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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).
Peer Reviewed
The causes and consequences of COVID-19 misperceptions: Understanding the role of news and social media
We investigate the relationship between media consumption, misinformation, and important attitudes and behaviours during the coronavirus disease 2019 (COVID-19) pandemic. We find that comparatively more misinformation circulates on Twitter, while news media tends to reinforce public health recommendations like social distancing. We find that exposure to social media is associated with misperceptions regarding basic facts about COVID-19 while the inverse is true for news media. These misperceptions are in turn associated with lower compliance with social distancing measures. We thus draw a clear link from misinformation circulating on social media, notably Twitter, to behaviours and attitudes that potentially magnify the scale and lethality of COVID-19.
Department of Political Science, McGill University, Canada
Munk School of Global Affairs and Public Policy, University of Toronto, Canada
Max Bell School of Public Policy, McGill University, Canada
School of Computer Science, McGill University, Canada
Department of Languages, Literatures, and Cultures, McGill University, Canada
Computer Science Program, McGill University, Canada
Research Questions
- How prevalent is misinformation surrounding COVID-19 on Twitter, and how does this compare to Canadian news media?
- Does the type of media one is exposed to influence social distancing behaviours and beliefs about COVID-19?
- Is there a link between COVID-19 misinformation and perceptions of the pandemic’s severity and compliance with social distancing recommendations?
Essay Summary
- We evaluate the presence of misinformation and public health recommendations regarding COVID-19 in a massive corpus of tweets as well as all articles published on nineteen Canadian news sites. Using these data, we show that preventative measures are more encouraged and covered on traditional news media, while misinformation appears more frequently on Twitter.
- To evaluate the impact of this greater level of misinformation, we conducted a nationally representative survey that included questions about common misperceptions regarding COVID-19, risk perceptions, social distancing compliance, and exposure to traditional news and social media. We find that being exposed to news media is associated with fewer misperceptions and more social distancing compliance while conversely, social media exposure is associated with more misperceptions and less social distancing compliance.
- Misperceptions regarding the virus are in turn associated with less compliance with social distancing measures, even when controlling for a broad range of other attitudes and characteristics.
- Association between social media exposure and social distancing non-compliance is eliminated when accounting for effect of misperceptions, providing evidence that social media is associated with non-compliance through increasing misperceptions about the virus.
Implications
The COVID-19 pandemic has been accompanied by a so-called “infodemic”—a global spread of misinformation that poses a serious problem for public health. Infodemics are concerning because the spread of false or misleading information has the capacity to change transmission patterns (Kim et al., 2019) and consequently the scale and lethality of a pandemic. This information can be shared by any media, but there is reason to be particularly concerned about the role that social media, such as Facebook and Twitter, play in incidentally boosting misperceptions. These platforms are increasingly relied upon as primary sources of news (Mitchell et al., 2016) and misinformation has been heavily documented on them (Garrett, 2019; Vicario et al., 2016). Scholars have found medical and health misinformation on the platforms, including that related to vaccines (Radzikowski et al., 2016) and other virus epidemics such as Ebola (Fung et al., 2016) and Zika (Sharma et al., 2017).
However, misinformation content typically makes up a low percentage of overall discussion of a topic (e.g. Fung et al., 2016) and mere exposure to misinformation does not guarantee belief in that misinformation. More research is thus needed to understand the extent and consequences of misinformation surrounding COVID-19 on social media. During the COVID-19 pandemic, Twitter, Facebook and other platforms have engaged in efforts to combat misinformation but they have continued to receive widespread criticism that misinformation is still appearing on prominent pages and groups (Kouzy et al., 2020; NewsGuard, 2020). The extent to which misinformation continues to circulate on these platforms and influence people’s attitudes and behaviours is still very much an open question.
Here, we draw on three data sets and a sequential mixed method approach to better understand the consequences of online misinformation for important behaviours and attitudes. First, we collected nearly 2.5 million tweets explicitly referring to COVID-19 in the Canadian context. Second, we collected just over 9 thousand articles from nineteen Canadian English-language news sites from the same time period. We coded both of these media sets for misinformation and public health recommendations. Third, we conducted a nationally representative survey that included questions related to media consumption habits, COVID-19 perceptions and misperceptions, and social distancing compliance. As our outcome variables are continuous, we use Ordinary Least Squares (OLS) regression to identify relationships between news and social media exposure, misperceptions, compliance with social distancing measures, and risk perceptions. We use these data to illustrate: 1) the relative prevalence of misinformation on Twitter; and 2) a powerful association between social media usage and misperceptions, on the one hand, and social distancing non-compliance on the other.
Misinformation and compliance with social distancing
We first compare the presence of misinformation on Twitter with that on news media and find, consistent with the other country cases (Chadwick & Vaccari, 2019; Vicario et al., 2016), comparatively higher levels of misinformation circulating on the social media platform. We also found that recommendations for safe practices during the pandemic (e.g. washing hands, social distancing) appeared much more frequently in the Canadian news media. These findings are in line with literature examining fake news which finds a large difference in information quality across media (Al-Rawi, 2019; Guess & Nyhan, 2018).
Spending time in a media environment that contains misinformation is likely to change attitudes and behaviours. Even if users are not nested in networks that propagate misinformation, they are likely to be incidentally exposed to information from a variety of perspectives (Feezell, 2018; Fletcher & Nielsen, 2018; Weeks et al., 2017). Even a highly curated social media feed is thus still likely to contain misinformation. As cumulative exposure to misinformation increases, users are likely to experience a reinforcement effect whereby familiarity leads to stronger belief (Dechêne et al., 2010).
To evaluate this empirically, we conducted a national survey that included questions on information consumption habits and a battery of COVID-19 misperceptions that could be the result of exposure to misinformation. We find that those who self-report exposure to the misinformation-rich social media environment do tend to have more misperceptions regarding COVID-19. These findings are consistent with others that link exposure to misinformation and misperceptions (Garrett et al., 2016; Jamieson & Albarracín, 2020). Social media users also self-report less compliance with social distancing.
Misperceptions are most meaningful when they impact behaviors in dangerous ways. During a pandemic, misperceptions can be fatal. In this case, we find that misperceptions are associated with reduced COVID-19 risk perceptions and with lower compliance with social distancing measures. We continue to find strong effects after controlling for socio-economic characteristics as well as scientific literacy. After accounting for the effect of misperceptions on social distancing non-compliance, social media usage no longer has a significant association with non-compliance, providing evidence that social media may lead to less social distancing compliance through its effect on COVID-19 misperceptions.
While some social media companies have made efforts to suppress misinformation on their platforms, there continues to be a high level of misinformation relative to news media. Highly polarized political environments and media ecosystems can lead to the spread of misinformation, such as in the United States during the COVID-19 pandemic (Allcott et al., 2020; Motta et al., 2020). But even in healthy media ecosystems with less partisan news (Owen et al., 2020), social media can continue to facilitate the spread of misinformation. There is a real danger that without concerted efforts to reduce the amount of misinformation shared on social media, the large-scale social efforts required to combat COVID-19 will be undermined.
We contribute to a growing base of evidence that misinformation circulating on social media poses public health risks and join others in calling for social media companies to put greater focus on flattening the curve of misinformation (Donovan, 2020). These findings also provide governments with stronger evidence that the misinformation circulating on social media can be directly linked to misperceptions and public health risks. Such evidence is essential for them to chart an effective policy course. Finally, the methods and approach developed in this paper can be fruitfully applied to study other waves of misinformation and the research community can build upon the link clearly drawn between misinformation exposure, misperceptions, and downstream attitudes and behaviours.
