a valid approximation of the availability of goods and services and technology (T) involved in supporting each unit of consumption.
As shown in the methodological framework in Fig. 1 , the paper starts with a brief review of the impacts of historical plagues to shed more light on the link between the past and the unprecedented time, which then led to an overview of the positive and negative impacts of COVID-19. The role of CE as a vehicle for constructive change in the light of COVID-19 was then explored followed by the synthesis, analysis and reflections on the information gathered during the review, leading to sector-specific CE strategy recommendations in a post-COVID-19 world.
Methodological framework for the critical literature review.
3. A brief account of the socio-economic impacts of historical outbreaks
At a minimum, pandemics result in the twin crisis of stressing the healthcare infrastructure and straining the economic system. However, beyond pandemics, several prior studies have long noted that depending on latency, transmission rate, and geographic spread, any form of communicable disease outbreak is a potent vector of localized economic hazards ( Bloom and Cadarette, 2019 ; Bloom and Canning, 2004 ; Hotez et al., 2014 ). History is littered with a catalogue of such outbreaks in the form of endemics, epidemics, plagues and pandemics. In many instances, some of these outbreaks have hastened the collapse of empires, overwhelmed the healthcare infrastructure, brought social unrest, triggered economic dislocations and exposed the fragility of the world economy, with a knock-on effect on many sectors. Indeed, in the initial few months of COVID-19 pandemic, it has become more evident that natural, accidental or intentional biological threats or outbreak in any country now poses an unquantifiable risk to global health and the world economy ( Bretscher et al., 2020 ).
Saunders-Hastings and Krewski (2016) reported that there have been several pandemics over the past 100 years. A short but inexhaustible list of outbreaks of communicable diseases include ‘the great plague’ ( Duncan-Jones, 1996 ; Littman and Littman, 1973 ), the Justinian plague ( Wagner et al., 2014 ), the Black Death ( Horrox, 2013 ), the Third Plague pandemic ( Bramanti et al., 2019 ; Tan et al., 2002 ), the Spanish flu ( Gibbs et al., 2001 ; Trilla et al., 2008 ), HIV/AIDS ( De Cock et al., 2012 ), SARS ( Lee and McKibbin, 2004 ), dengue ( Murray et al., 2013 ), and Ebola ( Baseler et al., 2017 ), among others. The potency of each of these outbreaks varies. Consequently, their economic implications differ according to numerous retrospective analyses ( Bloom and Cadarette, 2019 ; Bloom and Canning, 2004 ; Hotez et al., 2014 ). For instance, the Ebola epidemic of 2013-2016 created socio-economic impact to the tune of $53 billion across West Africa, plummeted Sierra Leone's GDP in 2015 by 20% and that of Liberia by 8% between 2013 and 2014, despite the decline in death rates across the same timeframe ( Fernandes, 2020 ).
As the world slipped into the current inflection point, some of the historical lessons from earlier pandemics remain salutary, even if the world we live in now significantly differs from those of earlier period ( McKee and Stuckler, 2020 ). Several factors differentiate the current socio-economic crisis of COVID-19 from the previous ones ( Baker et al., 2020 ), which means direct simple comparisons with past global pandemics are impossible ( Fernandes, 2020 ). Some of the differentiating factors include the fact that COVID-19 is a global pandemic and it is creating knock-on effects across supply chains given that the world has become much more integrated due to globalisation and advancements in technology ( McKenzie, 2020 ). Moreover, the world has witnessed advances in science, medicine and engineering. The modest number of air travellers during past pandemics delayed the global spread of the virus unlike now where global travel has increased tremendously. From an economic impact perspective, interest rates are at record lows and there is a great imbalance between demand and supply of commodities ( Fernandes, 2020 ). More importantly, many of the countries that are hard hit by the current pandemic are not exclusively the usual low-middle income countries, but those at the pinnacle of the pyramid of manufacturing and global supply chains. Against this backdrop, a review of the impact of COVID-19 is presented in the next section.
4. COVID-19: Policy frameworks, global economy, ecosystems and sustainability
4.1. evaluation of policy frameworks to combat covid-19.
The strategies and policies adopted by different countries to cope with COVID-19 have varied over the evolving severity and lifetime of the pandemic during which resources have been limited ( Siow et al., 2020 ). It is instructive that countries accounting for 65% of global manufacturing and exports (i.e. China, USA, Korea, Japan, France, Italy, and UK) were some of the hardest to be hit by COVID-19 ( Baldwin and Evenett, 2020 ). Given the level of unpreparedness and lack of resilience of hospitals, numerous policy emphases have gone into sourcing for healthcare equipment such as personal protective equipment (PPE) and ventilators ( Ranney et al., 2020 ) due to global shortages. For ventilators, in particular, frameworks for rationing them along with bed spaces have had to be developed to optimise their usage ( White and Lo, 2020 ). Other industries have also been affected, with shocks to their existence, productivity and profitability ( Danieli and Olmstead-Rumsey, 2020 ) including the CE-sensitive materials extraction and mining industries that have been hit by disruption to their operations and global prices of commodities ( Laing, 2020 ).
As highlighted in subsequent sub-sections, one of the psychological impacts of COVID-19 is panic buying ( Arafat et al., 2020 ), which happens due to uncertainties at national levels (e.g. for scarce equipment) and at individual levels (e.g. for everyday consumer products). In both instances, the fragility, profiteering and unsustainability of the existing supply chain model have been exposed ( Spash, 2020 ). In fact, Sarkis et al. (2020) questioned whether the global economy could afford to return to the just-in-time (JIT) supply chain framework favoured by the healthcare sector, given its apparent shortcomings in dealing with much needed supplies. The sub-section that follow examines some of the macro and micro economic ramifications of COVID-19.
4.1.1. Macroeconomic impacts: Global productions, exports, and imports
One challenge faced by the healthcare industry is that existing best practices, in countries like the USA (e.g. JIT macroeconomic framework), do not incentivise the stockpiling of essential medical equipment ( Solomon et al., 2020 ). Although vast sums were budgeted, some governments (e.g. UK, India and USA) needed to take extraordinary measures to protect their supply chain to the extent that manufacturers like Ford and Dyson ventured into the ventilator design/production market ( Iyengar et al., 2020 ). The US, in particular activated the Defense Production Act to compel car manufacturers to shift focus on ventilator production ( American Geriatrics Society, 2020 ; Solomon et al., 2020 ) due to the high cost and shortage of this vital equipment. Hospitals and suppliers in the US were also forced to enter the global market due to the chronic shortfall of N95 masks as well as to search for lower priced equipment ( Solomon et al., 2020 ). Interestingly, the global production of these specialist masks is thought to be led by China ( Baldwin and Evenett, 2020 ; Paxton et al., 2020 ) where COVID-19 broke out, with EU's supply primarily from Malaysia and Japan ( Stellinger et al., 2020 ). Such was the level of shortage that the US was accused of ‘pirating’ medical equipment supplies from Asian countries intended for EU countries ( Aubrecht et al., 2020 ).
France and Germany followed suit with similar in-ward looking policy and the EU itself imposed restrictions on the exportation of PPEs, putting many hitherto dependent countries at risk ( Bown, 2020 ). Unsurprisingly, China and the EU saw it fit to reduce or waive import tariffs on raw materials and PPE, respectively ( Stellinger et al., 2020 ). Going forward, the life-threatening consequences of logistics failures and misallocation of vital equipment and products could breathe new life and impetus to technologies like Blockchain, RFID and IoT for increased transparency and traceability ( Sarkis et al., 2020 ). Global cooperation and scenario planning will always be needed to complement these technologies. In this regard, the EU developed a joint procurement framework to reduce competition amongst member states, while in the US, where states had complained that federal might was used to interfere with orders, a ventilator exchange program was developed ( Aubrecht et al., 2020 ). However, even with trade agreements and cooperative frameworks, the global supply chain cannot depend on imports – or donations ( Evenett, 2020 ) for critical healthcare equipment and this realisation opens doors for localisation of production with consequences for improvements in environmental and social sustainability ( Baldwin and Evenett, 2020 ). This can be seen in the case of N95 masks which overnight became in such high demand that airfreights by private and commercial planes were used to deliver them as opposed to traditional container shipping ( Brown, 2020 ).
As detailed in forthcoming sections, a significant reduction in emissions linked to traditional shipping was observed, yet there was an increase in use of airfreighting due to desperation and urgency of demand. Nevertheless, several countries are having to rethink their global value chains ( Fig. 2 ) as a result of realities highlighted by COVID-19 pandemic ( Javorcik, 2020 ). This is primarily because national interests and protectionism have been a by-product of COVID-19 pandemic and also because many eastern European/Mediterranean countries have a relative advantage with respect to Chinese exports. As shown in Fig. 2 , the global export share which each of these countries has, relative to China's share of the same exports (x-axis) is measured against the economies of countries subscribing to the European Bank for Reconstruction and Development (EBRD) (y-axis). For each product, the ideal is to have a large circle towards the top right-hand corner of the chart.
A summary of how some Eastern European / Mediterranean countries have advantages over China on certain exports – based on the Harmonized Commodity Description and Coding System from 2018, where export volume is represented by dot sizes in millions of USD; Source: Javorcik (2020) .
4.1.2. Microeconomic impacts: Consumer behaviour
For long, there has been a mismatch between consumerist tendencies and biophysical realities ( Spash, 2020 ). However, COVID-19 has further exacerbated the need to reflect on the social impacts of individual lifestyles. The behaviour of consumers, in many countries, was at some point alarmist with a lot of panic buying of food and sanitary products ( Sim et al., 2020 ). At private level, consumer sentiment is also changing. Difficult access to goods and services has forced citizens to re-evaluate purchasing patterns and needs, with focus pinned on the most essential items ( Company, 2020 ; Lyche, 2020 ). Spash (2020) argued that technological obsolescence of modern products brought about by rapid innovation and individual consumerism is also likely to affect the linear economy model which sees, for instance, mobile phones having an average life time of four years (two years in the US), assuming their manufacture/repair services are constrained by economic shutdown and lockdowns ( Schluep, 2009 ). On the other hand, a sector like healthcare, which could benefit from mass production and consumerism of vital equipment, is plagued by patenting. Most medical equipment are patented and the issue of a 3D printer's patent infringement in Italy led to calls for ‘Open Source Ventilators’ and ‘Good Samaritan Laws’ to help deal with global health emergencies like COVID-19 ( Pearce, 2020 ). It is plausible that such initiatives/policies could help address the expensive, scarce, high-skill and material-intensive production of critical equipment, via cottage industry production.
For perspective, it should be noted that production capacity of PPE (even for the ubiquitous facemasks) have been shown by COVID-19 to be limited across many countries ( Dargaville et al., 2020 ) with some countries having to ration facemask production and distribution in factories ( San Juan, 2020 ). Unsurprisingly, the homemade facemask industry has not only emerged for the protection of mass populations as reported by Livingston et al. (2020) , it has become critical for addressing shortages ( Rubio-Romero et al., 2020 ) as well as being part of a post-lockdown exit strategy ( Allison et al., 2020 ). A revival of cottage industry production of equipment and basic but essential items like facemasks could change the landscape of global production for decades, probably leading to an attenuation of consumerist tendencies.This pandemic will also impact on R&D going forward, given the high likelihood that recession will cause companies to take short-term views, and cancel long and medium-term R&D in favour of short-term product development and immediate cash flow/profit as was certainly the case for automotive and aerospace sectors in previous recessions.
4.2. Overview of the negative impacts of COVID-19
The negative effects have ranged from a severe contraction of GDP in many countries to multi-dimensional environmental and social issues across the strata of society. In many respects, socio-economic activities came to a halt as: millions were quarantined; borders were shut; schools were closed; car/airline, manufacturing and travel industries crippled; trade fairs/sporting/entertainment events cancelled, and unemployment claims reached millions while the international tourist locations were deserted; and, nationalism and protectionism re-surfaced ( Baker et al., 2020 ; Basilaia and Kvavadze, 2020 ; Devakumar et al., 2020 ; Kraemer et al., 2020 ; Thunstrom et al., 2020 ; Toquero, 2020 ). In the subsections that follow, an overview of some of these negative impacts on the global economy, environment, and society is presented.
4.2.1. Negative macroeconomic impact of COVID-19
Undoubtedly, COVID-19 first and foremost, constitutes a ferocious pandemic and a human tragedy that swept across the globe, resulting in a massive health crisis ( WHO, 2020b ), disproportionate social order ( UN DESA, 2020 ), and colossal economic loss ( IMF, 2020 ). It has created a substantial negative impact on the global economy, for which governments, firms and individuals scramble for adjustments ( Fernandes, 2020 ; Pinner et al., 2020 ; Sarkis et al., 2020 ; Sohrabi et al., 2020 ; Van Bavel et al., 2020 ). Indeed, the COVID-19 pandemic has distorted the world's operating assumptions, revealing the absolute lack of resilience of the dominant economic model to respond to unplanned shocks and crises ( Pinner et al., 2020 ). It has exposed the weakness of over-centralization of the complex global supply and production chains networks and the fragility of global economies, whilst highlighting weak links across industries( Fernandes, 2020 ; Guan et al., 2020 ; Sarkis et al., 2020 ). This has had a direct impact on employment and heightened the risk of food insecurity for millions due to lockdown and border restrictions ( Guerrieri et al., 2020 ). To some extent, some of the interventional measures introduced by governments across the world have resulted in the flattening of the COVID-19 curve (as shown in Fig. 3 ). This has helped in preventing healthcare systems from getting completely overwhelmed ( JHU, 2020 ), although as at the time of writing this paper, new cases are still being reported in different parts of the globe. Fernandes (2020) and McKibbin and Fernando (2020) reported thatthe socio-economic impact of COVID-19 will be felt for many months to come.
Daily confirmed new COVID-19 cases of the current 10 most affected countries based on a 5-day moving average. Valid as of August 31st, 2020 at 11:46 PM EDT ( JHU, 2020 ).
