new normal after covid 19 essay

Life after COVID: most people don’t want a return to normal – they want a fairer, more sustainable future

Chair of Cognitive Psychology, University of Bristol

Professor of Cognitive Psychology and Australian Research Council Future Fellow, The University of Western Australia

Disclosure statement

Stephan Lewandowsky receives funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement no. 964728 (JITSUVAX). He also receives funding from the Australian Research Council via a Discovery Grant to Ullrich Ecker, from Jigsaw (a technology incubator created by Google), from UK Research and Innovation (through the Centre of Excellence, REPHRAIN), and from the Volkswagen Foundation in Germany. He also holds a European Research Council Advanced Grant (no. 101020961, PRODEMINFO) and receives funding from the John Templeton Foundation (via Wake Forest University’s Honesty Project).

Ullrich Ecker receives funding from the Australian Research Council.

University of Western Australia provides funding as a founding partner of The Conversation AU.

University of Bristol provides funding as a founding partner of The Conversation UK.

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We are in a crisis now – and omicron has made it harder to imagine the pandemic ending. But it will not last forever. When the COVID outbreak is over, what do we want the world to look like?

In the early stages of the pandemic – from March to July 2020 – a rapid return to normal was on everyone’s lips, reflecting the hope that the virus might be quickly brought under control. Since then, alternative slogans such as “ build back better ” have also become prominent, promising a brighter, more equitable, more sustainable future based on significant or even radical change.

Returning to how things were, or moving on to something new – these are very different desires. But which is it that people want? In our recent research , we aimed to find out.

Along with Keri Facer of the University of Bristol, we conducted two studies, one in the summer of 2020 and another a year later. In these, we presented participants – a representative sample of 400 people from the UK and 600 from the US – with four possible futures, sketched in the table below. We designed these based on possible outcomes of the pandemic published in early 2020 in The Atlantic and The Conversation .

We were concerned with two aspects of the future: whether it would involve a “return to normal” or a progressive move to “build back better”, and whether it would concentrate power in the hands of government or return power to individuals.

Four possible futures

In both studies and in both countries, we found that people strongly preferred a progressive future over a return to normal. They also tended to prefer individual autonomy over strong government. On balance, across both experiments and both countries, the “grassroots leadership” proposal appeared to be most popular.

People’s political leanings affected preferences – those on the political right preferred a return to normal more than those on the left – yet intriguingly, strong opposition to a progressive future was quite limited, even among people on the right. This is encouraging because it suggests that opposition to “building back better” may be limited.

Our findings are consistent with other recent research , which suggests that even conservative voters want the environment to be at the heart of post-COVID economic reconstruction in the UK.

The misperceptions of the majority

This is what people wanted to happen – but how did they think things actually would end up? In both countries, participants felt that a return to normal was more likely than moving towards a progressive future. They also felt it was more likely that government would retain its power than return it to the people.

In other words, people thought they were unlikely to get the future they wanted. People want a progressive future but fear that they’ll get a return to normal with power vested in the government.

We also asked people to tell us what they thought others wanted. It turned out our participants thought that others wanted a return to normal much more than they actually did. This was observed in both the US and UK in both 2020 and 2021, though to varying extents.

This striking divergence between what people actually want, what they expect to get and what they think others want is what’s known as “ pluralistic ignorance ”.

This describes any situation where people who are in the majority think they are in the minority. Pluralistic ignorance can have problematic consequences because in the long run people often shift their attitudes towards what they perceive to be the prevailing norm. If people misperceive the norm, they may change their attitudes towards a minority opinion, rather than the minority adapting to the majority. This can be a problem if that minority opinion is a negative one – such as being opposed to vaccination , for example.

In our case, a consequence of pluralistic ignorance may be that a return to normal will become more acceptable in future, not because most people ever desired this outcome, but because they felt it was inevitable and that most others wanted it.

Ultimately, this would mean that the actual preferences of the majority never find the political expression that, in a democracy, they deserve.

To counter pluralistic ignorance, we should therefore try to ensure that people know the public’s opinion. This is not merely a necessary countermeasure to pluralistic ignorance and its adverse consequences – people’s motivation also generally increases when they feel their preferences and goals are shared by others. Therefore, simply informing people that there’s a social consensus for a progressive future could be what unleashes the motivation needed to achieve it.

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Two Years Into the Pandemic, Americans Inch Closer to a New Normal

Two years after the coronavirus outbreak upended life in the United States, Americans find themselves in an environment that is at once greatly improved and frustratingly familiar.

Around three-quarters of U.S. adults now report being fully vaccinated , a critical safeguard against the worst outcomes of a virus that has claimed the lives of more than 950,000 citizens. Teens and children as young as 5 are now eligible for vaccines . The national unemployment rate has plummeted from nearly 15% in the tumultuous first weeks of the outbreak to around 4% today. A large majority of K-12 parents report that their kids are back to receiving in-person instruction , and other hallmarks of public life, including sporting events and concerts, are again drawing crowds.