We found use of social media platforms broadly contributes to misperceptions but were unable to precise the overall level of misinformation circulating on non-Twitter social media. Data access for researchers to platforms such as Facebook, YouTube, and Instagram is limited and virtually non-existent for SnapChat, WhatsApp, and WeChat. Cross-platform content comparisons are an important ingredient for a rich understand of the social media environment and these social media companies must better open their platforms to research in the public interest.
Finding 1: Misinformation about COVID-19 is circulated more on Twitter as compared to traditional media.
We find large differences between the quality of information shared about COVID-19 on traditional news and Twitter. Figure 1 shows the percentage of COVID-19 related content that contains information linked to a particular theme. The plot reports the prevalence of information on both social and news media for: 1) three specific pieces of misinformation; 2) a general set of content that describes the pandemic itself as a conspiracy or a hoax; and 3) advice about hygiene and social distancing during the pandemic. We differentiate content that shared misinformation (red in the plot) from content that debunked misinformation (green in the plot).
There are large differences between the levels of misinformation on Twitter and news media. Misinformation was comparatively more common on Twitter across all four categories, while debunking was relatively more common in traditional news. Meanwhile, advice on hygiene and social distancing appeared much more frequently in news media. Note that higher percentages are to be expected for longer format news articles since we rely on keyword searches for identification. This makes the misinformation findings even starker – despite much higher average word counts, far fewer news articles propagate misinformation.
Finding 2: There is a strong association between social media exposure and misperceptions about COVID-19. The inverse is true for exposure to traditional news.
Among our survey respondents we find a corresponding strong association between social media exposure and misperceptions about COVID-19. These results are plotted in Figure 2, with controls included for both socioeconomic characteristics and demographics. Moving from no social media exposure to its maximum is expected to increase one’s misperceptions of COVID-19 by 0.22 on the 0-1 scale and decreased self-reported social distancing compliance by 0.12 on that same scale.
This result stands in stark contrast with the observed relationship between traditional news exposure and our outcome measures. Traditional news exposure is positively associated with correct perceptions regarding COVID-19. Moving from no news exposure to its highest level is expected to reduce misperceptions by 0.12 on the 0-1 scale and to increase social distancing compliance by 0.28 on that same scale. The effects are plotted in Figure 2. Social media usage appears to be correlated with COVID-19 misperceptions, suggesting these misperceptions are partially a result of misinformation on social media. The same cannot be said of traditional news exposure.
Finding 3: Misperceptions about the pandemic are associated with lower levels of risk perceptions and social distancing compliance.
COVID-19 misperceptions are also powerfully associated with lower levels of social distancing compliance. Moving from the lowest level of COVID-19 misperceptions to its maximum is associated with a reduction of one’s social distancing by 0.39 on the 0-1 scale. The previously observed relationship between social media exposure and misperceptions disappears, suggestive of a mediated relationship. That is, social media exposure increases misperceptions, which in turn reduces social distancing compliance. Misperceptions is also weakly associated with lower COVID-19 risk perceptions. Estimates from our models using COVID-19 concern as the outcome can be found in the left panel of Figure 3, while social distancing can be found in the right panel.
Finally, we also see that the relationship between misinformation and both social distancing compliance and COVID-19 concern hold when including controls for science literacy and a number of fundamental predispositions that are likely associated with both misperceptions and following the advice of scientific experts, such as anti-intellectualism, pseudoscientific beliefs, and left-right ideology. These estimates can similarly be found in Figure 3.
Canadian Twitter and news data were collected from March 26 th to April 6 th , 2020. We collected all English-language tweets from a set of 620,000 users that have been determined to be likely Canadians. For inclusion, a given user must self-identify as Canadian-based, follow a large number of Canadian political elite accounts, or frequently use Canadian-specific hashtags. News media was collected from nineteen prominent Canadian news sites with active RSS feeds. These tweets and news articles were searched for “covid” or “coronavirus”, leaving a sample of 2.25 million tweets and 8,857 news articles.
Of the COVID-19 related content, we searched for terms associated with four instances of misinformation that circulated during the COVID-19 pandemic: that COVID-19 was no more serious than the flu, that vitamin C or other supplements will prevent contraction of the virus, that the initial animal-to-human transfer of the virus was the direct result of eating bats, or that COVID-19 was a hoax or conspiracy. Given that we used keyword searches to identify content, we manually reviewed a random sample of 500 tweets from each instance of misinformation. Each tweet was coded as one of four categories: propagating misinformation, combatting misinformation, content with the relevant keywords but unrelated to misinformation, or content that refers to the misinformation but does not offer comment.
We then calculated the overall level of misinformation for that instance on Twitter by multiplying the overall volume of tweets by the proportion of hand-coded content where misinformation was identified. Each news article that included relevant keywords was similarly coded. The volume of the news mentioning these terms was sufficiently low that all news articles were hand coded. To identify health recommendations, we used a similar keyword search for terms associated with particular recommendations: 1) social distancing including staying at home, staying at least 6 feet or 2 meters away and avoiding gatherings; and 2) washing hands and not touching any part of your face. 1 Further details on the media collection strategy and hand-coding schema are available in the supporting materials.
For survey data, we used a sample of nearly 2,500 Canadian citizens 18 years or older drawn from a probability-based online national panel fielded from April 2-6, 2020. Quotas we set on age, gender, region, and language to ensure sample representativeness, and data was further weighted within region by gender and age based on the 2016 Canadian census.
We measure levels of COVID-19 misperceptions by asking respondents to rate the truthfulness of a series of nine false claims, such as the coronavirus being no worse than the seasonal flu or that it can be warded off with Vitamin C. Each was asked on a scale from definitely false (0) to definitely true (5). We use Cronbach’s Alpha as an indicator of scale reliability. Cronbach’s Alpha ranges from 0-1, with scores above 0.8 indicating the reliability is “good.” These items score 0.88, so we can safely construct a 0-1 scale of misperceptions from them.
We evaluate COVID-19 risk perceptions with a pair of questions asking respondents how serious of a threat they believe the pandemic to be for themselves and for Canadians, respectively. Each question was asked on a scale from not at all (0) to very (4). We construct a continuous index with these items.
We quantify social distancing by asking respondents to indicate which of a series of behaviours they had undertaken in response to the pandemic, such as working from home or avoiding in-person contact with friends, family, and acquaintances. We use principal component analysis (PCA) to reduce the number of dimensions in these data while minimizing information loss. The analysis revealed 2 distinct dimensions in our questions. One dimension includes factors strongly determined by occupation, such as working from home and switching to online meetings. The other dimension contains more inclusive behaviours such as avoiding contact, travel, and crowded places. We generate predictions from the PCA for this latter dimension to use in our analyses. The factor loadings can be found in Table A1 of the supporting materials.
We gauge news and social media consumption by asking respondents to identify news outlets and social media platforms they have used over the past week for political news. The list of news outlets included 17 organizations such as mainstream sources like CBC and Global, and partisan outlets like Rebel Media and National Observer. The list of social media platforms included 10 options such as Facebook, Twitter, YouTube, and Instagram. We sum the total number of outlets/platforms respondents report using and take the log to adjust for extreme values. We measure offline political discussion with an index based on questions asking how often respondents have discussed politics with family, friends, and acquaintances over the past week. Descriptions of our primary variables can be found in Table A2 of the supporting materials.