Guan et al. (2020) submitted that how badly and prolonged the recession rattles the world depends on how well and quickly the depth of the socio-economic implications of the pandemic is understood. IMF (2020) reported that in an unprecedented circumstance (except during the Great Depression), all economies including developed, emerging, and even developing will likely experience recession. In its April World Economic Outlook, IMF (2020) reversed its early global economic growth forecast from 3.3% to -3 %, an unusual downgrade of 6.3% within three months. This makes the pandemic a global economic shock like no other since the Great Depression and it has already surpassed the global financial crisis of 2009 as depicted in Fig. 4 . Economies in the advanced countries are expected to contract by -6.1% while recession in emerging and developing economies is projected (with caution) to be less adverse compared to the developed nations with China and India expected to record positive growth by the end of 2020. The cumulative GDP loss over the next year from COVID-19 could be around $9 trillion ( IMF, 2020 ).
Socioeconomic impact of COVID-19 lockdown: (a) Comparison of global economic recession due to COVID-19 and the 2009 global financial crisis; (b) Advanced economies, emerging and developing economies in recession; (c) the major economies in recession; (d) the cumulative economic output loss over 2020 and 2021. Note: Real GDP growth is used for economic growth, as year-on-year for per cent change ( IMF, 2020 ).
With massive job loss and excessive income inequality, global poverty is likely to increase for the first time since 1998 ( Mahler et al., 2020 ). It is estimated that around 49 million people could be pushed into extreme poverty due to COVID-19 with Sub-Sahara Africa projected to be hit hardest. The United Nations’ Department of Economic and Social Affairs concluded that COVID-19 pandemic may also increase exclusion, inequality, discrimination and global unemployment in the medium and long term, if not properly addressed using the most effective policy instruments ( UN DESA, 2020 ). The adoption of detailed universal social protection systems as a form of automatic stabilizers, can play a long-lasting role in mitigating the prevalence of poverty and protecting workers ( UN DESA, 2020 ).
4.2.2. Impact of COVID-19 on global supply chain and international trade
COVID-19 negatively affects the global economy by reshaping supply chains and sectoral activities. Supply chains naturally suffer from fragmentation and geographical dispersion. However, globalisation has rendered them more complex and interdependent, making them vulnerable to disruptions. Based on an analysis by the U.S. Institute for Supply Management, 75% of companies have reported disruptions in their supply chain ( Fernandes, 2020 ), unleashing crisis that emanated from lack of understanding and flexibility of the several layers of their global supply chains and lack of diversification in their sourcing strategies ( McKenzie, 2020 ). These disruptions will impact both exporting countries (i.e. lack of output for their local firms) and importing countries (i.e. unavailability of raw materials) ( Fernandes, 2020 ). Consequently, this will lead to the creation of momentary “manufacturing deserts” in which the output of a country, region or city drops significantly, turning into a restricted zone to source anything other than essentials like food items and drugs ( McKenzie, 2020 ). This is due to the knock-on effect of China's rising dominance and importance in the global supply chain and economy ( McKenzie, 2020 ). As a consequence of COVID-19, the World Trade Organization (WTO) projected a 32% decline in global trade ( Fernandes, 2020 ). For instance, global trade has witnessed a huge downturn due to reduced Chinese imports and the subsequent fall in global economic activities. This is evident because as of 25 th March 2020, global trade fell to over 4% contracting for only the second time since the mid-1980s ( McKenzie, 2020 ). Fig. 5 shows a pictorial representation of impact of pandemics on global supply chains based on different waves and threat levels.
Impact of pandemics on global supply chains. Adapted from Eaton and Connor (2020) .
4.2.3. Impact of COVID-19 on the aviation sector
The transportation sector is the hardest hit sector by COVID-19 due to the large-scale restrictions in mobility and aviation activities ( IEA, 2020 ; Le Quéré et al., 2020 ; Muhammad et al., 2020 ). In the aviation sector, for example, where revenue generation is a function of traffic levels, the sector has experienced flight cancellations and bans, leading to fewer flights and a corresponding immense loss in aeronautical revenues. This is even compounded by the fact that in comparison to other stakeholders in the aviation industry, when traffic demand declines, airports have limited avenues to reducing costs because the cost of maintaining and operating an airport remains the same and airports cannot relocate terminals and runaways or shutdown ( Hockley, 2020 ). Specifically, in terms of passenger footfalls in airports and planes, the Air Transport Bureau (2020) modelled the impact of COVID-19 on scheduled international passenger traffic for the full year 2020 under two scenarios namely Scenario 1 (the first sign of recovery in late May) and Scenario 2 (restart in the third quarter or later). Under Scenario 1, it estimated an overall reduction of: between 39%-56% of airplane seats; 872-1,303 million passengers, corresponding to a loss of gross operating revenues between ~$153 - $ 231 billion. Under Scenario 2, it predicted an overall drop of: between 49%-72% of airplane seats; 1,124 to 1,540 million passengers, with an equivalent loss of gross operating revenues between ~$198 - $ 273 billion. They concluded that the predicted impacts are a function of the duration and size of the pandemic and containment measures, the confidence level of customers for air travel, economic situations, and the pace of economic recovery ( Air Transport Bureau, 2020 ).
The losses incurred by the aviation industry require context and several other comparison-based predictions within the airline industry have also been reported. For instance, the International Civil Aviation Organization ICAO (2020) predicted an overall decline ininternational passengers ranging from 44% to 80% in 2020 compared to 2019. Airports Council International, ACI (2020) also forecasted a loss of two-fifths of passenger traffic and >$76 billion in airport revenues in 2020 in comparison to business as usual. Similarly, the International Air Transport Association IATA (2020) forecasted $113 billion in lost revenue and 48% drop in revenue passenger kilometres (RPKs) for both domestic and international routes ( Hockley, 2020 ). For pandemic scenario comparisons, Fig. 6 shows the impact of past disease outbreaks on aviation. As shown, the impact of COVID‐19 has already outstripped the 2003 SARS outbreak which had resulted in the reduction of annual RPKs by 8% and $6 billion revenues for Asia/Pacific airlines, for example. The 6‐month recovery path of SARS is, therefore, unlikely to be sufficient for the ongoing COVID-19 crisis ( Air Transport Bureau, 2020 ) but gives a backdrop and context for how airlines and their domestic/international markets may be impacted.
Impact of past disease outbreaks on aviation ( Air Transport Bureau, 2020 ).
Notably, these predictions are bad news for the commercial aspects of air travel (and jobs) but from the carbon/greenhouse gas emission and CE perspective, these reductions are enlightening and should force the airline industry to reflect on more environmentally sustainable models. However, the onus is also on the aviation industry to emphasise R&D on solutions that are CE-friendly (e.g. fuel efficiency; better use of catering wastes; end of service recycling of aircraft in sectors such as mass housing, or re-integrating airplane parts into new supply chains) and not merely investigating ways to recoup lost revenue due to COVID-19.
4.2.4. Impact of COVID-19 on the tourism industry
Expectedly, the impact of COVID-19 on aviation has led to a knock-on effect on the tourismindustry, which is nowadays hugely dependent on air travel. For instance, the United Nation World Tourism Organization UNWTO (2020) reported a 22% fall in international tourism receipts of $80 billion in 2020, corresponding to a loss of 67 million international arrivals. Depending on how long the travel restictions and border closures last, current scenario modelling indicated falls between 58% to 78% in the arrival of international tourists, but the outlook remains hugely uncertain. The continuous existence of the travel restrictions could put between 100 to 120 million direct tourism-related jobs at risk. At the moment, COVID-19 has rendered the sector worst in the historical patterns of international tourism since 1950 with a tendency to halt a 10-year period of sustained growth since the last global economic recession ( UNWTO, 2020 ). It has also been projected that a drop of ~60% in international tourists will be experienced this year, reducing tourism's contribution to global GDP, while affecting countries whose economy relies on this sector ( Naidoo and Fisher, 2020 ). Fig. 7 depicts the impact of COVID-19 on tourism in Q1 of 2020 based on % change in international tourists’ arrivals between January and March.
The impact of COVID-19 on tourism in quarter 1of 2020. Provisional data but current as of 31st August 2020 ( UNWTO, 2020 ).
4.2.5. Impact of COVID-19 on sustainable development goals
In 2015, the United Nations adopted 17 Sustainable Development Goals (SDGs) with the view to improve livelihood and the natural world by 2030, making all countries of the world to sign up to it. To succeed, the foundations of the SDGs were premised on two massive assumptions namely globalisation and sustained economic growth. However, COVID-19 has significantly hampered this assumption due to several factors already discussed. Indeed, COVID-19 has brought to the fore the fact that the SDGs as currently designed are not resilient to shocks imposed by pandemics. Prior to COVID-19, progress across the SDGs was slow. Naidoo and Fisher (2020) reported that two-thirds of the 169 targets will not be accomplished by 2030 and some may become counterproductive because they are either under threat due to this pandemic or not in a position to mitigate associated impacts.
4.3. Positive impact of COVID-19
In this section, we discussed some of the positive ramifications of COVID-19. Despite the many detrimental effects, COVID-19 has provoked some natural changes in behaviour and attitudes with positive influences on the planet. Nonetheless, to the extent that the trends discussed below were imposed by the pandemic, they also underscore a growing momentum for transforming business operations and production towards the ideal of the CE.
4.3.1. Improvements in air quality
Due to the COVID-19-induced lockdown, industrial activities have dropped, causing significant reductions in air pollution from exhaust fumes from cars, power plants and other sources of fuel combustion emissions in most cities across the globe, allowing for improved air quality ( Le Quéré et al., 2020 ; Muhammad et al., 2020 ). This is evident from the National Aeronautics and Space Administration ( NASA, 2020a ) and European Space Agency ( ESA, 2020 ) Earth Observatory pollution satellites showing huge reductions in air pollution over China and key cities in Europe as depicted in Fig. 8 . In China, for example, air pollution reduction of between 20-30% was achieved and a 20-year low concentration of airborne particles in India is observed; Rome, Milan, and Madrid experienced a fall of ~45%, with Paris recording a massive reduction of 54% ( NASA, 2020b ). In the same vein, the National Centre for Atmospheric Science, York University, reported that air pollutants induced by NO 2 fell significantly across large cities in the UK. Although Wang et al. (2020) reported that in certain parts of China, severe air pollution events are not avoided through the reduction in anthropogenic activities partially due to the unfavourable meteorological conditions. Nevertheless, these data are consistent with established accounts linking industrialization and urbanization with the negative alteration of the environment ( Rees, 2002 ).
The upper part shows the average nitrogen dioxide (NO 2 ) concentrations from January 1-20, 2020 to February 10-25, 2020, in China. While the lower half shows NO 2 concentrations over Europe from March 13 to April 13, 2020, compared to the March-April averaged concentrations from 2019 ( ESA, 2020 ; NASA, 2020a ).
The scenarios highlighted above reiterates the fact that our current lifestyles and heavy reliance on fossil fuel-based transportation systems have significant consequences on the environment and by extension our wellbeing. It is this pollution that was, over time, responsible for a scourge of respiratory diseases, coronary heart diseases, lung cancer, asthma etc.( Mabahwi et al., 2014 ), rendering plenty people to be more susceptible to the devastating effects of the coronavirus ( Auffhammer et al., 2020 ). Air pollution constitutes a huge environmental threat to health and wellbeing. In the UK for example, between ~28,000 to ~36,000 deaths/year was linked to long-term exposure to air pollutants ( PHE, 2020 ). However, the reduction in air pollution with the corresponding improvements in air quality over the lockdown period has been reported to have saved more lives than already caused by COVID-19 in China ( Auffhammer et al., 2020 ).
4.3.2. Reduction in environmental noise
Alongside this reduction in air pollutants is a massive reduction in environmental noise. Environmental noise, and in particular road traffic noise, has been identified by the European Environment Agency, EEA (2020) to constitute a huge environmental problem affecting the health and well-being of several millions of people across Europe including distortion in sleep pattern, annoyance, and negative impacts on the metabolic and cardiovascular system as well as cognitive impairment in children. About 20% of Europe's population experiences exposure to long-term noise levels that are detrimental to their health. The EEA (2020) submitted that 48000new cases of ischaemic heart disease/year and ~12000 premature deaths are attributed to environmental noise pollution. Additionally, they reported that ~22 million people suffer chronic high annoyance alongside ~6.5 million people who experienceextreme high sleep disturbance. In terms of noise from aircraft, ~12500 schoolchildren were estimated to suffer from reading impairment in school. The impact of noise has long been underestimated, and although more premature deaths are associated with air pollution in comparison to noise, however noise constitutes a bigger impact on indicators of the quality of life and mental health ( EEA, 2020 ).
A recent study on the aftereffect of COVID-19 pandemic on exercise rates across the globe concluded that reduced traffic congestions and by extension reduced noise and pollution has increased the rate at which people exercise as they leveraged the ensued pleasant atmosphere. Average, moderate, and passive (i.e. people who exercised once a week before COVID-19) athletes have seen the frequency of their exercise regime increased by 88%, 38%, and 156% respectively ( Snider-Mcgrath, 2020 ).
4.3.3. Increased cleanliness of beaches
Beaches constitute the interface between land and ocean, offering coastal protection from marine storms and cyclones ( Temmerman et al., 2013 ), and are an integral part of natural capital assets found in coastal areas ( Zambrano-Monserrate et al., 2018 ). They provide services (e.g. tourism, recreation) that are crucial for the survival of coastal communities and possess essential values that must be prevented against overexploitation ( Lucrezi et al., 2016 ; Vousdoukas et al., 2020 ). Questionable use to which most beaches have been subjected have rendered them pollution ridden ( Partelow et al., 2015 ). However, due to COVID-19-induced measures, notable changes in terms of the physical appearance of numerous beaches across the globe have been observed ( Zambrano-Monserrate et al., 2020 ).
4.3.4. Decline in primary energy use
Global energy demand during the first quarter of 2020 fell by ~3.8% compared to the first quarter of 2019, with a significant effect noticeable in March as control efforts heightened in North America and Europe ( IEA, 2020 ). The International Energy Agency (IEA) submitted that if curtailment measures in the form of restricted movement continue for long and economic recoveries are slow across different parts of the globe, as is progressively likely, annual energy demand will plummet by up to 6%, erasing the last five years energy demand growth. As illustrated in Fig. 9 , if IEA's projections become the reality, the world could experience a plunge in global energy use to a level not recorded in the last 70 years. The impact will surpass the effect of the 2008 financial crisis by a factor of more than seven times. On the other hand, if COVID-19 is contained earlier than anticipated and there is an early re-start of the economy at a successful rate, the fall in energy could be constrained to <4% ( IEA, 2020 ). However, a rough re-start of the economy characterised by supply chain disruptions and a second wave of infections in the second half of the year could further impede growth ( IEA, 2020 ).