This Pew Research Center data essay summarizes key public opinion trends and societal shifts as the United States approaches the second anniversary of the coronavirus outbreak . The essay is based on survey data from the Center, data from government agencies, news reports and other sources. Links to the original sources of data – including the field dates, sample sizes and methodologies of surveys conducted by the Center – are included wherever possible. All references to Republicans and Democrats in this analysis include independents who lean toward each party.

Data essay from March 2021: A Year of U.S. Public Opinion on the Coronavirus Pandemic

The landscape in other ways remains unsettled. The staggering death toll of the virus continues to rise, with nearly as many Americans lost in the pandemic’s second year as in the first, despite the widespread availability of vaccines. The economic recovery has been uneven, with wage gains for many workers offset by the highest inflation rate in four decades and the labor market roiled by the Great Resignation . The nation’s political fractures are reflected in near-daily disputes over mask and vaccine rules. And thorny new societal problems have emerged, including alarming increases in murder and fatal drug overdose rates that may be linked to the upheaval caused by the pandemic.

For the public, the sense of optimism that the country might be turning the corner – evident in surveys shortly after President Joe Biden took office and as vaccines became widely available – has given way to weariness and frustration. A majority of Americans now give Biden negative marks for his handling of the outbreak, and ratings for other government leaders and public health officials have tumbled . Amid these criticisms, a growing share of Americans appear ready to move on to a new normal, even as the exact contours of that new normal are hard to discern.

A year ago, optimism was in the air

Biden won the White House in part because the public saw him as more qualified than former President Donald Trump to address the pandemic. In a January 2021 survey, a majority of registered voters said a major reason why Trump lost the election was that his administration did not do a good enough job handling the coronavirus outbreak.

At least initially, Biden inspired more confidence. In February 2021, 56% of Americans said they expected the new administration’s plans and policies to improve the coronavirus situation . By last March, 65% of U.S. adults said they were very or somewhat confident in Biden to handle the public health impact of the coronavirus.

The rapid deployment of vaccines only burnished Biden’s standing. After the new president easily met his goal of distributing 100 million doses in his first 100 days in office, 72% of Americans – including 55% of Republicans – said the administration was doing an excellent or good job overseeing the production and distribution of vaccines. As of this January, majorities in every major demographic group said they had received at least one dose of a vaccine. Most reported being fully vaccinated – defined at the time as having either two Pfizer or Moderna vaccines or one Johnson & Johnson – and most fully vaccinated adults said they had received a booster shot, too.

The Biden administration’s early moves on the economy also drew notable public support. Two-thirds of Americans, including around a third of Republicans, approved of the $1.9 trillion aid package Biden signed into law last March, one of several sprawling economic interventions authorized by administrations of both parties in the outbreak’s first year. Amid the wave of government spending, the U.S. economy grew in 2021 at its fastest annual rate since 1984 .

Globally, people preferred Biden’s approach to the pandemic over Trump’s. Across 12 countries surveyed in both 2020 and 2021, the median share of adults who said the U.S. was doing a good job responding to the outbreak more than doubled after Biden took office. Even so, people in these countries gave the U.S. lower marks than they gave to Germany, the World Health Organization and other countries and multilateral organizations.

Data essay: The Changing Political Geography of COVID-19 Over the Last Two Years

A familiar undercurrent of partisan division

Even if the national mood seemed to be improving last spring, the partisan divides that became so apparent in the first year of the pandemic did not subside. If anything, they intensified and moved into new arenas.

Masks and vaccines remained two of the most high-profile areas of contention. In February 2021, Republicans were only 10 percentage points less likely than Democrats (83% vs. 93%) to say they had worn a face covering in stores or other businesses all or most of the time in the past month. By January of this year, Republicans were 40 points less likely than Democrats to say they had done so (39% vs. 79%), even though new coronavirus cases were at an all-time high .

Republicans were also far less likely than Democrats to be fully vaccinated (60% vs. 85%) and to have received a booster shot (33% vs. 62%) as of January. Not surprisingly, they were much less likely than Democrats to favor vaccination requirements for a variety of activities, including traveling by airplane, attending a sporting event or concert, and eating inside of a restaurant.

Some of the most visible disputes involved policies at K-12 schools, including the factors that administrators should consider when deciding whether to keep classrooms open for in-person instruction. In January, Republican K-12 parents were more likely than Democrats to say a lot of consideration should be given to the possibility that kids will fall behind academically without in-person classes and the possibility that students will have negative emotional consequences if they don’t attend school in person. Democratic parents were far more likely than Republicans to say a lot of consideration should be given to the risks that COVID-19 poses to students and teachers.

The common thread running through these disagreements is that Republicans remain fundamentally less concerned about the virus than Democrats, despite some notable differences in attitudes and behaviors within each party . In January, almost two-thirds of Republicans (64%) said the coronavirus outbreak has been made a bigger deal than it really is . Most Democrats said the outbreak has either been approached about right (50%) or made a smaller deal than it really is (33%). (All references to Republicans and Democrats include independents who lean toward each party.)