We evaluate our hypotheses using a standard design that evaluates the association between our explanatory and outcome variables controlling for other observable factors we measured. In practice, randomly assigning social media exposure is impractical, while randomly assigning misinformation is unethical. This approach allows us to describe these relationships, though we cannot make definite claims to causality.
We hypothesize that social media exposure is associated with misinformation on COVID-19. Figure 2 presents the coefficients of models predicting the effects of news exposure, social media exposure, and political discussion on COVID-19 misinformation, risk perceptions, and social distancing. Socio-economic and demographic control estimates are not displayed. Full estimation results can be found in the Table A3 of the supporting materials.
We further hypothesize that COVID-19 misinformation is associated with lower COVID-19 risk perceptions and less social distancing compliance. Figure 3 presents the coefficients for models predicting the effects of misinformation, news exposure, and social media exposure on severity perceptions and social distancing. We show models with and without controls for science literacy and other predispositions. Full estimation results can be found in the Table A4 of the supporting materials.
Limitations and robustness
A study such as this comes with clear limitations. First, we have evaluated information coming from only a section of the overall media ecosystem and during a specific time-period. The level of misinformation differs across platforms and online news sites and a more granular investigation into these dynamics would be valuable. Our analysis suggests that similar dynamics exist across social media platforms, however. In the supplementary materials we show that associations between misperceptions and social media usage are even higher for other social media platforms, suggesting that our analysis of Twitter content may underrepresent the prevalence of misinformation on social media writ large. As noted above, existing limitations on data access make such cross-platform research difficult.
Second, our data is drawn from a single country and language case study and other countries may have different media environments and levels of misinformation circulating on social media. We anticipate the underlying dynamics found in this paper to hold across these contexts, however. Those who consume information from platforms where misinformation is more prevalent will have greater misperceptions and that these misperceptions will be linked to lower compliance with social distancing and lower risk perceptions. Third, an ecological problem is present wherein we do not link survey respondents directly to their social media consumption (and evaluation of the misinformation they are exposed to) and lack the ability to randomly assign social media exposure to make a strong causal argument. We cannot and do not make a causal argument here but argue instead that there is strong evidence for a misinformation to misperceptions to lower social distancing compliance link.
- / Fake News
- / Mainstream Media
- / Public Health
- / Social Media
Cite this Essay
Bridgman, A., Merkley, E., Loewen, P. J., Owen, T., Ruths, D., Teichmann, L., & Zhilin, O. (2020). The causes and consequences of COVID-19 misperceptions: Understanding the role of news and social media. Harvard Kennedy School (HKS) Misinformation Review . https://doi.org/10.37016/mr-2020-028
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The project was funded through the Department of Canadian Heritage’s Digital Citizens Initiative.
Competing Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
The research protocol was approved by the institutional review board at University of Toronto. Human subjects gave informed consent before participating and were debriefed at the end of the study.
This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided that the original author and source are properly credited.
Data Availability
All materials needed to replicate this study are available via the Harvard Dataverse: https://doi.org/10.7910/DVN/5QS2XP .
STUDENT ESSAY The Disproportional Impact of COVID-19 on African Americans
Volume 22/2, December 2020, pp 299-307
Maritza Vasquez Reyes
Introduction
We all have been affected by the current COVID-19 pandemic. However, the impact of the pandemic and its consequences are felt differently depending on our status as individuals and as members of society. While some try to adapt to working online, homeschooling their children and ordering food via Instacart, others have no choice but to be exposed to the virus while keeping society functioning. Our different social identities and the social groups we belong to determine our inclusion within society and, by extension, our vulnerability to epidemics.
COVID-19 is killing people on a large scale. As of October 10, 2020, more than 7.7 million people across every state in the United States and its four territories had tested positive for COVID-19. According to the New York Times database, at least 213,876 people with the virus have died in the United States. [1] However, these alarming numbers give us only half of the picture; a closer look at data by different social identities (such as class, gender, age, race, and medical history) shows that minorities have been disproportionally affected by the pandemic. These minorities in the United States are not having their right to health fulfilled.
According to the World Health Organization’s report Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health , “poor and unequal living conditions are the consequences of deeper structural conditions that together fashion the way societies are organized—poor social policies and programs, unfair economic arrangements, and bad politics.” [2] This toxic combination of factors as they play out during this time of crisis, and as early news on the effect of the COVID-19 pandemic pointed out, is disproportionately affecting African American communities in the United States. I recognize that the pandemic has had and is having devastating effects on other minorities as well, but space does not permit this essay to explore the impact on other minority groups.
Employing a human rights lens in this analysis helps us translate needs and social problems into rights, focusing our attention on the broader sociopolitical structural context as the cause of the social problems. Human rights highlight the inherent dignity and worth of all people, who are the primary rights-holders. [3] Governments (and other social actors, such as corporations) are the duty-bearers, and as such have the obligation to respect, protect, and fulfill human rights. [4] Human rights cannot be separated from the societal contexts in which they are recognized, claimed, enforced, and fulfilled. Specifically, social rights, which include the right to health, can become important tools for advancing people’s citizenship and enhancing their ability to participate as active members of society. [5] Such an understanding of social rights calls our attention to the concept of equality, which requires that we place a greater emphasis on “solidarity” and the “collective.” [6] Furthermore, in order to generate equality, solidarity, and social integration, the fulfillment of social rights is not optional. [7] In order to fulfill social integration, social policies need to reflect a commitment to respect and protect the most vulnerable individuals and to create the conditions for the fulfillment of economic and social rights for all.
Disproportional impact of COVID-19 on African Americans
As noted by Samuel Dickman et al.:
economic inequality in the US has been increasing for decades and is now among the highest in developed countries … As economic inequality in the US has deepened, so too has inequality in health. Both overall and government health spending are higher in the US than in other countries, yet inadequate insurance coverage, high-cost sharing by patients, and geographical barriers restrict access to care for many. [8]
For instance, according to the Kaiser Family Foundation, in 2018, 11.7% of African Americans in the United States had no health insurance, compared to 7.5% of whites. [9]
Prior to the Affordable Care Act—enacted into law in 2010—about 20% of African Americans were uninsured. This act helped lower the uninsured rate among nonelderly African Americans by more than one-third between 2013 and 2016, from 18.9% to 11.7%. However, even after the law’s passage, African Americans have higher uninsured rates than whites (7.5%) and Asian Americans (6.3%). [10] The uninsured are far more likely than the insured to forgo needed medical visits, tests, treatments, and medications because of cost.
As the COVID-19 virus made its way throughout the United States, testing kits were distributed equally among labs across the 50 states, without consideration of population density or actual needs for testing in those states. An opportunity to stop the spread of the virus during its early stages was missed, with serious consequences for many Americans. Although there is a dearth of race-disaggregated data on the number of people tested, the data that are available highlight African Americans’ overall lack of access to testing. For example, in Kansas, as of June 27, according to the COVID Racial Data Tracker, out of 94,780 tests, only 4,854 were from black Americans and 50,070 were from whites. However, blacks make up almost a third of the state’s COVID-19 deaths (59 of 208). And while in Illinois the total numbers of confirmed cases among blacks and whites were almost even, the test numbers show a different picture: 220,968 whites were tested, compared to only 78,650 blacks. [11]
Similarly, American Public Media reported on the COVID-19 mortality rate by race/ethnicity through July 21, 2020, including Washington, DC, and 45 states (see figure 1). These data, while showing an alarming death rate for all races, demonstrate how minorities are hit harder and how, among minority groups, the African American population in many states bears the brunt of the pandemic’s health impact.