Annual rate of change in primary energy demand, since 1900, with key events impacting energy demand highlighted ( IEA, 2020 ).
Coal was reported to have been hit the hardest by ~8% in comparison to the first quarter of 2019 due to the impact of COVID-19 in China whose economy is driven by coal, reduced gas costs, continued growth in renewables, and mild weather conditions. Oil demand was also strongly affected, plummeting by ~5% in the first quarter driven mainly by restrictions in mobility and aviation activities which constitute ~60% of global oil demand ( IEA, 2020 ). For instance, global road transport and aviation activities were respectively ~50% and 60% below the 2019 average. Global electricity demand declined by >20% during full lockdown restrictions, with a corresponding spill over effect on the energy mix. Accordingly, the share of renewable energy sources across the energy supply increased due to priority dispatch boosted by larger installed capacity and the fact that their outputs are largely unconstrained by demand ( IEA, 2020 ). However, there was a decline for all other sources of electricity including gas, coal and nuclear power ( IEA, 2020 ).
4.3.5. Record low CO 2 emissions
Unprecedented reduction in global CO 2 emissions is another positive effect that can be attributed to the COVID-19 pandemic.The massive fall in energy demand induced by COVID-19 accounted for the dramatic decline in global GHG emissions. The annual CO 2 emissions have not only been projected to fall at a rate never seen before, but the fall is also envisioned to be the biggest in a single year outstripping the fall experienced from the largest recessions of the past five decades combined ( IEA, 2020 ).The global CO 2 emissions are projected to decline by ~8% (2.6 GCO 2 ) to the levels of the last decade. If achieved, this 8% emissions reduction will result in the most substantial reduction ever recorded as it is expected to be six times larger than the milestone recorded during the 2009 financial crisis, ( Fig. 10 ). Characteristically, after an economic meltdown, the surge in emissions may eclipse the decline, unless intervention options to set the economy into recovery mode is based on cleaner and more resilient energy infrastructure ( IEA, 2020 ).
Global energy-related emissions (top) and annual change (bottom) in GtCO 2 , with projected 2020 levels highlighted in red. Other major events are indicated to provide a sense of scale ( IEA, 2020 ).
4.3.6. Boost in digitalisation
The COVID-19 pandemic has been described as an opportunity to further entrench digital transformation without the ‘digitalism’ which is an extreme and adverse form of connectedness ( Bayram et al., 2020 ). Protecting patients from unnecessary exposure was a driver for telemedicine ( Moazzami et al., 2020 ) and virtual care would become the new reality ( Wosik et al., 2020 ). The necessity for social distancing under lockdown circumstances has also highlighted the importance (and need) for remote working ( Dingel and Neiman, 2020 ; Omary et al., 2020 ), which has had implications for broadband connectivity ( Allan et al., 2020 ) as well as reductions in transportation-related pollution levels ( Spash, 2020 ). The impact of COVID-19 on remote working and digitalisation of work is expected to constitute long-term implications for reduced fossil fuel consumption due to mobility and commuting ( Kanda and Kivimaa, 2020 ). Besides, the survival and thriving of many small business restaurants during the lockdown period depended on whether they had a digital resilience, via online platforms, through which they could exploit the home delivery market via Uber Eats ( Raj et al., 2020 ). For consumers, the pandemic has seen a noticeable increase in online orders for food in many countries such as: Taiwan ( Chang and Meyerhoefer, 2020 ); Malaysia ( Hasanat et al., 2020 ); Germany ( Dannenberg et al., 2020 ) as well as Canada ( Hobbs, 2020 ).
4.4. Unsustainability of current economic and business models amidst COVID-19
It is interesting to observe that while COVID-19 has led to a very steep reduction in air pollution in advanced economies due to reduced economic activity imposed by the lockdown, this pandemic-driven positive impact is only temporary as they do not reflect changes in economic structures of the global economy ( Le Quéré et al., 2020 ). The changes are not due to the right decisions from governments in terms of climate breakdown policies and therefore should not be misconstrued as a climate triumph. More importantly, life in lockdown will not linger on forever as economies will need to rebuild and we can expect a surge in emissions again. To drive home the point, we conducted a decomposition analysis of key drivers (accelerators or retardants) of four global air pollutants using Logarithmic Mean Divisia Index (LMDI) framework ( Ang, 2005 ; Fujii et al., 2013 ), with the results shown in Fig. 11 . The drivers of the pollutants considered based on the production side of an economy include: (i) economic activity effect, given thatemissions can increase or decrease as a result of changes in the activity level of the entire economy; (ii) industrialeconomy structure effect, based on the fact thatthe growth in emissions is a function of the changes in the industrial activity composition; (iii) emissions intensity effect, which can be improvements or deteriorations at the sectoral level, depending on theenergy efficiency (e.g. cleaner production processes) of the sector; (iv) fuel mix or fuel dependency effect, given that its composition influences the amount of emissions; and (v) emission factors effect, because these factors, for different fuel types, changes over time due toswitching from fossil fuels to renewables, for example.
Drivers of representative four (4) global pollutants: a) CO 2 emissions; b) NO x emissions; c) SO x emissions; d) CO emissions. All data for the decomposition analysis of the four pollutants were obtained from the WIOD database ( Timmer et al., 2012 ).
As shown in Fig. 11 a, for example, between 1995 and 2009, global change in CO 2 emission was 32%, where economic activity (+48%) and emission factor (+2%) acted as accelerators, while economic structure (-8%), emission intensity (-9%) and fuel mix (-1%) acted as retardants, of the global CO 2 emission dynamics and trajectory.This implies that although economic activities, as expected, alongside emission factor drove up emissions, however, the upward effect of both drivers was offset by the combined improvements of other driving factors namely economic structure, emission intensity, and fuel mix. Indeed, cutting back on flying or driving less as we have experienced due to COVID-19 contributed to ~8% in emission reduction, however, zero-emissions cannot be attained based on these acts alone. Simply put, emissions reduction cannot be sustained until an optimal balance across the aforementioned drivers informed by structural changes in the economy is attained. As Gates (2020a) rightly stated – the world should be using more energy, not less, provided it is clean.
Characteristically, after an economic meltdown, like the global recession in 2008, there is a surge in emissions ( Feng et al., 2015 ; Koh et al., 2016 ). The current social trauma of lockdown and associated behavioural changes tends to modify the future trajectory unpredictably. However, social responses would not drive the profound and sustained reduction required to attain a low-carbon economy ( Le Quéré et al., 2020 ). This is evident given that we live on a planet interlinked by networked product supply chains, multidimensional production technologies, and non-linear consumption patterns ( Acquaye et al., 2017 ; Ibn-Mohammed et al., 2018 ; Koh et al., 2016 ). Additionally, post COVID-19, the society may suffer from green bounce back– there appears to be an increasing awareness of climate change and air pollution because of this pandemic (though the linkages are non-causal). On the one hand this might promote greener choices on behalf of consumers, but on the other it may result in increased car ownership (at the expense of mass transit), driving up emissions. As such, establishing approaches that ensure an optimal balance between quality of life and the environmental burden the planet can bear is pertinent, if the boundaries of environmental sustainability informed by the principles of low-carbon CE are to be extended. In the next section, the role of the CE as a potential strategy for combating pandemics such as COVID-19 is discussed.
5. The role of circular economy
For long, the central idea of the industrial economy rests on the traditional linear economic system of taking resources, making products from them, and disposing of the product at the end of life. Experts referred to this as “extract-produce-use-dump”, “take-make-waste”, or “take-make-dispose” energy flow model of industrial practice ( Geissdoerfer et al., 2017 ; Kirchherr et al., 2017 ; MacArthur, 2013 ). However, the unlimited use of natural resources with no concern for sustainability jeopardizes the elastic limit of the planet's resource supply. For instance, Girling (2011) submitted that ~90% of the raw materials used in manufacturing become waste before the final product leaves the production plant while ~80% of products manufactured are disposed of within the first 6 months of their life. Similarly, Hoornweg and Bhada-Tata (2012) reported that ~1.3 billion tonnes of solid waste with a corresponding cost implication of $205.4 billion/year is generated by cities across the globe and that such waste might grow to ~2.2 billion tonnes by 2025, with a corresponding rate of $375.5 billion. This is further compounded by the fact that at the global level, the demand for resources is forecasted to double by 2050 ( Ekins et al., 2016 ).
Against this backdrop, the search for an industrial economic model that satisfies the multiple roles of decoupling of economic growth from resource consumption, waste management and wealth creation, has heightened interests in concepts about circular economy ( Ekins et al., 2016 ; MacArthur, 2013 ).In theory, CE framework hinges on three principles: designing out waste, keeping products and materials in use and regenerating the natural systems ( MacArthur, 2013 ). Practically, CE is aimed at: (i) emphasizing environmentally-conscious manufacturing and product recovery ( Gungor and Gupta, 1999 ); (ii) promoting the avoidance of unintended ecological degradation in symbiotic cooperation between corporations, consumers and government ( Bauwens et al., 2020 ); and (iii) shifting the focus to a holistic product value chain and cradle-to-cradle life cycle via promotion of product repair/re-use and waste management ( Duflou et al., 2012 ; Lieder and Rashid, 2016 ; Rashid et al., 2013 ).
Given the current COVID-19 pandemic, there has never been a more adequate time to consider how the principles of CE could be translated into reality when the global economy begins to recover. This is pertinent because the pandemic has further exposed the limitations of the current dominant linear economy regarding how it is failing the planet and its inhabitants, and has revealed the global ecosystem's exposure to many risks including climate breakdown, supply chain vulnerabilities and fragility, social inequality and inherent brittleness ( Bachman, 2020 ; Sarkis et al., 2020 ). The pandemic continues to amplify the global interlinkages of humankind and the interdependencies that link our natural environment, economic, and social systems ( Haigh and Bäunker, 2020 ). In the subsections that follow, the potentials of CE as a tool for: (i) climate change mitigation; (ii) crafting a more resilient economy, and ; (iii) facilitating a socially just and inclusive society, is briefly discussed.
5.1. Circular economy as a tool for climate breakdown mitigation
As highlighted in Section 4.3.5 , a CO 2 emission reduction of 8%, which in real terms implies an equivalent of ~172 billion tCO 2 will be released instead of ~187 billion tCO 2 , is indeed unprecedented. Nevertheless, the peculiar conclusion from the lockdown is that it still entails emissions of 92% of the initial value while there was restrictions to mobility and other related leisure activities. Measures for mitigating climate change have often been presented dramatically as a "prohibition of the nice things of life", but as shown, a cut-off of such an amount of nice things only delivers an 8% reduction. More importantly, it comes at a heavy cost of between $3,200/tCO 2 and $5,400/tCO 2 in the US, for example, based on data from the Rhodium Group ( Gates, 2020a ). In other words, the shutdown is reducing emissions at a cost between 32 and 54 times the $100/tCO 2 deemed a reasonable carbon price by economists ( Gates, 2020a ). This suggests that a completely different approach to tackling climate issue is required.
Accordingly, there is the need for a system that calls for greater adoption of a more resilient low-carbon CE model, given the predictions by experts that climate breakdown and not COVID-19 will constitute the biggest threat to global health ( Hussey and Arku, 2020 ; Watts et al., 2018a ; Watts et al., 2018b ). International bodies and country-level environmental policies have highlighted the fact that a significant reduction in GHG emissions cannot be achieved by transitioning to renewables alone but with augmentation with CE strategies. The demands side CE strategies such as (i)material recirculation (more high-value recycling, less primary material production, lower emissions per tonne of material); (ii)product material efficiency (improved production process, reuse of components and designing products with fewer materials); (iii)circular business models (higher utilisation and longer lifetime of products through design for durability and disassembly, utilisation of long-lasting materials, improved maintenance and remanufacturing), could reduce emissions whilst contributing to climate change mitigation ( Enkvist et al., 2018 ). CE principles, when adopted in a holistic manner provide credible solutions to the majority of the structural weaknesses exposed by COVID-19, offering considerable opportunities in competitiveness and long-term reduced GHG emissions across value chains. Investments in climate-resilient infrastructure and the move towards circular and low-carbon economy future can play the dual role of job creation while enhancing environmental and economic benefits.
5.2. Circular economy as a vehicle for crafting more resilient economies
Haigh and Bäunker (2020) reported that if we muddle through every new crisis based on the current economic model, using short-term solutions to mitigate the impact, future shocks will continue to surpass capacities. It is, therefore, necessary to devise long-term risk-mitigation and sustainable fiscal thinking with the view to shift away from the current focus on profits and disproportionate economic growth. Resilience in the context of the CE largely pertains to having optimized cycles (i.e. products are designed for longevity and optimized for a cycle of disassembly and reuse that renders them easier to handle and transform). Some cycles can be better by being closed locally (e.g. many food items), and for other cycles, a global value chain could be a better option (e.g. rare earth elements). Due to globalization, all cycles have become organized at the global level, diminishing resilience. COVID-19 has further shown how some particular cycles had the wrong scale level, as such, the adoption of CE can be seen as an invitation to reconsider the optimal capacity of cycles.
Sustainability through resilience thinking would have a positive and lasting impact as reported by the Stockholm Resilience Centre (2016) , which concluded that prosperity and sustainability cannot be accomplished without building “ resilient systems that promote radical innovation in economic policy, corporate strategy, and in social systems and public governance”. It calls for sustainability through resilience thinking to become an overarching policy driver and encourages the application of the principles of such thinking to enhance social innovation. Haigh and Bäunker (2020) concluded that when resilience thinking is employed as a guide, all innovations emanating from circular thinking would extend beyond focusing mainly on boosting the market and competitiveness and recognise the general well-being of the populace as an equal goal. As the global economy recovers from COVID-19, it has become more apparent that there is a strong sense of interconnectedness between environmental, economic and social sustainability ( Bauwens et al., 2020 ).