Approximately 97.9 out of every 100,000 African Americans have died from COVID-19, a mortality rate that is a third higher than that for Latinos (64.7 per 100,000), and more than double than that for whites (46.6 per 100,000) and Asians (40.4 per 100,000). The overrepresentation of African Americans among confirmed COVID-19 cases and number of deaths underscores the fact that the coronavirus pandemic, far from being an equalizer, is amplifying or even worsening existing social inequalities tied to race, class, and access to the health care system.
Considering how African Americans and other minorities are overrepresented among those getting infected and dying from COVID-19, experts recommend that more testing be done in minority communities and that more medical services be provided. [12] Although the law requires insurers to cover testing for patients who go to their doctor’s office or who visit urgent care or emergency rooms, patients are fearful of ending up with a bill if their visit does not result in a COVID test. Furthermore, minority patients who lack insurance or are underinsured are less likely to be tested for COVID-19, even when experiencing alarming symptoms. These inequitable outcomes suggest the importance of increasing the number of testing centers and contact tracing in communities where African Americans and other minorities reside; providing testing beyond symptomatic individuals; ensuring that high-risk communities receive more health care workers; strengthening social provision programs to address the immediate needs of this population (such as food security, housing, and access to medicines); and providing financial protection for currently uninsured workers.
Social determinants of health and the pandemic’s impact on African Americans’ health outcomes
In international human rights law, the right to health is a claim to a set of social arrangements—norms, institutions, laws, and enabling environment—that can best secure the enjoyment of this right. The International Covenant on Economic, Social and Cultural Rights sets out the core provision relating to the right to health under international law (article 12). [13] The United Nations Committee on Economic, Social and Cultural Rights is the body responsible for interpreting the covenant. [14] In 2000, the committee adopted a general comment on the right to health recognizing that the right to health is closely related to and dependent on the realization of other human rights. [15] In addition, this general comment interprets the right to health as an inclusive right extending not only to timely and appropriate health care but also to the determinants of health. [16] I will reflect on four determinants of health—racism and discrimination, poverty, residential segregation, and underlying medical conditions—that have a significant impact on the health outcomes of African Americans.
Racism and discrimination
In spite of growing interest in understanding the association between the social determinants of health and health outcomes, for a long time many academics, policy makers, elected officials, and others were reluctant to identify racism as one of the root causes of racial health inequities. [17] To date, many of the studies conducted to investigate the effect of racism on health have focused mainly on interpersonal racial and ethnic discrimination, with comparatively less emphasis on investigating the health outcomes of structural racism. [18] The latter involves interconnected institutions whose linkages are historically rooted and culturally reinforced. [19] In the context of the COVID-19 pandemic, acts of discrimination are taking place in a variety of contexts (for example, social, political, and historical). In some ways, the pandemic has exposed existing racism and discrimination.
Poverty (low-wage jobs, insurance coverage, homelessness, and jails and prisons)
Data drawn from the 2018 Current Population Survey to assess the characteristics of low-income families by race and ethnicity shows that of the 7.5 million low-income families with children in the United States, 20.8% were black or African American (while their percentage of the population in 2018 was only 13.4%). [20] Low-income racial and ethnic minorities tend to live in densely populated areas and multigenerational households. These living conditions make it difficult for low-income families to take necessary precautions for their safety and the safety of their loved ones on a regular basis. [21] This fact becomes even more crucial during a pandemic.
Low-wage jobs: The types of work where people in some racial and ethnic groups are overrepresented can also contribute to their risk of getting sick with COVID-19. Nearly 40% of African American workers, more than seven million, are low-wage workers and have jobs that deny them even a single paid sick day. Workers without paid sick leave might be more likely to continue to work even when they are sick. [22] This can increase workers’ exposure to other workers who may be infected with the COVID-19 virus.
Similarly, the Centers for Disease Control has noted that many African Americans who hold low-wage but essential jobs (such as food service, public transit, and health care) are required to continue to interact with the public, despite outbreaks in their communities, which exposes them to higher risks of COVID-19 infection. According to the Centers for Disease Control, nearly a quarter of employed Hispanic and black or African American workers are employed in service industry jobs, compared to 16% of non-Hispanic whites. Blacks or African Americans make up 12% of all employed workers but account for 30% of licensed practical and licensed vocational nurses, who face significant exposure to the coronavirus. [23]
In 2018, 45% of low-wage workers relied on an employer for health insurance. This situation forces low-wage workers to continue to go to work even when they are not feeling well. Some employers allow their workers to be absent only when they test positive for COVID-19. Given the way the virus spreads, by the time a person knows they are infected, they have likely already infected many others in close contact with them both at home and at work. [24]
Homelessness : Staying home is not an option for the homeless. African Americans, despite making up just 13% of the US population, account for about 40% of the nation’s homeless population, according to the Annual Homeless Assessment Report to Congress. [25] Given that people experiencing homelessness often live in close quarters, have compromised immune systems, and are aging, they are exceptionally vulnerable to communicable diseases—including the coronavirus that causes COVID-19.
Jails and prisons : Nearly 2.2 million people are in US jails and prisons, the highest rate in the world. According to the US Bureau of Justice, in 2018, the imprisonment rate among black men was 5.8 times that of white men, while the imprisonment rate among black women was 1.8 times the rate among white women. [26] This overrepresentation of African Americans in US jails and prisons is another indicator of the social and economic inequality affecting this population.
According to the Committee on Economic, Social and Cultural Rights’ General Comment 14, “states are under the obligation to respect the right to health by, inter alia , refraining from denying or limiting equal access for all persons—including prisoners or detainees, minorities, asylum seekers and illegal immigrants—to preventive, curative, and palliative health services.” [27] Moreover, “states have an obligation to ensure medical care for prisoners at least equivalent to that available to the general population.” [28] However, there has been a very limited response to preventing transmission of the virus within detention facilities, which cannot achieve the physical distancing needed to effectively prevent the spread of COVID-19. [29]
Residential segregation
Segregation affects people’s access to healthy foods and green space. It can also increase excess exposure to pollution and environmental hazards, which in turn increases the risk for diabetes and heart and kidney diseases. [30] African Americans living in impoverished, segregated neighborhoods may live farther away from grocery stores, hospitals, and other medical facilities. [31] These and other social and economic inequalities, more so than any genetic or biological predisposition, have also led to higher rates of African Americans contracting the coronavirus. To this effect, sociologist Robert Sampson states that the coronavirus is exposing class and race-based vulnerabilities. He refers to this factor as “toxic inequality,” especially the clustering of COVID-19 cases by community, and reminds us that African Americans, even if they are at the same level of income or poverty as white Americans or Latino Americans, are much more likely to live in neighborhoods that have concentrated poverty, polluted environments, lead exposure, higher rates of incarceration, and higher rates of violence. [32]
Many of these factors lead to long-term health consequences. The pandemic is concentrating in urban areas with high population density, which are, for the most part, neighborhoods where marginalized and minority individuals live. In times of COVID-19, these concentrations place a high burden on the residents and on already stressed hospitals in these regions. Strategies most recommended to control the spread of COVID-19—social distancing and frequent hand washing—are not always practical for those who are incarcerated or for the millions who live in highly dense communities with precarious or insecure housing, poor sanitation, and limited access to clean water.