5.3. Circular economy as a facilitator of a socially just and inclusive society
Advanced economies have mainly focused on maintaining the purchasing power of households through the establishment of the furlough scheme (in the UK, for example). Most developing countries have also adopted a similar approach through the integration of containment measures with a huge increase in social protection spending. However, these intervention strategies in response to the pandemic have further revealed the social injustice and inequality between countries and communities given that the deployment of such strategy in advanced economies could devastate developing countries and communities ( Ahmed et al., 2020 ; Haigh and Bäunker, 2020 ). Guan and Hallegatte (2020) revealed that developing and underdeveloped economies face tougher and more challenging situation in comparison to their developed counterparts, because even under the assumption that social protection systems could fully replace income and shield businesses from bankruptcy, maintaining access to essential commodities is impossible if the country is lacking in production capabilities in the first place. Furthermore, in the underdeveloped world, the idea of working from home is very difficult due to the lack of infrastructure and access to health facilities is severely cumbersome. As such, short-term fixes adopted by governments cannot adequately address deep-rooted inequality and social injustice.
Accordingly, Preston et al. (2019) submitted that CE has the potential to minimise prevailing pressures and struggles regarding conflicts due to imbalanced distribution of resources, through participatory forms of governance that entails the inclusion of local stakeholders in resource management initiatives. This can be achieved through the adoption of CE strategy such as closed-loop value chains, where wastes are transformed into resources with the view to not only reduce pollution but to simultaneously aid the pursuance of social inclusion objectives. A number of companies are already embracing this idea. For instance, under the Food Forward SA initiative, “ the world of excess is connected with the world of need ” through the recovery of edible surplus food from the consumer goods supply chain and gets redistributed to the local community. This ensures loops are closed and the needy receive nourishment ( Haigh and Bäunker, 2020 ). With sufficient investment in the CE, developing countries can leapfrog their developed counterparts in digital and materials innovation to integrate sustainable production and consumption and low-carbon developments at the core of their economies. Additionally, Stahel (2016) reported that another benefit of the CE as a facilitator of a socially just and inclusive society is that it is likely to be more labour-intensive due to the variety of end-of-life products and the high cost of automating their processing compared to manual work. As such, CE can enable the creation of local jobs and “reindustrialisation of regions” ( Stahel, 2019 ) through the substitution of: manpower for energy, materials for (local) labour, and local workshops for centralised factories ( Stahel, 2019 ), while boosting the repair economy and local micro industries. Of course, not everybody will see this as a benefit, and many would like to see more automation, not less. However, this is a political/economic argument, not an engineering or scientific one. In the next section, barriers to CE in general and in the context of COVID-19 is discussed.
5.4. Barriers to CE in the context of COVID-19
On the surface, the benefits of CE should be obvious as it strives for three wins in the three dimensions of social, economic and environment impacts through a symbiotic vision of reduced material usage, reduced waste generation, extending value retention in products and designing products for durability. However, limiting barriers obviating the success of CE have existed around technical implementation, behavioural change, financial and intellectual investments, policy and regulations, market dynamics, socio-cultural considerations as well as operational cost of transforming from the linear economy to one based on circularity ( Friant et al., 2020 ). In more concrete terms, the barriers dwell within the ecosystem of actors (and the interactions within the actors) involved in the move towards CE ( Lieder and Rashid, 2016 ).
Pre-COVID-19, Korhonen et al. (2018) enumerated six fundamental factors hindering the promise of CE: (i) thermodynamic factors (i.e. limit imposed by material and energy combustion in recycling/re-manufacturing); (ii) complexity of spatial and temporal boundaries (i.e. material and energy footprints for a product cannot be easily reduced to a point in space and time for an in-depth analysis of environmental impacts); (iii) interlink of governance and nation's economy; (iv) consumer and organizational inertia (i.e. reluctance to embrace new way of doing things due to uncertainty about the success of business models as well as fuzziness around organizational culture and management models that rely on CE); (v) fragile industrial ecosystems (featuring the difficulty of establishing and managing intra-/inter-organizational collaboration along with local/regional authorities); and (vi) lack of consensus on what the many Rs (re-use, recycle, recover, repurpose, repair, refurbish, remanufacture) embedded in CE framework really means ( Kirchherr et al., 2017 ). Challenges in data sharing between product end points and stakeholders, complexity in the supply chain with unclear details of product biography over time, and prohibitive start-up investment costs have also been identified as CE barrier in other climes ( Jaeger and Upadhyay, 2020 ; Manninen et al., 2018 ). Other issues along similar lines were captured in the work by several other authors including Galvão et al. (2020) , Kirchherr et al. (2018) , Govindan and Hasanagic (2018) , De Jesus and Mendonça (2018) and many more.
The paradox of COVID-19 is grounded on creating a once in a lifetime opportunity to re-examine the difficulty of some of these barriers, but it also unveiled a new set of challenges. For instance, the sharing economy models that have been hitherto hailed as exemplars of CE strategy is now perceived differently by many urban dwellers because of the behavioural change embedded in “social distancing”, which is necessary to limit the spread of the virus. Although if concepts such as “access over ownership” or “pay for performance” service have become fully operational, they could have constituted a significant solution to offer flexibility. Additionally, it has been argued that COVID-19 will ‘disrupt some disruptors’ peer-to-peer (P2P) providers such as Airbnb, which has reported a 4.16% drop in local bookings for every doubling new COVID-19 cases ( Hu and Lee, 2020 ). In transportation, demand from ride-sharing modes could increase due to commuters wanting to minimise exposure to COVID-19 in mass transport systems like buses and trains ( Chandra, 2020 ). However, the risks of human-to-human transmission of COVID-19 for passengers not wearing facemask have been noted ( Liu and Zhang, 2020 ), including when either passengers or drivers in ride-hailing and car-sharing disruptors like Uber do not wear facemasks ( Wong et al., 2020 ).
Reducing emissions, in the long run, requires large investments, from both the public and private sectors, in low-carbon technologies and infrastructure in terms of both innovation and diffusion ( OECD, 2018 ). Given the downturn of the global economy due to COVID-19, the prospects of significant low-carbon investments from the private sector have significantly reduced compared to pre-COVID-19. This view is not just limited to the private sector, but also to the public sector, as echoed by Naidoo and Fisher (2020) . Hence, post COVID-19, accelerating progress towards CE still requires: (i) a decisive legal and financial championships from local, regional and national authorities; (ii) innovation across multiple domains (product design, production technologies, business models, financing and consumer behaviours); (iii) governments to promote green logistics and waste management regulations with reasonable incentives to aid producers and manufacturers in minimizing loss while maximizing value. It is therefore recommended that governments provide the much-needed policy framework that will eliminate some of aforementioned barriers to facilitate the urgent transition to CE. Doing this will build resilience for community response to future pandemic and it also aligns with some of the existing roadmaps for resource efficiency ( European Commission, 2011 ).
6. Opportunities for circular economy post COVID-19
COVID-19 has instigated a focus on vibrant local manufacturing as an enabler of resilient economy and job creation; fostered behavioural change in consumers; triggered the need for diversification and circularity of supply chains, and evinced the power of public policy for tackling urgent socio-economic crises. As we rise to the challenges imposed by COVID-19, the question is no longer should we build back better, but how. Consequently, going forward, crafting a roadmap for a sustainable future is as much about the governmental will to forge a new path to socio-economic growth as it is about local businesses joining forces with the consumers to enable the transition to CE. As already documented in the earlier sections of this paper, governments around the world have deployed many financial policy instruments to combat the short-term consequences of COVID-19 pandemic. Still, in the long-term, the adoption of circular economy principles across various technological frontiers holds the promise to bring about a desired technical and behavioural change that will benefit many nations around the world.
Specifically, adopting the CE principle will alleviate some of the detrimental effects of COVID-19 pandemic in the future. To mention just a few: (i) a national level adoption of CE will reduce the over-reliance on one country as the manufacturing hub of the world; (ii) a systematic shift away from the traditional polluting, energy-intensive, manufacturing-driven economy to a CE, based on renewable energy, smart materials, smart re-manufacturing, and digital technology will strengthen the fight against pollution; and (iii) the transition to CE will also spur local job creation along several of the axes of societal needs (e.g. built environment, mobility, health, consumables, etc.). Accordingly, in the subsections that follow, an overview of recommendations as well as policy measures, incentives, and regulatory support for advancing sector-specific CE strategies in a post-COVID-19 world is presented.
6.1. Local manufacturing and re-manufacturing of essential medical accessories
Disruptions due to COVID-19 has been attributed to unprecedented demand, panic buying, and intentional hoarding of essential medical goods for profit ( Bradsher and Alderman, 2020 ; Fischer et al., 2020 ). The shortage of many items was so dire in many countries that the principle of CE, such as re-use, is already been unwittingly recommended ( Gondi et al., 2020 ), by respectable bodies such as the US Centres for Disease Control and Prevention (CDC) ( Ranney et al., 2020 ). However, designed and produced from non-CE compliant processes, medical accessories such as PPE cannot be easily refurbished for re-use without leading to severe degradation in their efficiencies, as noticed for example, in the case of particulate respirators ( Liao et al., 2020 ). Accordingly, it is recommended that companies strive to establish competencies in eco-design and environmentally beneficial innovation to facilitate product re-use in the long run. Some of the desired competencies centre on design strategies for closing resource loops (e.g. designing for technological and biological cycles) as pioneered by McDonough and Braungart (2010) .
A detailed discussion of these competencies is also enunciated by Braungart et al. (2007) , where the authors differentiated between eco-efficiency (less desirable) and eco-effectiveness (the desired dream of CE), for companies to be compliant with the CE framework. Meanwhile, a starting point for companies to shift to eco-effectiveness at the product design level, which will facilitate product re-use, is to follow the five-step framework enumerated by Braungart et al. (2007) or to adopt the analytical framework to explore some of the key dimensions in eco-design innovations developed by Carrillo-Hermosilla et al. (2010) . During implementation, the preceding steps comport with the idea of eco-factories that take pride in design for effortless end-of-life product re-use and design for “upcycling” and remanufacturing ( Bocken et al., 2016 ; Herrmann et al., 2014 ; Ijomah, 2010 ), all of which falls under the umbrella of CE.
Another emerging evidence in favour of CE, also adopted inadvertently during this pandemic, is the ease with which several manufacturers have pivoted their factory floors to make different products in response to the shortage of medical accessories. Few examples of these companies in the UK include, but not limited to: AE Aerospace, which retooled its factory floor to produce milled parts for ventilators; Alloy Wire International re-purposed its machinery to make springs for ventilators; AMTICO (flooring manufacture) re-configured its production lines to make visors for front line workers; BAE Systems deployed its factory resources to produce and distribute over 40000 face shields; and BARBOUR (a clothing company) re-purposed to produce PPE for nurses ( Williamson, 2020 ).
6.2. CE strategies for managing hospital medical and general waste
Wastes generated by the healthcare industry (HCI) normally arouse concerns about operational, public, and environmental safety as a result of the awareness of the corrosive, hazardous, infectious, reactive, possibly radioactive, and toxic nature of the wastes’ composition ( Lee et al., 1991 ; Prüss-Üstün et al., 1999 ). Consequently, the management of the different categories of healthcare waste far removed from the traditional municipal wastes, falls under stringent national or local regulatory frameworks. Pre-COVID-19, the staggering scale of HCI waste is reported to reach into millions of tonnes per year and there have been many studies of national-level attempts at managing these wastes ( Da Silva et al., 2005 ; Insa et al., 2010 ; Lee et al., 1991 ; Oweis et al., 2005 ; Tudor et al., 2005 ). However, this problem is expected to worsen with the tremendous surge, in the last few months, in the volume of disposable medical hardware (PPE, masks, gloves, disposable gears worn by healthcare workers and sanitation workers as well as those contaminated by contacts with COVID-19 patients). Another allied problem is the troubling shift among consumers who now prioritize concerns for hygiene by leaning towards plastic packaging (e.g. in food delivery and grocery shopping) during this pandemic at the expense of environmental impacts ( Prata et al., 2020 ). Most of these products are derived from non-biodegradable plastics, and their disposal has not been given much thought. As a result, the management of these wastes has raised understandable angst in several quarters ( Klemeš et al., 2020 ; Xiao and Torok, 2020 ). Frustratingly, there is much less that can be done at the moment apart from devising judicious waste management policy for these potentially hazardous wastes.
The traditional steps concerning the treatment of HCI wastes (such as collection and separation, storage, transportation to landfill, and decontamination/disposal) suffer from many complications that make the management a challenging undertaking ( Windfeld and Brooks, 2015 ). To alleviate the complexity, the characterization of the physicochemical composition of HCI waste has become an important tool in devising crucial steps for setting up waste minimization and recycling programs ( Kaiser et al., 2001 ). This aligns with the objective of circular economy (CE), which prioritizes the prevention of waste, failing which it proposes the re-use/recyclability of materials from waste to close the loop.
Wong et al. (1994) reported that hospital wastes involve different types of materials: plastics (tubes, gloves, syringes, blood bags), metals (basins, aluminium cans), papers (towel papers, toilet papers, newspapers), cotton/textiles (drapes, table covers, diapers, pads, bandages), glass (bottles) etc. With this categorization in mind, a CE product design consideration that looks promising in the near future, as a way to avert some of the dangers that can be triggered by events such as COVID-19, is to increase the volume of recyclable materials and biodegradable bioplastics in the production of medical accessories. However, the reality is that not all medical gears and products can be derived from bio-plastics or recyclable materials, and some will inevitably continue to be fabricated with materials that need further downstream processing. Yet, the application of CE to the healthcare industry (HCI) remains a touchy subject. Understandably, health and safety concerns, as well as requirements to meet stringent regulations, tend to override the environmental gain from the 4R practice promoted by CE ( Kane et al., 2018 ). Nonetheless, the benefits of CE are starting to catch on in the HCI as a means of optimizing hospital supply chains and reduce overhead cost, all the while creating environmental benefits in the course of saving human lives.