Underlying health conditions
African Americans have historically been disproportionately diagnosed with chronic diseases such as asthma, hypertension and diabetes—underlying conditions that may make COVID-19 more lethal. Perhaps there has never been a pandemic that has brought these disparities so vividly into focus.
Doctor Anthony Fauci, an immunologist who has been the director of the National Institute of Allergy and Infectious Diseases since 1984, has noted that “it is not that [African Americans] are getting infected more often. It’s that when they do get infected, their underlying medical conditions … wind them up in the ICU and ultimately give them a higher death rate.” [33]
One of the highest risk factors for COVID-19-related death among African Americans is hypertension. A recent study by Khansa Ahmad et al. analyzed the correlation between poverty and cardiovascular diseases, an indicator of why so many black lives are lost in the current health crisis. The authors note that the American health care system has not yet been able to address the higher propensity of lower socioeconomic classes to suffer from cardiovascular disease. [34] Besides having higher prevalence of chronic conditions compared to whites, African Americans experience higher death rates. These trends existed prior to COVID-19, but this pandemic has made them more visible and worrisome.
Addressing the impact of COVID-19 on African Americans: A human rights-based approach
The racially disparate death rate and socioeconomic impact of the COVID-19 pandemic and the discriminatory enforcement of pandemic-related restrictions stand in stark contrast to the United States’ commitment to eliminate all forms of racial discrimination. In 1965, the United States signed the International Convention on the Elimination of All Forms of Racial Discrimination, which it ratified in 1994. Article 2 of the convention contains fundamental obligations of state parties, which are further elaborated in articles 5, 6, and 7. [35] Article 2 of the convention stipulates that “each State Party shall take effective measures to review governmental, national and local policies, and to amend, rescind or nullify any laws and regulations which have the effect of creating or perpetuating racial discrimination wherever it exists” and that “each State Party shall prohibit and bring to an end, by all appropriate means, including legislation as required by circumstances, racial discrimination by any persons, group or organization.” [36]
Perhaps this crisis will not only greatly affect the health of our most vulnerable community members but also focus public attention on their rights and safety—or lack thereof. Disparate COVID-19 mortality rates among the African American population reflect longstanding inequalities rooted in systemic and pervasive problems in the United States (for example, racism and the inadequacy of the country’s health care system). As noted by Audrey Chapman, “the purpose of a human right is to frame public policies and private behaviors so as to protect and promote the human dignity and welfare of all members and groups within society, particularly those who are vulnerable and poor, and to effectively implement them.” [37] A deeper awareness of inequity and the role of social determinants demonstrates the importance of using right to health paradigms in response to the pandemic.
The Committee on Economic, Social and Cultural Rights has proposed some guidelines regarding states’ obligation to fulfill economic and social rights: availability, accessibility, acceptability, and quality. These four interrelated elements are essential to the right to health. They serve as a framework to evaluate states’ performance in relation to their obligation to fulfill these rights. In the context of this pandemic, it is worthwhile to raise the following questions: What can governments and nonstate actors do to avoid further marginalizing or stigmatizing this and other vulnerable populations? How can health justice and human rights-based approaches ground an effective response to the pandemic now and build a better world afterward? What can be done to ensure that responses to COVID-19 are respectful of the rights of African Americans? These questions demand targeted responses not just in treatment but also in prevention. The following are just some initial reflections:
First, we need to keep in mind that treating people with respect and human dignity is a fundamental obligation, and the first step in a health crisis. This includes the recognition of the inherent dignity of people, the right to self-determination, and equality for all individuals. A commitment to cure and prevent COVID-19 infections must be accompanied by a renewed commitment to restore justice and equity.
Second, we need to strike a balance between mitigation strategies and the protection of civil liberties, without destroying the economy and material supports of society, especially as they relate to minorities and vulnerable populations. As stated in the Siracusa Principles, “[state restrictions] are only justified when they support a legitimate aim and are: provided for by law, strictly necessary, proportionate, of limited duration, and subject to review against abusive applications.” [38] Therefore, decisions about individual and collective isolation and quarantine must follow standards of fair and equal treatment and avoid stigma and discrimination against individuals or groups. Vulnerable populations require direct consideration with regard to the development of policies that can also protect and secure their inalienable rights.
Third, long-term solutions require properly identifying and addressing the underlying obstacles to the fulfillment of the right to health, particularly as they affect the most vulnerable. For example, we need to design policies aimed at providing universal health coverage, paid family leave, and sick leave. We need to reduce food insecurity, provide housing, and ensure that our actions protect the climate. Moreover, we need to strengthen mental health and substance abuse services, since this pandemic is affecting people’s mental health and exacerbating ongoing issues with mental health and chemical dependency. As noted earlier, violations of the human rights principles of equality and nondiscrimination were already present in US society prior to the pandemic. However, the pandemic has caused “an unprecedented combination of adversities which presents a serious threat to the mental health of entire populations, and especially to groups in vulnerable situations.” [39] As Dainius Pūras has noted, “the best way to promote good mental health is to invest in protective environments in all settings.” [40] These actions should take place as we engage in thoughtful conversations that allow us to assess the situation, to plan and implement necessary interventions, and to evaluate their effectiveness.
Finally, it is important that we collect meaningful, systematic, and disaggregated data by race, age, gender, and class. Such data are useful not only for promoting public trust but for understanding the full impact of this pandemic and how different systems of inequality intersect, affecting the lived experiences of minority groups and beyond. It is also important that such data be made widely available, so as to enhance public awareness of the problem and inform interventions and public policies.
In 1966, Dr. Martin Luther King Jr. said, “Of all forms of inequality, injustice in health is the most shocking and inhuman.” [41] More than 54 years later, African Americans still suffer from injustices that are at the basis of income and health disparities. We know from previous experiences that epidemics place increased demands on scarce resources and enormous stress on social and economic systems.
A deeper understanding of the social determinants of health in the context of the current crisis, and of the role that these factors play in mediating the impact of the COVID-19 pandemic on African Americans’ health outcomes, increases our awareness of the indivisibility of all human rights and the collective dimension of the right to health. We need a more explicit equity agenda that encompasses both formal and substantive equality. [42] Besides nondiscrimination and equality, participation and accountability are equally crucial.
Unfortunately, as suggested by the limited available data, African American communities and other minorities in the United States are bearing the brunt of the current pandemic. The COVID-19 crisis has served to unmask higher vulnerabilities and exposure among people of color. A thorough reflection on how to close this gap needs to start immediately. Given that the COVID-19 pandemic is more than just a health crisis—it is disrupting and affecting every aspect of life (including family life, education, finances, and agricultural production)—it requires a multisectoral approach. We need to build stronger partnerships among the health care sector and other social and economic sectors. Working collaboratively to address the many interconnected issues that have emerged or become visible during this pandemic—particularly as they affect marginalized and vulnerable populations—offers a more effective strategy.
Moreover, as Delan Devakumar et al. have noted:
the strength of a healthcare system is inseparable from broader social systems that surround it. Health protection relies not only on a well-functioning health system with universal coverage, which the US could highly benefit from, but also on social inclusion, justice, and solidarity. In the absence of these factors, inequalities are magnified and scapegoating persists, with discrimination remaining long after. [43]
This current public health crisis demonstrates that we are all interconnected and that our well-being is contingent on that of others. A renewed and healthy society is possible only if governments and public authorities commit to reducing vulnerability and the impact of ill-health by taking steps to respect, protect, and fulfill the right to health. [44] It requires that government and nongovernment actors establish policies and programs that promote the right to health in practice. [45] It calls for a shared commitment to justice and equality for all.