Principally, the applications of CE in HCI, like in other fields, are tied to materials flow and an examination of the nature of wastes. Pioneering studies on hospital wastes characterizations ( Diaz et al., 2008 ; Eleyan et al., 2013 ; Özkan, 2013 ; Wong et al., 1994 ), revealed that close to 80% of the wastes can be classified as general wastes, while the remaining 20% falls under the infectious waste category ( WHO, 1998 ). A prevalent method of dealing with the two HCI waste categories has been incineration ( Wong et al., 1994 ). Although suitable for large volumes, incineration produces toxic pollutants such as heavy metals, dioxins, acid gases, and hydrogen chloride ( Yang et al., 2009 ). Consequently, pre-COVID-19, besides incineration, reducing or preventing the volume of wastes in both categories is also shaped by the adoption of green purchasing practices ( Wormer et al., 2013 ). While this may help in the short term, a holistic approach to confronting this problem is the adoption of CE, which can facilitate the shift towards eco-efficient HCI, starting with lifecycle evaluations of medical products to the proposal for re-usable medical instruments ( Cimprich et al., 2019 ; De Soete et al., 2017 ; Penn et al., 2012 ). Numerous CE strategies for healthcare waste management are detailed by Kane et al. (2018) and Voudrias (2018) . Undoubtedly, with COVID-19, there is an uptick in the percentage of waste under the infectious category due to hospitals taking various precautions to facilitate control of the pandemic ( Peng et al., 2020 ). Nevertheless, by subjecting the general waste category to proper sterilization procedure via any of thermal, microwave, bio-chemical sterilization, the huge potential from upcycling of the retrieved materials will edge towards fulfilling the promise of CE within the sector ( Yang et al., 2009 ).
6.3. Embracing resource efficiency in the construction and built environment
As with other economic sectors, COVID-19 has exposed the shortcomings of the built and natural environment's business-as-usual practices, highlighting the prevalence of poor-quality buildings, issues regarding affordability of decent housing and rigidity of the current building stocks ( EMF, 2020b ). Living in poor-quality houses and in small constricted energy inefficient homes, led to the in-house transmission of the virus in some cases ( Clair, 2020 ). This is particularly the case in poorer countries where inadequate access to sanitation amenities has prevented people from adopting best practices necessary for halting the transmission ( Andrew et al., 2020 ). These issues alongside the growing concern and awareness regarding the resource-wasting nature of the sector, present a strong case for rethinking it. The CE is well positioned to offer potential solutions to these problems.
CE can help balance behavioural challenges and opportunities from occupancy requirements. Humans spend up to 90% of their time indoors ( Marques et al., 2018 ; Pitarma et al., 2017 ). The pandemic has led to people spending more time at ‘home’ than at work, leading to massively underutilised office and business spaces, which is likely to increase due to on-going social distancing constraints ( Feber et al., 2020 ) or perhaps due to more organisation discovering the cost benefits of remote working. It is also plausible that upgrading of existing (or design of new) office and commercial spaces would require making them flexible and adaptable to cope with changing needs (e.g. occupant density, social distancing, ventilation, etc.) by using movable walls ( Carra and Magdani, 2017 ). Insufficient ventilation can increase the risk of infection to healthcare workers and susceptible patients in healthcare buildings, especially makeshift hospitals ( Chen and Zhao, 2020 ). The impact of these engineering measures on energy consumption of typical buildings and healthcare facilities needs to be considered because of social distancing measures, which may require a decrease in occupant density but an increase in ventilation rates. So, although energy recovery is high on the agenda for CE in the built environment ( Eberhardt et al., 2019 ), the additional requirement of more mechanical ventilation for less people will stretch the energy consumed by buildings. Some researchers have argued for buildings to avoid recirculation (essential for energy savings) and use 100% fresh outdoor air for mechanical ventilation systems ( Pinheiro and Luís, 2020 ). Such scenarios are likely to increase the adoption of renewable energy sources to support acceptable indoor air quality (IAQ).
The adoption of CE strategies such as material reuse and development of recycling infrastructure can facilitate value circulation and efficient use of resources within the built and natural environment, ensuring a more competitive and cost-effective post-COVID-19 recovery, while contributing to GHG emissions reduction and creating job opportunities ( EMF, 2020b ). For instance, a study by ARUP estimated that designing for steel reuse has the potential of generating savings of 6-27% and 9-43% for a warehouse and an office respectively, whilst constituting up to 25% savings on material costs ( SYSTEMIQ, 2017 ). The EU is leading in policy direction that would make it a legal requirement to introduce recycled content (i.e. material looping) in specific construction products, after the functionality and safety have been vetted ( European Commission, 2020 ). Such initiatives will encourage designers and researchers to incorporate material looping into their overall design strategy across the value chain to ensure they are fit for circulation ( Deloitte, 2020 ). This material looping has been shown to reduce disposal fees and generate new income streams from the secondary materials market ( Rios et al., 2015 ). It is an approach that would help reduce construction waste, which accounts for a third of all solid wastes in countries like India ( EMF, 2016 ). The adoption of digital material passports that supports end-to-end tracking of building materials has been reported by SYSTEMIQ (2017) to aid the identification of materials for reuse as they approach their end of first life, thereby allowing the longevity and encouraging tighter material looping.
COVID-19 in the context of CE will encourage prefabrication, design thinking and renovation. As the building industry moves towards the industrialisation of construction via prefabrication/offsite production, seven strategies have been suggested by Minunno et al. (2018) out of which the principle of designing for eventual disassembly and reuse is critical. With a combined smart and industrialised prefabrication (SAIP) process ( Abbas Elmualim et al., 2018 ), the intelligent performance and circularity of buildings can be boosted by advanced smart technologies ( Windapo and Moghayedi, 2020 ). The building of 1,000 bed Huoshenshan Hospital in Wuhan covering 34,000m 2 in ten days using modular pre-fabricated components, which can be disassembled and reused ( Zhou et al., 2020 ) has demonstrated the capability of the construction industry to deliver adaptable buildings in record time. But it is perhaps in the sphere of refurbishment and renovation that CE in the built environment would mostly be felt. A CE strategy that promotes repair and refurbishment is preferable to one which encourages recycling, since the economic and environmental value of a product is retained better by the former ( Sauerwein et al., 2019 ).
Renovation helps achieve carbon reduction targets while contributing to economic stimulation ( Ibn-Mohammed et al., 2013 ) . Retrofitting, refurbishing or repairing existing buildings leads to lower emission facilities, is less resource-intensive and more cost-effective than demolition or new construction ( Ardente et al., 2011 ; Ibn-Mohammed et al., 2014 ). Nevertheless, circular renovation of buildings must align with circular design thinking – as alluded to above, in terms of re-integrating materials back into the value chain – as well as the need to enhance material/product durability and energy efficiency ( Pomponi and Moncaster, 2017 ). In Europe, renovation of buildings decreases the residential sector's GHG emissions by 63%, with a reduction of up to 73% in the non-residential sector ( Artola et al., 2016 ). In meeting the emerging needs of the renovation sub-sector, digital infrastructure technologies (such as thermographic and infrared surveys, photogrammetry and 3D laser scanning, as well as BIM and Digital Twinning) will play a crucial role in ensuring the low carbon and energy-efficient future of the built environment ( ARUP, 2020 ).
6.4. Bio-cycle economy and the food sector
COVID-19 or not, the food sector is generally wasteful ( Dilkes-Hoffman et al., 2018 ), contributes to environmental degradation ( Beretta and Hellweg, 2019 ), disrupts nutrient flows due to the current linear nature of its value chain, thereby diminishing the nutritional quality of food ( Castañé and Antón, 2017 ). To address these issues, as part of a future resilience in the food sector, a number of CE levers applicable to the sector is highlighted: (i) closing nutrient loops through the adoption of regenerative agriculture ( Rhodes, 2017 ). The organic content of soil reflects its healthiness and propensity to produce nutritious crops. The adoption of regenerative agriculture can facilitate the preservation of soil health through returning organic matter to the soil in the form of food waste or composted by-products or digestates from treatment plants ( Sherwood and Uphoff, 2000 ); (ii) value recovery from organic nutrients through the adoption of anaerobic digestion facilities ( De Gioannis et al., 2017 ; Huang et al., 2017 ), which is related to controlled biogas production for onward injection into natural gas network or conversion to electrical energy ( Atelge et al., 2020 ; Monlau et al., 2015 ). This has the potential to transform ensuing methane from food waste into carbon-neutral energy; and (iii) the embrace of urban and peri-urban agriculture ( Ayambire et al., 2019 ; Lwasa et al., 2014 ; Opitz et al., 2016 ; Thebo et al., 2014 ), which entails the “ cultivation of crops and rearing of animals for food and other uses within and surrounding the boundaries of cities, including fisheries and forestry ”( EPRS, 2014 ). Indeed, by cultivating food in proximity to where it will be consumed, carbon footprint can be mitigated in numerous ways. For instance, through the adoption of urban agriculture, Lee et al. (2015) demonstrated GHG reduction of 11,668 t yr −1 in the transportation sector. The popularity of local farms has severely increased as a direct consequence of COVID-19, whereby people could experience the power of local food cycles and avoid perceived contamination risks in supermarkets. This will further bolster urban and peri-urban agriculture.
All the above-mentioned CE strategies will contribute towards the establishment of a better and more resilient future food system. However, in the context of COVID-19, transitioning to regenerative agricultural production processes and expanding food collection, redistribution and volarisation facilities constitute an integral part of a more resilient and healthy food system that allows greater food security and less wastage, post COVID-19 ( EMF, 2020a ). Investments towards accelerating regenerative agriculture offer economic benefits facilitated by reforms in food, land, and ocean use ( World Economic Forum, 2020 ). It also offer environmental benefits by supporting biologically active ecosystems ( EMF, 2020a ) and through numerous farming mechanisms including no-till farming, adoption of cover crops, crop rotations and diversification ( Ranganatha et al., 2020 ) as well as managed grazing for regenerative livestock rearing ( Fast Company, 2019 ). Similarly, expanding food collection, redistribution and volarisation facilities offers both economic and environmental benefits for the food system ( EMF, 2020a ). However, realising these benefits will require investment in: (i) physical infrastructure like cold chains that support the storage, processing, and supply of edible food, especially in low-income countries, and (ii) processing infrastructure for the collection and volarisation of waste food ( EMF, 2020a ). This will facilitate door-to-door waste food collection, offering avenues for municipal organic waste volarisation.
6.5. Opportunities for CE in the transport and mobility sector
Facilitating the movement of people, products and materials, transportation infrastructures are imperative to the success of circularity in the shift towards sustainable cities given its impact on the quality of life, the local environment and resource consumption ( Van Buren et al., 2016 ). As noted in an earlier section, the transport sector was one of the sectors most heavily impacted by COVID-19. Going forward, many CE strategies could be adopted as part of building a resilient transport sector. Development of compact city for effective mobility given their attributes in terms of being dense with mixed-use neighbourhoods and transit-oriented ( EMF, 2019 ), can create an enabling environment for both shared mobility options (e.g. trams, buses, ride-shares) and active mobility options (e.g. bicycling, walking) ( Chi et al., 2020 ; Shaheen and Cohen, 2020 ). This will help to re-organize urban fabric and promote intelligent use of transportation infrastructures ( Marcucci et al., 2017 ). However, the behavioural change embedded in “social distancing”, which is necessary to limit the contagion, may affect the perception of many urban dwellers about this. On the other hand, less compact cities require increased mobility infrastructure with a corresponding increase in operational vehicle use, leading to more traffic congestion, energy and resource depletion as well as pollution ( UN Habitat, 2013 ).
The use of urban freight strategies for effective reverse logistics and resource flows is also a viable CE strategy for the transport sector ( EMF, 2019 ) as it enables the provision of services in a manner that also supports similar priorities for economic growth, air quality, environmental noise and waste management ( Akgün et al., 2019 ; Kiba-Janiak, 2019 ). Beyond vehicles and infrastructure, the adoption of these strategies can enable the development of new technologies and practices such as virtualisation of products, digital manufacturing, waste collection, and sorting systems. Interestingly, innovative environmentally-friendly logistics solutions resting on the backbone of the CE framework are already materializing and being trialled in various capacities, including: urban consolidation centre (UCC) ( Johansson and Björklund, 2017 ), crowshipping ( Buldeo Rai et al., 2017a ; Rai et al., 2018 ) and off-hour delivery ( Gatta et al., 2019 ). UCC stresses the use of logistics facilities in city suburbs to ease good deliveries to customers ( Browne et al., 2005 ), while crowshipping is a collaborative measure that employs the use of free mobility resources to perform deliveries ( Buldeo Rai et al., 2017b ).
The availability of rich transport data (e.g. impacts of events on transport, commuter habits) and AI-enabled complex data processing technologies can be leveraged to inform the planning, management, and operations of transport networks over time. Real-time data can also be adopted for monitoring and for instant regulations of traffic flow based on route planning, dynamic pricing and parking space allocation. Noticeably, many of these innovative CE-related initiatives still need an efficient governance mechanism ( Janné and Fredriksson, 2019 ). However, coupling them with the deployment of environmentally efficient vehicles and superior technical solutions hinging on the internet-of-things will bring many nations closer to reaping the benefits of CE. Given that urban planning is most often within the remit of governmental agencies, they must therefore develop integrated pathways and strategies for urban mobility to ensure effective logistics and resource flows. Stakeholder engagements within the transport sector can also facilitate innovative solutions that enable better use of assets and big data solutions.
6.6. Sustaining improvements in air quality
Improvements in air quality is one of the positives recorded due to the COVID-19-imposed lockdown as transportation and industrial activities halted. To sustain such improvements, there is the need to facilitate a step change by ramping up the uptake of low emission vehicles through setting more ambitious targets for the embrace of electric vehicles, constructing more electric car charging points as well as encouraging low emissions fuels. This entails heightening investments in cleaner means of public transportation as well as foot and cycle paths for health improvements; redesigning of cities to ensure no proximity to highly polluting roads and the populace as well as preventing highly polluting vehicles from accessing populated areas using classifications such as clear air or low emission zones ( PHE, 2020 ).
Batteries constitute an integral part towards the decarbonisation of road transportation and support the move to a renewable energy system ( World Economic Forum, 2019 ). As such, it is important to establish a battery value chain that is circular, responsible and just, to realise the aforementioned transitions. This entails the identification of the ( World Economic Forum, 2019 ): (i) challenges inhibiting the scaling up of the battery value chain (e.g. battery production processes, risks of raw materials supplies); (ii) levers to mitigate the challenges such as a circular value chain (e.g. design for life extension, implementation of V1G and V2G and scaling up of electric shared and pooled mobility, coupling the transport and power sectors); sustainable business and technology (e.g. increasing the share of renewables and energy efficiency measures across the value chain, effective regulations and financial incentives to support value creation); and a responsible and just value chain based on a balanced view and interplay between environmental, social and economic factors. Indeed, cost-effective and sustainable batteries, as well as an enabling ecosystem for the deployment of battery-enabled renewable energy technologies backed with a dense infrastructure network for charging, will facilitate the transition towards broader acceptance of electric vehicles and by extension guarantees a sustained improvement in air quality ( Masiero et al., 2017 ; PHE, 2020 ; World Economic Forum, 2019 ).We recognize that if all cars are simply replaced by electricones, there will still be the same volume of traffic and an increased need for raw materials, posing significant social, environmental and integrity risks across its value chain. However, CE through the aforementioned levers can address these challenges and support the achievement of a sustainable battery value chain. This will entail lowering emission during manufacturing, eradicating human rights violations, ensuring safe working conditions across the value chain and improving reuse, recycling and remanufacturing ( World Economic Forum, 2019 ).