Maritza Vasquez Reyes, MA, LCSW, CCM, is a PhD student and Research and Teaching Assistant at the UConn School of Social Work, University of Connecticut, Hartford, USA.
Please address correspondence to the author. Email: [email protected]
Competing interests: None declared.
Copyright © 2020 Vasquez Reyes. This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original author and source are credited.
[1] “Coronavirus in the U.S.: Latest map and case count,” New York Times (October 10, 2020). Available at https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html.
[2] World Health Organization Commission on the Social Determinants of Health, Closing the gap in a generation: Health equity through action on the social determinants of health (Geneva: World Health Organization, 2008), p. 1.
[3] S. Hertel and L. Minkler, Economic rights: Conceptual, measurement, and policy issues (New York: Cambridge University Press, 2007); S. Hertel and K. Libal, Human rights in the United States: Beyond exceptionalism (Cambridge: Cambridge University Press, 2011); D. Forsythe, Human rights in international relations , 2nd edition (Cambridge: Cambridge University Press, 2006).
[4] Danish Institute for Human Rights, National action plans on business and human rights (Copenhagen: Danish Institute for Human Rights, 2014).
[5] J. R. Blau and A. Moncada, Human rights: Beyond the liberal vision (Lanham, MD: Rowman and Littlefield, 2005).
[6] J. R. Blau. “Human rights: What the United States might learn from the rest of the world and, yes, from American sociology,” Sociological Forum 31/4 (2016), pp. 1126–1139; K. G. Young and A. Sen, The future of economic and social rights (New York: Cambridge University Press, 2019).
[7] Young and Sen (see note 6).
[8] S. Dickman, D. Himmelstein, and S. Woolhandler, “Inequality and the health-care system in the USA,” Lancet , 389/10077 (2017), p. 1431.
[9] S. Artega, K. Orgera, and A. Damico, “Changes in health insurance coverage and health status by race and ethnicity, 2010–2018 since the ACA,” KFF (March 5, 2020). Available at https://www.kff.org/disparities-policy/issue-brief/changes-in-health-coverage-by-race-and-ethnicity-since-the-aca-2010-2018/.
[10] H. Sohn, “Racial and ethnic disparities in health insurance coverage: Dynamics of gaining and losing coverage over the life-course,” Population Research and Policy Review 36/2 (2017), pp. 181–201.
[11] Atlantic Monthly Group, COVID tracking project . Available at https://covidtracking.com .
[12] “Why the African American community is being hit hard by COVID-19,” Healthline (April 13, 2020). Available at https://www.healthline.com/health-news/covid-19-affecting-people-of-color#What-can-be-done?.
[13] World Health Organization, 25 questions and answers on health and human rights (Albany: World Health Organization, 2002).
[14] Ibid; Hertel and Libal (see note 3).
[17] Z. Bailey, N. Krieger, M. Agénor et al., “Structural racism and health inequities in the USA: Evidence and interventions,” Lancet 389/10077 (2017), pp. 1453–1463.
[20] US Census. Available at https://www.census.gov/library/publications/2019/demo/p60-266.html.
[21] M. Simms, K. Fortuny, and E. Henderson, Racial and ethnic disparities among low-income families (Washington, D.C.: Urban Institute Publications, 2009).
[23] Centers for Disease Control and Prevention, Health Equity Considerations and Racial and Ethnic Minority Groups (2020). Available at https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/race-ethnicity.html.
[24] Artega et al. (see note 9).
[25] K. Allen, “More than 50% of homeless families are black, government report finds,” ABC News (January 22, 2020). Available at https://abcnews.go.com/US/50-homeless-families-black-government-report-finds/story?id=68433643.
[26] A. Carson, Prisoners in 2018 (US Department of Justice, 2020). Available at https://www.bjs.gov/content/pub/pdf/p18.pdf.
[27] United Nations Committee on Economic, Social and Cultural Rights, General Comment No. 14, The Right to the Highest Attainable Standard of Health, UN Doc. E/C.12/2000/4 (2000).
[28] J. J. Amon, “COVID-19 and detention,” Health and Human Rights 22/1 (2020), pp. 367–370.
[30] L. Pirtle and N. Whitney, “Racial capitalism: A fundamental cause of novel coronavirus (COVID-19) pandemic inequities in the United States,” Health Education and Behavior 47/4 (2020), pp. 504–508.
[31] Ibid; R. Sampson, “The neighborhood context of well-being,” Perspectives in Biology and Medicine 46/3 (2003), pp. S53–S64.
[32] C. Walsh, “Covid-19 targets communities of color,” Harvard Gazette (April 14, 2020). Available at https://news.harvard.edu/gazette/story/2020/04/health-care-disparities-in-the-age-of-coronavirus/.
[33] B. Lovelace Jr., “White House officials worry the coronavirus is hitting African Americans worse than others,” CNBC News (April 7, 2020). Available at https://www.cnbc.com/2020/04/07/white-house-officials-worry-the-coronavirus-is-hitting-african-americans-worse-than-others.html.
[34] K. Ahmad, E. W. Chen, U. Nazir, et al., “Regional variation in the association of poverty and heart failure mortality in the 3135 counties of the United States,” Journal of the American Heart Association 8/18 (2019).
[35] D. Desierto, “We can’t breathe: UN OHCHR experts issue joint statement and call for reparations” (EJIL Talk), Blog of the European Journal of International Law (June 5, 2020). Available at https://www.ejiltalk.org/we-cant-breathe-un-ohchr-experts-issue-joint-statement-and-call-for-reparations/.
[36] International Convention on the Elimination of All Forms of Racial Discrimination, G. A. Res. 2106 (XX) (1965), art. 2.
[37] A. Chapman, Global health, human rights and the challenge of neoliberal policies (Cambridge: Cambridge University Press, 2016), p. 17.
[38] N. Sun, “Applying Siracusa: A call for a general comment on public health emergencies,” Health and Human Rights Journal (April 23, 2020).
[39] D. Pūras, “COVID-19 and mental health: Challenges ahead demand changes,” Health and Human Rights Journal (May 14, 2020).
[41] M. Luther King Jr, “Presentation at the Second National Convention of the Medical Committee for Human Rights,” Chicago, March 25, 1966.
[42] Chapman (see note 35).
[43] D. Devakumar, G. Shannon, S. Bhopal, and I. Abubakar, “Racism and discrimination in COVID-19 responses,” Lancet 395/10231 (2020), p. 1194.
[44] World Health Organization (see note 12).
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Effects of COVID-19 pandemic in daily life
Dear Editor,
COVID-19 (Coronavirus) has affected day to day life and is slowing down the global economy. This pandemic has affected thousands of peoples, who are either sick or are being killed due to the spread of this disease. The most common symptoms of this viral infection are fever, cold, cough, bone pain and breathing problems, and ultimately leading to pneumonia. This, being a new viral disease affecting humans for the first time, vaccines are not yet available. Thus, the emphasis is on taking extensive precautions such as extensive hygiene protocol (e.g., regularly washing of hands, avoidance of face to face interaction etc.), social distancing, and wearing of masks, and so on. This virus is spreading exponentially region wise. Countries are banning gatherings of people to the spread and break the exponential curve. 1 , 2 Many countries are locking their population and enforcing strict quarantine to control the spread of the havoc of this highly communicable disease.