6.7. Digitalisation for supply chain resilience post COVID-19
Digitalisation of supply chains through leveraging disruptive digital technologies (DDTs) - technologies or tools underpinning smart manufacturing such as the Internet of Things (IoT), artificial intelligence, big data analytics, cloud computing and 3D printing - constitute an important step for companies to prepare for and mitigate against the disruptions and attain business resilience amidst global pandemics such as COVID-19. Circular supply chain value drivers’ entails elongation of useful lifespan and maximisation of asset utilisation. Intelligent assets value drivers entail gathering knowledge regarding the location, condition and availability of assets ( Morlet et al., 2016 ). Paring these drivers could provide a broad range of opportunities, which could change the nature of both products and business models, enabling innovation and value creation ( Antikainen et al., 2018 ; Morlet et al., 2016 ). For instance, big data analytics, when adopted properly can aid companies in streamlining their supplier selection processes; cloud-computing is currently being used to facilitate and manage supplier relationships; through automation and the IoT, logistics and shipping processes can be greatly enhanced ( McKenzie, 2020 ). Digitalisation enables predictive maintenance, preventing failures while extending the lifespan of a product across the supply chains. It therefore, constitutes an ideal vehicle for circular supply chains transitioning, providing opportunities to close material loops and improve processes ( Morlet et al., 2016 ; Pagoropoulos et al., 2017 ).
Indeed, COVID-19 has prompted renewed urgency in the adoption of automation and robotics towards mitigating against the disruptive impact on supply chains through restrictions imposed on people's movement. Numerous companies are taking advantage of this to automate their production lines. Prior to COVID-19, momentum towards adopting 5G mobile technology was mounting but delays caused by factors including anticipated use evaluations, security, competition and radio communications regulatory issues limited progress ( McKenzie, 2020 ). It is likely that the experience of COVID-19 may accelerate the provision of regulatory certainty for 5G, which will in turn fast-track the deployment of IoT-enabled devices for remote monitoring, to support supply chain resilience post COVID-19.
Despite the benefits of DDTs, tension exists between their potential benefits (i.e. ability to deliver measurable environmental benefits at an affordable cost), and the problems (i.e. heavy burden imposed during manufacturing and disposal phases of their lifecycle) they constitute, creating rebound effects. As such, the tension between the push for increasing digitalisation and the associated energy costs and environmental impacts should be investigated such that they do not exacerbate the existing problems of resource use and pollution caused by rapid obsolescence and disposal of products containing such technologies. This entails identifying, mapping and mitigating unintended consequences across their supply chains, whilst taking into account technological design embedded within green ethical design processes, to identify environmental sustainability hotspots, both in conception, application and end of life phases.
6.8. Policy measures, incentives and regulatory support for CE transitioning
Becque et al. (2016) in their analysis of the political economy of the CE identified six main types of policy intervention to facilitate, advance and guide the move to a CE by addressing either barriers that aim to fix the market and regulatory failures or encourage market activity. Some of the policy intervention options identified include: (i) education, information and awareness that entails the integration of CE and lifecycle systems thinking into educational curricula supported by public communication and information campaigns; (ii) setting up platforms for collaboration including public-private partnerships with ventures at the local, regional and national levels, encouraging information sharing as well as value chain and inter-sectoral initiatives, establishing research and development to facilitate breakthroughs in materials science and engineering, biomaterials systems etc.; (iii) introduction of sustainability initiatives in public procurement and infrastructure ; (iv) provision of business/financial/technical support schemes such as initial capital outlay, incentive programs, direct subsidies and financial guarantees as well as technical support, training, advice and demonstration of best practices; (v) regulatory frameworks such as regulation of products (including design), extension of warranties and product passports; strategies for waste management including standards and targets for collection and treatments, take-back systems and extended producer responsibility; strategies at the sectoral levels and associated targets for resource productivity and CE; consumer, competition, industry and trade regulations; introduction of standard carbon accounting standards and methodologies; and (vi) fiscal frameworks such as reductions of VAT or excise tax for products and services designed with CE principles.
7. Conclusion
COVID-19 has highlighted the environmental folly of ‘extract-produce-use-dump’ economic model of material and energy flows. Short-term policies to cope with the urgency of the pandemic are unlikely to be sustainable models in the long run. Nonetheless, they shed light on critical issues that deserve emphases, such as the clear link between environmental pollution and transportation/industrialization. The role of unrestricted air travel in spreading pandemics particularly the viral influenza types (of which COVID-19 is one) is not in doubt, with sectors like tourism and aviation being walloped (some airlines may never recover or return to profitability in a long time) due to reduced passenger volumes. The fallout will re-shape the aviation sector, which like tourism has been among the hardest to be hit economically, albeit with desirable outcomes for the reduction in adverse environmental impacts. Peer-to-peer (P2P) or sharing economy models (e.g. Uber, Airbnb) which have birthed a new generation of service providers and employees are found to be non-resilient to global systemic shocks.
The urgency of supply and demand led to a reduction in cargo shipping in favour of airfreights whose transatlantic cost/kg tripled overnight. This is matched by job losses, income inequalities, mass increase in global poverty levels and economic shocks across industries and supply chains. The practicability of remote working (once the domain of technology/service industries) has been tried and tested for specific industries/professions with its associated impacts on reduced commuting for workers. Remote healthcare/telemedicine/ and remote working, in general, is no longer viewed as unfeasible because it has been practiced with success over the best part of a four-month global lockdown period. There was a corresponding reduction in primary energy consumption due to the slowing and shutting down of production and economic activities, and the delivery of education remotely is also no longer questioned. The potential of automation, IoT, and robotics in improving manufacturing processes, as well as the use of cloud computing and big data analytics in streamlining supplier selection processes and management of supplier relationships and logistics are now better appreciated.
The inadequacies of modern healthcare delivery systems to cope with mass casualties and emergencies are universally acknowledged, primarily due to the incapacity of hospital JIT procurement process to provide essential medical and emergency supplies in vast quantities at short notice. This had deadly consequences with thousands of patients and healthcare workers paying the ultimate price for lack of planning and shortfalls in PPE inventory and critical care equipment. Protectionism and in-ward looking policies on exports and tariff reductions/waivers on the importation of raw materials and critical PPE have emphasized the importance of cooperation to cope with shortages, which evolved in tandem with profiteering, thereby emphasizing the role/need for cottage industries to help meet global production of essentials (facemasks, 3D printed parts/equipment, etc.). The increase in infectious hospital wastes due to the pandemic was necessitated by precautionary measures to control the transmission, but proper/advanced sterilization procedures via thermal, microwave, biochemical processes can help in upcycling discarded or retrieved materials and PPE.
Changes in consumer behaviour with social distancing have necessitated a huge increase in online purchasing, which has benefitted the big players but seriously harmed SMEs, who were not exploiting web-based product and service delivery. A CE-based resilience of the consumer food sector was found to require: (i) closing nutrient loops with the use of regenerative agriculture; (ii) value recovery from organic nutrients via anaerobic digestion facilities; (iii) adoption of urban and peri-urban agriculture; and (iv) expanding food collection, redistribution and volarisation facilities. It is believed that CE will facilitate a socially just and inclusive society,driven by the need for resilience and sustainability goals, which could see a rise in bio-economy and sharing economy (SE). The consequences of these would be felt in terms of global cooperation and mutual interests; long-term planning as well as the need to strike an optimum balance between dependence on outsourcing/importation and local manufacturing/productivity. A realignment of value chains is likely to occur because of countries with raw materials exploiting this pandemic for their sustainable growth, and a new world order not shaped by the technological superiority of super-powers is likely to emerge.
During the lockdown, offices and commercial spaces were massively underutilized and the need to increase ventilation rates, e.g. in hospitals is leading to more energy consumption. However, there are opportunities to (re)design buildings to have movable walls for adaptable use. The use of modular techniques for fast construction of buildings that can be disassembled and re-configured for new needs, as demonstrated in China, is likely to increase. Renovation and refurbishment will witness a renewed vigour as existing buildings get a new lease of life with reduced carbon emissions and new jobs being created. Nonetheless, integrating circularity (product durability, energy efficiency, recyclability, etc.) via design thinking is essential from the onset if all these potential benefits are to be achieved. Digital technologies will play a crucial role in ensuring the low carbon and energy-efficient future of the built environment.
Governments are recognizing the need for national-level CE policies in many aspects, such as: (a) reducing over-reliance on other manufacturing countries for essential goods as massive shortages forced the unwitting adoption of CE principles such as re-use; (b) intensive research into bio-based materials for the development of biodegradable products and the promotion of bio-economy; (c) legal framework for local, regional and national authorities to promote green logistics and waste management regulations which incentivize local production and manufacturing; and (d) development of compact smart cities for effective mobility (with social distancing considerations) as well as enabling environment for shared mobility options (e.g. ride-shares) and active mobility options (e.g. bicycling, walking).
Going forward, resilience thinking should guide lessons learnt and innovations emanating from circular thinking should target the general well-being of the populace and not merely focus on boosting the competitiveness, profitability or growth of businesses and national economies. The post-COVID-19 investments needed to accelerate towards more resilient, low carbon and circular economies should also be integrated into the stimulus packages for economic recovery being promised by governments, since the shortcomings in the dominant linear economic model are now recognized and the gaps to be closed are known.
Credit author statement
IMT, MKB and GJ conceived the idea. IMT developed the methodological notes. IMT, MKB, AZ & FH conducted the analysis. IMT, MKB, AZ, BKA, ADD, AA and FH designed the structure and outline of the paper. All authors contributed to the writing the paper, with comments and feedback from GJ and KSCL.
Declaration of Competing Interest
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Student Wins Scholarship with Essay on COVID-19 and Climate Change
February 25, 2021
Scott, who is also the grant coordinator for UNC's Student LEAF organization , wrote an essay titled, "Crisis! The Relationship between COVID-19 and Climate Change," that looks at how the ongoing COVID-19 pandemic has impacted climate-change efforts.
“The main message of my essay was that no matter how much we want things to return 'back to normal' from the tragic events that occurred during 2020 (Breonna Taylor, George Floyd, global fires and floods displacing millions), we can see that our 'normal' wasn’t working; instead of going backwards, we now have our chance to create a new normal," Scott said. "It’s been a great experience and an even greater feeling to see my work published for others to read.”
Read her winning essay below:
Crisis! The Relationship between COVID-19 and Climate Change
By Emmy Scott
“I wish things were back to normal again”, a phrase that’s become quite popular in the last year. With rising cases in roughly 215 countries, stay-at-home orders put in place to control the spread of COVID-19 have been testing people’s physical and mental health. Isolation and drastic change has left people longing to return to their normal lives before the virus spread –but what exactly was our normal? Over the past 50 years, the “normal” has been a trend toward a 2% increase in global temperate (National Climate Assessment 2014). This increase will result in climate change which will bring a rise in sea level causing extreme hurricanes, floods, and other natural disasters that will destroy homes and businesses. The temperature rise will also create droughts making water-scarce and cultivating difficult.
Then, the abuse of natural resources from human activity will result in resource scarcities worldwide (NASA, 2020). Over 1,300 independent scientific studies concluded that there is more than a 95% probability that human activity has contributed to climate change (National Climate Assessment 2014).
At the start of the global pandemic, there seemed to be positive impacts on the environment. With less to no people outside, china’s air pollution improved, rivers in Italy cleared up, and there was a reduction in carbon emissions around the world (Kumari & Toshniwal, 2020). There was a decline in greenhouse gas emission, outdoor air pollution, environmental noise level, and land and wildlife pressure (Patrício Silva et al., 2021). Showing us that our normal lives are the main contributors to the crisis of climate change. Still, while outside air pollution was going down, other pollutants began causing harm to the environment (Patrício Silva et al., 2021).
One of the main pollutants caused by COVID-19 is the extreme increase in personal protection equipment (masks, gloves, face shields, etc.). The increase in large is due to the products being used by first responders and everyday people with no slowing in sight. For example, to provide citizens worldwide with the necessary amount of personal protection equipment (PPE) we would need roughly 129 billion face masks and 65 billion gloves monthly (Patrício Silva et al., 2021). Most PPE is also made up of nonwoven synthetic polymers such as polyethylene, polypropylene (PP), and polyethylene terephthalate (PET) –all of which contain plastic (Patrício Silva et al., 2021). Such plastics can take hundreds to thousands of years to decompose, in the meantime, the plastics break up into smaller and smaller pieces called microplastics (National Climate Assessment 2014).
PPE disposed of today is already creating a “never-ending-story” of plastics in our land and water. The nonwoven synthetic fibers were the main derivation of micro-plastic found in both water and sediment samples in the Magdalena River in Columbia (Patrício Silva et al., 2021). A UCL Plastic Waste Innovation report regarding mask use found that the use of reusable masks that could be washed had the lowest contribution to climate change, and reduced mask waste by 95% (Patrício Silva et al., 2021). Unfortunately, surgical masks and gloves are recommended not to be worn longer than a few hours and should be adequately disposed of to avoid cross-contamination; therefore, reusable masks aren’t an option for first responders.
The recommendation is necessary for the medical industry, but the increased use of PPE soon became accompanied by an increase in other single-used-plastics that degrade into microplastics. Reusable products such as metal straws, canvas bags, and bamboo silverware can be used in public spaces to replace single-use products offered. Yet with COVID-19, the fear of contamination has led to more institutions: restaurants, markets, schools, offices, etc.: refusing to use reusable materials that could potentially spread COVID-19. Also, several U.S. states have stopped recycling programs with concerns of the virus spreading if recycling is not sanitized and handled properly (Patrício Silva et al., 2021). Long-term, a pause in recycling could potentially harm the global momentum towards better recycling programs even after the pandemic has been controlled.