COVID-19 has rapidly affected our day to day life, businesses, disrupted the world trade and movements. Identification of the disease at an early stage is vital to control the spread of the virus because it very rapidly spreads from person to person. Most of the countries have slowed down their manufacturing of the products. 3 , 4 The various industries and sectors are affected by the cause of this disease; these include the pharmaceuticals industry, solar power sector, tourism, Information and electronics industry. This virus creates significant knock-on effects on the daily life of citizens, as well as about the global economy.
Presently the impacts of COVID-19 in daily life are extensive and have far reaching consequences. These can be divided into various categories:
- • Challenges in the diagnosis, quarantine and treatment of suspected or confirmed cases
- • High burden of the functioning of the existing medical system
- • Patients with other disease and health problems are getting neglected
- • Overload on doctors and other healthcare professionals, who are at a very high risk
- • Overloading of medical shops
- • Requirement for high protection
- • Disruption of medical supply chain
- • Slowing of the manufacturing of essential goods
- • Disrupt the supply chain of products
- • Losses in national and international business
- • Poor cash flow in the market
- • Significant slowing down in the revenue growth
- • Service sector is not being able to provide their proper service
- • Cancellation or postponement of large-scale sports and tournaments
- • Avoiding the national and international travelling and cancellation of services
- • Disruption of celebration of cultural, religious and festive events
- • Undue stress among the population
- • Social distancing with our peers and family members
- • Closure of the hotels, restaurants and religious places
- • Closure of places for entertainment such as movie and play theatres, sports clubs, gymnasiums, swimming pools, and so on.
- • Postponement of examinations
This COVID-19 has affected the sources of supply and effects the global economy. There are restrictions of travelling from one country to another country. During travelling, numbers of cases are identified positive when tested, especially when they are taking international visits. 5 All governments, health organisations and other authorities are continuously focussing on identifying the cases affected by the COVID-19. Healthcare professional face lot of difficulties in maintaining the quality of healthcare in these days.
Declaration of competing interest
None declared.
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What is coronavirus?
Coronaviruses are a family of viruses that can cause respiratory illness in humans. They are called “corona” because of crown-like spikes on the surface of the virus. Severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS) and the common cold are examples of coronaviruses that cause illness in humans.
The new strain of coronavirus — SARS-CoV-2 — was first reported in Wuhan, China in December 2019. It has since spread to every country around the world.
Where do coronaviruses come from?
Coronaviruses are often found in bats, cats and camels. The viruses live in but don’t infect the animals. Sometimes these viruses then spread to different animal species. The viruses may change (mutate) as they transfer to other species. Eventually, the virus can jump from animal species and begin to infect humans. In the case of SARS-CoV-19, the first people infected are thought to have contracted the virus at a food market that sold meat, fish and live animals.
How do you get COVID-19?
SARS-CoV-2, the virus that causes COVID-19, enters your body through your mouth, nose or eyes (directly from the airborne droplets or from the transfer of the virus from your hands to your face). It then travels to the back of your nasal passages and mucous membrane in the back of your throat. It attaches to cells there, begins to multiply and moves into lung tissue. From there, the virus can spread to other body tissues.
How does the new coronavirus (SARS-CoV-2) spread from person to person?
Coronavirus is likely spread:
- The virus travels in respiratory droplets released into the air when an infected person coughs, sneezes, talks, sings or breathes near you. You may be infected if you inhale these droplets.
- You can also get coronavirus from close contact (touching, shaking hands) with an infected person and then touching your face.
How long is a person with COVID-19 considered contagious?
If you have COVID-19 it can take several days to develop symptoms — but you’re contagious during this time. You are no longer contagious 10 days after your symptoms began.
The best way to avoid spreading COVID-19 to others is to:
- Stay 6 feet away from others whenever possible.
- Wear a cloth mask that covers your mouth and nose when around others.
- Wash your hands often. If soap isn’t available, use a hand sanitizer that contains at least 60% alcohol.
- Avoid crowded indoor spaces. Open windows to bring in outdoor air as much as possible.
- Stay self-isolated at home if you are feeling ill with symptoms that could be COVID-19 or have a positive test for COVID-19.
- Clean and disinfect frequently touched surfaces.
Who’s most at risk for getting COVID-19?
Persons at greatest risk of contracting COVID-19 include those who:
- Live in or have recently traveled to any area with ongoing active spread.
- Have had close contact with a person who has a laboratory-confirmed or a suspected case of the COVID-19 virus. Close contact is defined as being within 6 feet of an infected person for a cumulative total of 15 minutes or more over a 24-hour period.
- Are over the age of 60 with pre-existing medical conditions or a weakened immune system.
How soon after becoming infected with SARS-CoV-2 will I develop COVID-19 symptoms?
The time between becoming infected and showing symptoms (incubation period) can range from two to 14 days. The average time before experiencing symptoms is five days. Symptoms can range in severity from very mild to severe. In about 80% of people, COVID-19 causes only mild symptoms, although this may change as variants emerge.
If I recover from a case of COVID-19, can I be infected again?
If you test positive for SARS-CoV-2 three months after your last positive test, it’s considered a reinfection. Before the omicron variant, reinfection with SARS-CoV-2 was rare but possible.
Omicron (B.1.1.529) was first reported in South Africa in November 2021 and quickly spread around the world. With many mutations, omicron was able to evade immune systems and we had more reinfections than ever before.
As the virus that causes COVID-19 continues to mutate , reinfection remains possible. Vaccination — including a booster dose — is the best protection against severe disease.
Symptoms and Causes
What are the symptoms of covid-19.
COVID-19 symptoms vary from person to person. In fact, some infected people don’t develop any symptoms (asymptomatic). In general, people with COVID-19 report some of the following symptoms:
- Fever or chills.
- Shortness of breath or difficulty breathing.
- Muscle or body aches.
- New loss of taste or smell.
- Sore throat.
- Congestion or runny nose.
- Nausea or vomiting .
Additional symptoms are possible.
Symptoms may appear two to 14 days after exposure to the virus. Children have similar, but usually milder, symptoms than adults. Older adults and people who have severe underlying medical conditions are at higher risk of more serious complication from COVID-19.
Call 911 and get immediate medical attention if you have these warning signs:
- Trouble breathing.
- Persistent pain or pressure in your chest.
- New confusion.
- Inability to wake up from sleep.
- Bluish lips or face.
This list does not include all possible symptoms. Contact your healthcare provider if you’re concerned you may have coronavirus or have any severe symptoms.
Diagnosis and Tests
How is coronavirus diagnosed.
COVID-19 is diagnosed with a laboratory test. Your healthcare provider may collect a sample of your saliva or swab your nose or throat to send for testing.
When should I be tested for the coronavirus (COVID-19)?
Call your healthcare provider if you:
- Feel sick with fever, cough or have difficulty breathing.
- Have been in close contact with a person known or suspected to have COVID-19.
Your healthcare provider will ask you questions about your symptoms and tell you if you need to be tested for COVID-19.
If I have a positive test for coronavirus, how long should I self-isolate?
According to current CDC recommendations, you should self-isolate until you've met both of the following criteria:
- It's been five days since your symptoms first appeared and your symptoms are improving.
- You've not had a fever for 24 hours and you've not used fever-lowing medications during this time.
While at home, self-isolate within a separate room of your home if possible to limit interaction with other family members. If you can’t stay 100% isolated in a separate room, keep 6 feet away from others and wear a cloth mask, wash your/family members' hands often and frequently disinfect commonly touched surfaces and shared areas.
You don't need to be retested after your period of self-isolation. But every case is unique, so follow your healthcare provider's recommendations for testing.
If you have a weakened immune system or have had a severe case of COVID-19, the CDC's criteria don’t apply to you. You may need to stay home for up to 20 days after your symptoms first appeared. Talk with your healthcare provider about your situation.
How long do I need to isolate myself if I’ve been around a person with COVID-19?
You should quarantine for five days if:
- You haven’t been fully vaccinated.
- More than six months have gone by since your second vaccine dose and you haven’t been boosted.
After this time, you should wear a well-fitting mask whenever you’re around others for an additional five days. The CDC recommends testing on day five if possible. This quarantine period may vary depending on variant strains and the availability of testing.
Is it possible to test negative for coronavirus and still be infected with it?
Yes, it’s possible. There are several reasons for “false negative” test results — meaning you really do have COVID-19 although the test result says you don’t.
Reasons for a false negative COVID-19 test result include:
- You were tested too early in the course of illness. The virus hasn’t multiplied in your body to the level that it could be detected by the test.
- The swab didn’t get a good specimen. You or the healthcare personnel may not have swabbed deeply enough in your nasal cavity to collect a good sample. There could also be less likely handling errors and transportation errors.
- The test itself was not sensitive or specific enough to detect SARS-CoV-2, the virus that causes COVID-19. Sensitivity refers to the ability of the test to detect the smallest amount of virus. Specificity refers to the ability of the test to detect only the COVID-19 virus and not other similar viruses. Many different commercial and hospital laboratories have developed tests for SARS-CoV-2. All must meet standards, but there’s always the possibility of “false negative” and “false positive” tests.
If you think you might have COVID-19 even if your test is negative, it’s best to follow the current CDC recommendations. Stay home for 10 days if you think you are sick (“social distancing”). Stay 6 feet away from others (“physical distancing”) and wear a cloth mask. Contact your healthcare provider if your symptoms worsen. Don’t decide on your own if it’s safe for you to be around others. Instead, contact your healthcare provider when your symptoms improve.
Management and Treatment
What treatments do people receive if they have covid-19.
Treatments for COVID-19 vary depending on the severity of your symptoms. If you’re not in the hospital or don’t need supplemental oxygen, no specific antiviral or immunotherapy is recommended.
Depending on the severity of your COVID symptoms, you may need:
- Supplemental oxygen (given through tubing inserted into your nostrils).
- Some people may benefit from an infusion of monoclonal antibodies.
- Antiviral medications may reduce the risk of hospitalization and death in certain patients with COVID-19.
- Mechanical ventilation (oxygen through a tube inserted down your trachea). You are given medications to keep you comfortable and sleepy as long as you’re receiving oxygen through a ventilator.
- Extracorporeal membrane oxygenation (ECMO). You continue to receive treatment while a machine pumps your blood outside your body. It takes over the function of your body’s lungs and heart.
Can vaccinated people still get COVID-19?
Yes, it’s possible to get COVID-19 even if you’ve been vaccinated. No vaccines are 100% effective. In fact, breakthrough cases (when someone tests positive more than two weeks after they're fully vaccinated) are expected, especially as the SARS-CoV-2 virus mutates.
The vaccines significantly reduce — but don’t eliminate — your risk of infection. The risk of a severe illness or death from a breakthrough infection is very low .
How can I manage my symptoms at home?
If you have mild COVID-19 symptoms, you can likely manage your health at home . Follow these tips:
- If you have a fever, drink plenty of fluids (water is best), get lots of rest and take acetaminophen (Tylenol®).
- If you have a cough, lie on your side or sit up (don’t lie on your back). Add a teaspoon of honey to your hot tea or hot water (don’t give honey to children under 1 year of age). Gargle with salt water. Call your healthcare provider or pharmacist for advice about over-the-counter, comfort care products like cough suppressants and cough drops/lozenges. Have a friend or family member pick up any needed medicines. You must stay at home.
- If you’re anxious about your breathing, try to relax. Take slow deep breaths in through your nose and slowly release through pursed lips (like you’re are slowly blowing out a candle).
- If you’re having trouble breathing, call 911.
If you have a mild case of COVID-19, you should start to feel better in a few days to a week. If you think your symptoms are getting worse, call your healthcare provider.
How can I keep from getting COVID-19?
The best defense to prevent getting COVID-19 is to get vaccinated. You should also follow the same steps you would take to prevent getting other viruses, such as the common cold or the flu .
- Wash your hands for at least 20 seconds — especially before eating and preparing food, after using the bathroom, after wiping your nose, and after coming in contact with someone who has a cold.
- Wear a multilayered cloth facemask that fits snugly on your face and covers your mouth, nose and chin as recommended by the CDC.
- Avoid touching your eyes, nose and mouth to prevent the spread of viruses from your hands.
- Cover your mouth and nose with a tissue when sneezing and coughing or sneeze and cough into your sleeve. Throw the tissue in the trash. Wash your hands afterward. Never cough or sneeze into your hands!
- Avoid close contact (within 6 feet) with those who have coughs, colds or are sick. Stay home if you’re sick.
- If you’re prone to sickness or have a weakened immune system, stay away from large crowds of people. Follow the directions of your healthcare authorities, especially during outbreaks.
- Clean frequently used surfaces (such as doorknobs and countertops) with a virus-killing disinfectant.
- Use hand sanitizers that contain at least 60% alcohol if soap and water are not available.
- Greet people with a friendly gesture instead of shaking hands.
- Get enough sleep, eat a healthy diet, drink plenty of liquids and exercise if you are able. These steps will strengthen your immune system and help you fight off infections more easily.
Should I wear a face mask?
Your healthcare provider can answer any questions you have about when you should wear a face mask to help slow the transmission of COVID-19. In general, the CDC recommends wearing a face mask in the following situations:
- If you’re in an area with high community levels of COVID-19, wear a face mask in public.
- If you’re sick but can’t avoid being around others.
- If you’re caring for someone who has COVID-19.
- If you’re at higher risk for severe illness or live with someone who is.
A note from Cleveland Clinic
We’ve come a long way since the first cases of COVID-19 were confirmed in the United States. We’ve learned a lot about the virus and how to treat people who have it. We’ve also greatly increased our ability for testing. You — our communities — have made tremendous efforts to adapt, too.
The changes we’ve all made to stay safe and healthy can feel challenging. But please stay vigilant. We know it’s not easy, but it’s critical. COVID-19 shouldn't be taken lightly. While most people get only mild symptoms, others develop serious complications of the lungs, brain and heart. There may also be other long-term effects that we don’t yet know about.
Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy
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Essays on Covid 19
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Coronavirus disease 2019 (COVID-19) is a contagious disease caused by a virus, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
The first known case was identified in Wuhan, China, in December 2019. The disease spread worldwide, leading to the COVID-19 pandemic.
Infectious disease
The symptoms of COVID-19 are variable, ranging from mild symptoms to critical and possibly fatal illness. Common symptoms include coughing, fever, loss of smell (anosmia) and taste (ageusia), with less common ones including headaches, nasal congestion and runny nose, muscle pain, sore throat, diarrhea, eye irritation, and toes swelling or turning purple, and in moderate to severe cases breathing difficulties.
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