For consumers, safety concerns related to shopping in public have led to a preference for fresh-food being packaged in plastic containers to avoid food contamination (Dcnewton, 2020). The demand for plastic packaging is expected to increase by 40% with a 17% increase in other single-use plastic, including medical products. Still, it hasn’t been proven that reusable products accompany any more risk of spreading the virus than shoes or disposable gloves (Patrício Silva et al., 2021). Other than an increase in irreversible plastic waste in the environment, the longterm effects of reusable products being seen as “unsafe” to use during COVID-19, is the notation that nonsingular-use products are dirty. The COVID-19 pandemic could change what people think about using reusable products in public spaces forever.
Conclusively, to dispose of PPE and other possible containments, countries have been supporting incineration and landfilling which creates air, land, and water pollution. While some regions will be able to dispose of medical waste with alternative methods, minimizing some of the environmental risks, others with less waste management resources may be forced to utilize inappropriate strategies resulting in adverse effects on the environment (Patrício Silva et al., 2021). Incineration, for example, releases greenhouse gasses (GHGs) and other potentially hazardous compounds (heavy metals, dioxins, polychlorinated biphenyl [various chlorinated mixtures], and furans [contains carbon]) into the air (Patrício Silva et al., 2021). COVID-19 has taken the lives of over 1 million people; air pollutants caused by human activity are responsible for over 6 million deaths worldwide and counting (Patrício Silva et al., 2021 and WHO, 2020). By ignoring the risks and externalities of increasing plastic use and disposing of it in unsustainable ways, we have also increased the risks of pollutants in our air, water, and land.
Overall, the COVID-19 pandemic has shifted the world’s focus away from the climate change crisis. Public safety pressures have resulted in less and less attention from governmental agencies, the scientific community, and the general public. The distress of COVID-19 spreading has put new and ongoing climate change mitigation strategies on pause for both businesses, public institutions, governments, and individuals. New York, for example, pushed back their statewide ban on single-use plastic to January 2021. While other states such as Massachusetts went as far as banning the use of reusable shopping bags to minimize the risk of contamination to workers and customers (Patrício Silva et al., 2021).
Furthermore, it’s hindered the progress of companies switching to more eco-friendly business practices. Businesses are not just increasing their use of single-use products for safety, with the uncertainty of COVID-19 affects they are also becoming unwilling to spend more on sustainable practices (WHO, 2020). Face-to-face restriction, concerns of safety in public settings, and an increase in job-loss have led to less shopping worldwide. With fewer people out traveling, shopping, going to work, school, or visiting friends, the economy has seen high rates of job loss, furloughs, and businesses having to close their doors.
Worldwide, the International Monetary Fund predicts COVID-19 will reduce growth rates by 4% leading to a global recession (Kumari & Toshniwal, 2020). The global increase in job loss and stay-at-home regulations have left businesses, organizations, and institutions in terrifying positions. COVID-19 has forced the closure of 60% of business across the U.S. Leaving business owners, as well as employees, with a significant financial burden (Sundaram, 2020). Nonprofit organizations have seen an 83% reduction in revenue and over 50% have closed their doors as well (Independent Sector, 2020). The decline of nonprofits is worth mentioning because most of the organizations identified as human service organizations, allies, and supporters in the fight for environmental and human rights (Independent Sector, 2020). Also, stay-at-home orders have impacted schools which are obstructing lower and higher education learning.
The stay-at-home orders are in place to guard us, but having to enforce them has reinforced inequality and inequity for historically underrepresented populations (Dcnewton, 2020). Communities of color and low-income groups have been disproportionately impacted by the economic effects of COVID-19 (Dcnewton, 2020). Renters -many of them being people of color, low-income, or have job insecurity in the face of an epidemic- with less economic resources and less recovery support, are especially susceptible to risks such as displacement during any crisis (Ramirez, 2020). If we combine that with the fact that there are more renters in the U.S. than homeowner’s a risk of extreme displacement emerges (Ramirez, 2020). In just the United States, COVID-19 threatens 30-40 million renters with the risk of eviction (Benfer, Gilman, Edmonds, Butler, & Robinson, 2020). The displacement being caused by the virus is only a preview of what could happen if the climate crisis continues. The natural disasters, droughts, and resource scarcity brought on by climate change will result in millions of people having to move from their homes to survive the effects of climate change (NASA, 2020).
As climate change worsens, it’s predicted that the extreme natural disasters (floods, hurricanes, tornadoes, droughts, etc.) will destroy more businesses, homes, and schools, or displace people due to resource scarcity (NASA, 2020). Also, similar to trying to protect public health during the COVID-19 crisis, stay-at-home orders could be put back in place if the climate crisis is not solved, but this time it would be to protect us from the pollution in the air created by us –such as the greenhouse gases we’ve produced. While COVID-19 is rightfully a pressing matter, without mitigating our global impact on the environment and mending the damage already created, we could see a similar or even worse drop in the economy than what COVID-19 has created (Kumari & Toshniwal, 2020).
Although it is not all bad, with the similarities between COVID-19 and the climate crisis, we can turn the tragedy of COVID-19 into a blueprint for preparing for climate change. For one, the crisis has taught us that we cannot sit back and wait for change; we have to create it. In the COVID-19 crisis, we saw this in the way people reinvented working, learning, and living from the same distance. Similarly, for the climate crisis actions towards mitigation, we will need to change how we work, learn, and live. To reverse the damage created over the past 50 years, we will have to be innovative and adapt to change –just as we have been during the COVID-19 crisis.
Navigating through the COVID-19 has also shown us that in times of crisis it is not just about moving quickly, being unified is critical. The climate crisis is an urgent matter, but without unity, effective solutions will be difficult to reach. In the U.S. the politicization of wearing a mask showed how the division between people can shift focus away from what is important, our health. When we are united, we can create unimaginable change: such as converting the world almost completely online or discovering multiple effective vacations to a devastating virus within less than a year. To solve a crisis as major as climate change, we will need to be unified in how we’ve been at times during COVID-19. Strategies that consider intersectionality (the links between disasters, health, equity, racial disparities, and community investment) and put human and environmental rights at the forefront can create long-term solutions (Ramirez, 2020). Solutions that create more resilient and equitable places to live, resulting in a future that solves the crisis of climate change.
The current pandemic has also shown us strategies that could be used to protect individuals impacted by the effects of climate change. Stimulation packages and pandemic unemployment for furloughed employees have helped elevate the economic impacts of the virus –a plan of action that would be necessary to alleviate the economic effects of an increase in natural disasters. Similar to COVID-19, it will important for governments to create plans to protect businesses from climate change impacts. Forgivable loans, payroll tax relief, help with employee healthcare costs, and program grants are strategies being used that could help if climate change worsens -92% of a diverse group of business owners suggested forgivable loans are the most helpful to keep their companies afloat (Independent Sector, 2020).
As mentioned, with a combination of economic stress and a high percentage of the world not owning property, global displacement will arise. Policies and regulations that protect renters from eviction have been implemented during the beginning of COVID-19, showing us that an important step to the global crisis is displacement policies and the protection of low-income communities. Anti-displacement plans should be put together by multiple diverse agencies. Antidisplacement is important to keep the economy flowing, ensure public health and safety, and minimize financial burdened for businesses (Ramirez, 2020). Anti-displacement plans would include countries’ promoting healthy development growth, restricting divestment in underrepresented communities to provide security for renters, low-income, or those who may lose their jobs due to climate change effects, and support of refugee programs. As we’ve learned from COVID-19, a displacement plan will be necessary.
COVID-19 has devastated the economy, environment, and people’s lives. What began as a health crisis quickly progressed into an economic, social, and environmental threat. COVID-19 brought an increase in pollution, adverse effects on our air, water, and resources, as well as financial burdens, and an increase in displacement. Aid for the pandemic has cost the United States trillions of dollars. With the predictions of climate change being similar to the effects brought by COVID-19: an increase in pollution, adverse effects on our air, water, and resources, as well as financial burdens, and an increase in displacement: climate change has the potential of costing over trillions of dollars (NASA, 2020). This is why I mentioned the innovation of our everyday activities as the first step to be learned from COVID-19, as well as unity next. To minimize the economic cost of displacement and financial relief, cohesive change of our everyday activities will be necessary to attempt to reverse the damage we have already created.
Without the steps we have taken worldwide to mitigating COVID-19: unifying, working quickly for a solution, finding innovative ways to adapt to the crisis, and protecting financially vulnerable individuals or those with fewer resources: gaining control of the spread of the virus may have never been possible. For our safety and well-being, we must take similar steps to prepare for the climate crisis or reverse the damage we have already created quickly. To keep the economy afloat, schools in sessions and society flowing, we cannot go back to normal. Our “normal” has been leading us into the biggest crisis of our lifetimes, climate change. With a unified plan of action, we can design a new normal. Together, we can create a more adaptable, equitable, resilient, and thriving World.
Works Cited
- Benfer, E., Gilman, S., Edmonds, L., Butler, S., & Robinson, D. (2020, September 16). The COVID-19 Eviction Crisis: An Estimated 30-40 Million People in America Are at Risk. Retrieved December 19, 2020, from https://www.aspeninstitute.org/blog-posts/the-covid19-eviction-crisis-an-estimated-30-40-million-people-in-america-are-at-risk/).
- Dcnewton. (2020, April 15). The Dark Side of Environmentalism: Ecofascism and COVID-19. Retrieved December 19, 2020, from https://usfblogs.usfca.edu/sustainability/2020/04/15/the-dark-side-of-environmentalismecofascism-and-covid-19/
- Independent Sector. (2020, June 15). The Impact of COVID-19 on Large and Mid-Sized Nonprofits. Retrieved December 19, 2020, from https://independentsector.org/resource/covid19-survey/
- Kumari, P., & Toshniwal, D. (2020, October 16). Impact of lockdown on air quality over major cities across the globe during COVID-19 pandemic. Retrieved December 19, 2020, from https://www.sciencedirect.com/science/article/pii/S2212095520304387
- NASA (2020, August 21). The Effects of Climate Change. Retrieved December 19, 2020, from https://climate.nasa.gov/effects/
- National Climate Assessment. (n.d.). Retrieved December 19, 2020, from https://nca2014.globalchange.gov/
- Patrício Silva, A., Prata, J., Walker, T., Duarte, A., Ouyang, W., Barcelò, D., & Rocha-Santos, T. (2021, February 1). Increased plastic pollution due to COVID-19 pandemic: Challenges and recommendations. Retrieved December 19, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7430241/
- Ramirez, M. (2020, September 25). Research: Displacement in the Face of Climate Change. Retrieved December 19, 2020, from https://www.nrdc.org/experts/marissaramirez/research-displacement-face-climate-change
- Sundaram, A. (2020, December 11). Yelp data shows 60% of business closures due to the coronavirus pandemic are now permanent. Retrieved December 19, 2020, from https://www.cnbc.com/2020/09/16/yelp-data-shows-60percent-of-business-closures-dueto-the-coronavirus-pandemic-are-now-permanent.html
- WHO. WHO Coronavirus Disease (COVID-19) Dashboard. Retrieved December 19, 2020, from https://covid19.who.int/
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COVID-19 photo essay: We’re all in this together
About the author, department of global communications.
The United Nations Department of Global Communications (DGC) promotes global awareness and understanding of the work of the United Nations.
23 June 2020 – The COVID-19 pandemic has demonstrated the interconnected nature of our world – and that no one is safe until everyone is safe. Only by acting in solidarity can communities save lives and overcome the devastating socio-economic impacts of the virus. In partnership with the United Nations, people around the world are showing acts of humanity, inspiring hope for a better future.
Everyone can do something
Rauf Salem, a volunteer, instructs children on the right way to wash their hands, in Sana'a, Yemen. Simple measures, such as maintaining physical distance, washing hands frequently and wearing a mask are imperative if the fight against COVID-19 is to be won. Photo: UNICEF/UNI341697
Creating hope
Venezuelan refugee Juan Batista Ramos, 69, plays guitar in front of a mural he painted at the Tancredo Neves temporary shelter in Boa Vista, Brazil to help lift COVID-19 quarantine blues. “Now, everywhere you look you will see a landscape to remind us that there is beauty in the world,” he says. Ramos is among the many artists around the world using the power of culture to inspire hope and solidarity during the pandemic. Photo: UNHCR/Allana Ferreira
Inclusive solutions
Wendy Schellemans, an education assistant at the Royal Woluwe Institute in Brussels, models a transparent face mask designed to help the hard of hearing. The United Nations and partners are working to ensure that responses to COVID-19 leave no one behind. Photo courtesy of Royal Woluwe Institute
Humanity at its best
Maryna, a community worker at the Arts Centre for Children and Youth in Chasiv Yar village, Ukraine, makes face masks on a sewing machine donated by the Office of the United Nations High Commissioner for Refugees (UNHCR) and civil society partner, Proliska. She is among the many people around the world who are voluntarily addressing the shortage of masks on the market. Photo: UNHCR/Artem Hetman
Keep future leaders learning
A mother helps her daughter Ange, 8, take classes on television at home in Man, Côte d'Ivoire. Since the COVID-19 pandemic began, caregivers and educators have responded in stride and have been instrumental in finding ways to keep children learning. In Côte d'Ivoire, the United Nations Children’s Fund (UNICEF) partnered with the Ministry of Education on a ‘school at home’ initiative, which includes taping lessons to be aired on national TV and radio. Ange says: “I like to study at home. My mum is a teacher and helps me a lot. Of course, I miss my friends, but I can sleep a bit longer in the morning. Later I want to become a lawyer or judge." Photo: UNICEF/UNI320749
Global solidarity
People in Nigeria’s Lagos State simulate sneezing into their elbows during a coronavirus prevention campaign. Many African countries do not have strong health care systems. “Global solidarity with Africa is an imperative – now and for recovering better,” said United Nations Secretary-General António Guterres. “Ending the pandemic in Africa is essential for ending it across the world.” Photo: UNICEF Nigeria/2020/Ojo
A new way of working
Henri Abued Manzano, a tour guide at the United Nations Information Service (UNIS) in Vienna, speaks from his apartment. COVID-19 upended the way people work, but they can be creative while in quarantine. “We quickly decided that if visitors can’t come to us, we will have to come to them,” says Johanna Kleinert, Chief of the UNIS Visitors Service in Vienna. Photo courtesy of Kevin Kühn
Life goes on
Hundreds of millions of babies are expected to be born during the COVID-19 pandemic. Fionn, son of Chloe O'Doherty and her husband Patrick, is among them. The couple says: “It's all over. We did it. Brought life into the world at a time when everything is so uncertain. The relief and love are palpable. Nothing else matters.” Photo: UNICEF/UNI321984/Bopape
Putting meals on the table
Sudanese refugee Halima, in Tripoli, Libya, says food assistance is making her life better. COVID-19 is exacerbating the existing hunger crisis. Globally, 6 million more people could be pushed into extreme poverty unless the international community acts now. United Nations aid agencies are appealing for more funding to reach vulnerable populations. Photo: UNHCR
Supporting the frontlines
The United Nations Air Service, run by the World Food Programme (WFP), distributes protective gear donated by the Jack Ma Foundation and Alibaba Group, in Somalia. The United Nations is using its supply chain capacity to rapidly move badly needed personal protective equipment, such as medical masks, gloves, gowns and face-shields to the frontline of the battle against COVID-19. Photo: WFP/Jama Hassan
Brazilian ballet pirouettes during pandemic
Ballet Manguinhos, named for its favela in Rio de Janeiro, returns to the stage after a long absence during the COVID-19 pandemic. It counts 250 children and teenagers from the favela as its performers. The ballet group provides social support in a community where poverty, hunger and teen pregnancy are constant issues.
Radio journalist gives the facts on COVID-19 in Uzbekistan
The pandemic has put many people to the test, and journalists are no exception. Coronavirus has waged war not only against people's lives and well-being but has also spawned countless hoaxes and scientific falsehoods.
Access to information is the cure of disinformation
The pandemic has exposed how important it is for the right to access to information to be respected and for accurate reliable information to be freely available for decision-making by both governments and citizens: A win-win situation.
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Special Issue: COVID-19
This essay was published as part of a Special Issue on Misinformation and COVID-19, guest-edited by Dr. Meghan McGinty (Director of Emergency Management, NYC Health + Hospitals) and Nat Gyenes (Director, Meedan Digital Health Lab).
Promoting health literacy during the COVID-19 pandemic: A call to action for healthcare professionals
The extraordinary spread of misinformation during the COVID-19 pandemic is impressive. And, to public health professionals like us, it’s worrying: We know that good information and good health go hand in hand. Knowing what we do about the practice of public health and what the science tells us about how people fall for misinformation, we see promising strategies for intervention in our own field. We therefore call on fellow healthcare professionals to take concerted action against misinformation, and we suggest here one lever our field is perfectly situated to address: health literacy. In this commentary, we propose concrete strategies for colleagues at four levels of practice: in healthcare organizations, community-based partnerships, cross-sector collaborations, and as individual healthcare providers.
Bloomberg School of Public Health, Johns Hopkins University, USA
Introduction
Health literacy is crucial for health, and healthcare professionals must acknowledge and prioritize its importance in every interaction with patients and communities (Berkman et al., 2011; Paasche-Orlow & Wolf, 2007). But we can’t stop there. Given its impact on health itself, health literacy merits a privileged position in our entire scope of operations, from program planning to evaluation to patient safety to communications. A strong body of evidence testifies to the benefits of integrating individual healthcare practice with public health strategy, and the current pandemic is the perfect moment for professionals from these two sectors to join forces in a shared battle against misinformation (Linde-Feucht & Couluris, 2012; Committee on Integrating Primary and Public Health, Board on Population Health and Public Health Practice & Institute of Medicine, 2012). In the midst of what the WHO has called a “misinfodemic,” the stakes of health literacy – or illiteracy – are high, and we consider it our duty, as healthcare professionals, to do everything we can to help people access and act on the sort of health-related information that effectively promotes the achievement of good health. A strengthened commitment to health literacy throughout the entire family of healthcare professionals, within and across organizations and down to each individual provider, offers us great promise for addressing this urgent problem. Here we show why and how.
Before officially declaring COVID-19 a pandemic, the World Health Organization described the massive info demic surrounding it, pointing to a global overabundance of information that had already made it difficult for the public to distinguish trustworthy health sources from phony experts and created widespread confusion about real evidence-based safety measures (Zarocostas, 2020). Indeed, a recent Pew survey of American adults found that close to half (48%) of the respondents reported seeing at least some made-up news about COVID-19 (Mitchell & Oliphant, 2020).
Research suggests that several key factors drive individual and collective belief in health-related misinformation (Scheufele & Krause, 2019; Uscinski et al., 2016). One of the most important is low health literacy – and the extraordinarily scope and scale of the current COVID-19 “misinfodemic” represents an acute challenge to healthcare professionals in just this regard (Gyenes & Marrelli, 2019; Mian & Khan, 2020). History has shown us the tragic consequences that the spread of misinformation can carry during health crises. (For example, the South African government’s outright denial of the efficacy of antiretroviral therapies and its mass promotion of herbal remedies to combat HIV/AIDS under President Thabo led to the loss of over 300,000 lives as a result of excess HIV transmission, particularly among pregnant mothers)(Nlooto & Naidoo, 2016; Bateman, 2007). The Affordable Care Act (2010) defines health literacy as “the degree to which an individual has the capacity to obtain, communicate, process, and understand health information and services to make appropriate health decisions.” In short, it is the sort of competence that enables people to recognize the severity of a given situation, acquire a basic grasp of how to protect themselves and others, and understand the scope of their choices. In the context of COVID-19, it is what makes people able to differentiate between proposals to take social distancing measures and ones to drink bleach.
While limited health literacy affects people of all ages, incomes, and education levels, some are more vulnerable than others. According to the Centers for Disease Control and Prevention (CDC), racial and ethnic minorities, non-native speakers of English, those with low socioeconomic status, and medically underserved people (e.g., the uninsured and Medicaid-insured) are disproportionately susceptible. Hispanic adults have the lowest average health literacy scores of all racial and ethnic groups, followed by African Americans and American Indian/Alaska Natives; one study found that 74% of Spanish-speaking patients, for example, demonstrated ”below basic” health literacy (the lowest level possible), while only 7% of English-speaking patients did. And disadvantages such as these matter because there are serious consequences: People with low health literacy are twice as likely as others to report poor health status (Cutilli & Bennett, 2009).
Recent scientific work has affirmed that misinformation (generally) and limited health literacy (specifically) are major obstacles to health, and have helped to explain and respond to the problem (The National Academies of Sciences, Engineering, and Medicine, 2016; The National Academies of Sciences, Engineering, and Medicine, 2017). In 2017, the National Academies of Sciences (NAS) convened a Committee on the Science of Science Communication to highlight the challenges inherent in effectively conveying scientific information to the public. Additional thought leaders in the field have built on the committee’s work by recognizing misinformation as a product of individual information processing as well as of macro-level causes that include the pervasiveness of social networks and the tenure of highly varied information ecologies (Scheufele & Krause, 2019). Previous studies have noted a lack of understanding of science, the inability to recognize misinformation, the holding of beliefs inconsistent with the best available science, and credence in conspiracy theories as a few of the individual factors associated with the acceptance of inaccurate information (Uscinski et al., 2016; Garrett & Weeks, 2017; Southwell & Thorson, 2015). Other research has suggested that emotional states can influence individuals’ ideologies and alter their propensity to assimilate falsehoods from the information environment (Kalichman et al., 2012; Flynn, Nyhan & Reifler, 2017).
Group -level dynamics have also been found to influence individuals’ uptake of misinformation. For example, insular social networks can shape people’s attitudes and beliefs, allowing for the normalization of falsehoods and making it difficult to counter unfounded beliefs with correct information (DiFonzo et al., 2013). There are also major systems -level factors that contribute to the spread of misinformation in the United States, including: (1) declining social capital; (2) growing economic inequalities; (3) increasing political polarization; (4) declining trust in science; (5) politically asymmetric credulity; (6) an evolving media landscape; and (7) a fractioning of the media that rewards political extremism (The National Academies of Sciences, Engineering, and Medicine, 2017).
Understanding how these individual-, group-, and systems-level factors condition health literacy gives us clues about how misinfodemics are born and spread. But they also suggest measures that might be levered to develop intervention strategies and solutions to this slippery problem. We have identified a few such strategies, and we issue to healthcare professionals of all sorts a call to action. In the following recommendations, we propose health literacy promotion approaches that can be taken by four key professional stakeholder groups: healthcare organizations; community-based partnerships; cross-sector collaborations; and individual providers.
Healthcare organizations should strengthen their commitment to health literacy across the scope of operations
Healthcare systems are staffed by a clinical workforce that can leverage its therapeutic relationships with patients to promote and track progress in health literacy. Organizational leadership should avail of these relationships to prioritize the promotion of health literacy in all its outward-facing interactions, integrating health literacy content into planning, evaluation, communication, and patient safety strategies (Brach, 2017). It should identify appropriate “teachable moments” for addressing misinformation – such as care transitions, the prescription of medicines, and vaccination appointments – and plan appropriate health literacy interventions for each one.
Community health centers are sites of great potential for the promotion of health literacy. For over 50 years, health centers funded by the U.S. Health Resources and Services Administration (HRSA) have functioned as the nation’s primary care backbone for the medically underserved, coordinating care for over 29 million people across the U.S. And since part of these health centers’ statutory mission is to provide comprehensive healthcare to the medically underserved regardless of their insurance status or ability to pay, their patients include 1 of every 3 people living in poverty, 1 in 5 rural residents, 1 in 5 uninsured persons, 1 in 6 Medicaid beneficiaries, 1.4 million homeless people, and 385,000 veterans. Its more than 12,000 service delivery locations reach every state and territory, and 45% are in rural areas (National Association of Community Health Centers, 2019). If the healthcare organizations that manage these health centers recognize their potential, they could become key sites for promoting health literacy among the most vulnerable members of society – and for combatting the misinfodemics that thrive in just those contexts of exclusion where health literacy does not.
Healthcare professionals should build and enhance partnerships with the communities they serve
Healthcare organizations and providers already interact with the populations they serve, but strengthening relationships with diverse community organizations, congregations, and non-medical service agencies will strengthen their position in communities and open new opportunities for information exchange. For example, community-targeted forums can be organized in locally important venues such as churches, recreation centers, and community centers and designed to deliver and discuss relevant health information with the public. Similarly, local organizations can be recruited to serve as direct sources of timely, accurate information, leveraging their existing relationships and rapport with individuals and communities. These entities have an insider’s perspective and can offer valuable insights regarding the best ways to disseminate information and help to reach even the hardest-to-reach members of their communities.
Establishing strong partnerships with local organizations is especially important since the oral cultures of many communities make personal interactions crucial for information dissemination. At the same time, there is a strong scientific evidence base supporting participatory program design processes and demonstrating the benefits of involving members of target audiences in the design and testing of communication products (Cyril et al., 2015).
Healthcare professionals should reinforce their cross-sector collaborations with public health systems
In 2010, The Affordable Care Act expanded health insurance coverage for millions of Americans. But it also highlighted the need for healthcare and public health systems to work together to address individual health within the context of the larger community, incentivizing practices such as accountable care organizations and patient-centered medical homes that adopt integrative strategies (42 U.S.C. § 18001). Two years later, recognizing similar benefits, the Institute of Medicine’s (IOM) Committee on Integrating Primary Care and Public Health outlined a set of recommendations for aligning primary care with public health strategy. Its review examined over 400 collaborations between medical and public health actions and identified benefits for both primary care providers (such as the provision of population-based information that effectively enhanced their capacity to address behavioral and other underlying causes of illness) and public health entities (which received support from primary care providers in the execution of population-based strategies such as the collection of individual-level data for surveillance purposes and the dissemination of health education and health promotion messages) (Committee on Integrating Primary and Public Health, Board on Population Health and Public Health Practice & Institute of Medicine, 2012; Lassker, 1997).
Similarly, just last year, the American Academy of Family Physicians (AAFP) issued a position paper insisting on the importance and value of primary care and public health integration and urging its members to pursue and support integrative collaborations and interventions (American Academy of Family Physicians, 2015).
The current crisis is a prime opportunity for healthcare and public health professionals to build on their growing legacy of collaboration to partner once more, joining forces now to combat the misinfodemic that threatens the health and well-being of individuals and populations alike.
Individual healthcare providers should make every effort to understand and respond to their patients’ unique health-related knowledge, belief, and literacy conditions
A 2018 Gallup poll found that four in five Americans (84%) rated the honesty and ethical standards of nurses as “very high” or “high,” making them the most well-regarded professionals among those considered; doctors ranked second at 67% (Brenan, 2018). Another Gallup poll, conducted this March in the midst of the COVID-19 pandemic, produced similar findings, showing hospitals and health agencies to be the most trustworthy of the nine major national institutions and leaders proposed (Newport, 2020). Despite this privileged social regard, however, many front-line providers remain unaware of their patients’ beliefs – because they never ask. The notion of a personal explanatory model of illness refers to a patient’s representation of disease and is based on beliefs, emotions, knowledge, and experiences that are grounded in culture (Kleinman, 1980).
These representations of disease are associated with illness-related beliefs (such as how strongly they believe in self-control over health) and behaviors (such as how long patients stay in treatment) (Lau et al., 1989; Leventhal et al., 1980). While these personal explanatory models can differ radically from scientific models concerning the causation of disease, what people actually do in the face of illness is often a logical extension of their personal beliefs rather than of the scientific standard (Good, 1992). Individual doctors must recognize, then, that understanding a patient’s beliefs is the starting point for engaging in a discussion of how the patient encounters her world and what matters most to her – and that can become an important, personal, and personalized opportunity to correct misinformation, to improve health literacy, and – ultimately – to improve health.
Reiterating our call to action: A multi-level healthcare response to the misinfodemic
Countering the COVID-19 misinfodemic is a critical task for individual and public health. Healthcare professionals in all sectors and at all levels must strengthen their commitment to health literacy. Here we have issued four recommendations describing how healthcare organizations, community-based partnerships, cross-sector collaborations, and individual healthcare providers can play roles in the fight against misinformation by strengthening their efforts to build health literacy among the people and populations they serve.
And play a role they must: This battle is scored in lives and deaths.
- / Healthcare
- / Public Health
Cite this Essay
Damian, A. J., & Gallo, J. J. (2020). Promoting health literacy during the COVID-19 pandemic: A call to action for healthcare professionals. Harvard Kennedy School (HKS) Misinformation Review . https://doi.org/10.37016/mr-2020-027
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