New variants and new problems

The decline in new coronavirus cases, hospitalizations and deaths that took place last spring and summer was so encouraging that Biden announced in a July 4 speech that the nation was “closer than ever to declaring our independence from a deadly virus.” But the arrival of two new variants – first delta and then omicron – proved Biden’s assessment premature.

Some 350,000 Americans have died from COVID-19 since July 4, including an average of more than 2,500 a day at some points during the recent omicron wave – a number not seen since the first pandemic winter, when vaccines were not widely available. The huge number of deaths has ensured that even more Americans have a personal connection to the tragedy .

The threat of dangerous new variants had always loomed, of course. In February 2021, around half of Americans (51%) said they expected that new variants would lead to a major setback in efforts to contain the disease. But the ferocity of the delta and omicron surges still seemed to take the public aback, particularly when governments began to reimpose restrictions on daily life.

After announcing in May 2021 that vaccinated people no longer needed to wear masks in public, the Centers for Disease Control and Prevention reversed course during the delta wave and again recommended indoor mask-wearing for those in high-transmission areas. Local governments brought back their own mask mandates . Later, during the omicron wave, some major cities imposed new proof-of-vaccination requirements , while the CDC shortened its recommended isolation period for those who tested positive for the virus but had no symptoms. This latter move was at least partly aimed at addressing widespread worker shortages , including at airlines struggling during the height of the holiday travel season.

Amid these changes, public frustration was mounting. Six-in-ten adults said in January 2022 that the changing guidance about how to slow the spread of the virus had made them feel confused , up from 53% the previous August. More than half said the shifting guidance had made them wonder if public health officials were withholding important information (57%) and made them less confident in these officials’ recommendations (56%). And only half of Americans said public health officials like those at the CDC were doing an excellent or good job responding to the outbreak, down from 60% last August and 79% in the early stages of the pandemic.

Economic concerns, particularly over rising consumer prices, were also clearly on the rise. Around nine-in-ten adults (89%) said in January that prices for food and consumer goods were worse than a year earlier . Around eight-in-ten said the same thing about gasoline prices (82%) and the cost of housing (79%). These assessments were shared across party lines and backed up by government data showing large cost increases for many consumer goods and services.

Overall, only 28% of adults described national economic conditions as excellent or good in January, and a similarly small share (27%) said they expected economic conditions to be better in a year . Strengthening the economy outranked all other issues when Americans were asked what they wanted Biden and Congress to focus on in the year ahead.

Looking at the bigger picture, nearly eight-in-ten Americans (78%) said in January that they were not satisfied with the way things were going in the country.

Imagining the new normal

As the third year of the U.S. coronavirus outbreak approaches, Americans increasingly appear willing to accept pandemic life as the new reality.

Large majorities of adults now say they are comfortable doing a variety of everyday activities , including visiting friends and family inside their home (85%), going to the grocery store (84%), going to a hair salon or barbershop (73%) and eating out in a restaurant (70%). Among those who have been working from home, a growing share say they would be comfortable returning to their office if it were to reopen soon.

With the delta and omicron variants fresh in mind, the public also seems to accept the possibility that regular booster shots may be necessary. In January, nearly two-thirds of adults who had received at least one vaccine dose (64%) said they would be willing to get a booster shot about every six months. The CDC has since published research showing that the effectiveness of boosters began to wane after four months during the omicron wave.

Despite these and other steps toward normalcy , uncertainty abounds in many other aspects of public life.

The pandemic has changed the way millions of Americans do their jobs, raising questions about the future of work. In January, 59% of employed Americans whose job duties could be performed remotely reported that they were still working from home all or most of the time. But unlike earlier in the pandemic, the majority of these workers said they were doing so by choice , not because their workplace was closed or unavailable.

A long-term shift toward remote work could have far-reaching societal implications, some good, some bad. Most of those who transitioned to remote work during the pandemic said in January that the change had made it easier for them to balance their work and personal lives, but most also said it had made them feel less connected to their co-workers.

The shift away from office spaces also could spell trouble for U.S. downtowns and the economies they sustain. An October 2021 survey found a decline in the share of Americans who said they preferred to live in a city and an increase in the share who preferred to live in a suburb. Earlier in 2021, a growing share of Americans said they preferred to live in a community where the houses are larger and farther apart , even if stores, schools and restaurants are farther away.

When it comes to keeping K-12 schools open, parental concerns about students’ academic progress and their emotional well-being now clearly outweigh concerns about kids and teachers being exposed to COVID-19. But disputes over school mask and vaccine rules have expanded into broader debates about public education , including the role parents should play in their children’s instruction. The Great Resignation has not spared K-12 schools , leaving many districts with shortages of teachers, bus drivers and other employees.

The turmoil in the labor market also could exacerbate long-standing inequities in American society. Among people with lower levels of education, women have left the labor force in greater numbers than men. Personal experiences at work and at home have also varied widely by race , ethnicity and household income level .

Looming over all of this uncertainty is the possibility that new variants of the coronavirus will emerge and undermine any collective sense of progress. Should that occur, will offices, schools and day care providers again close their doors, complicating life for working parents ? Will mask and vaccine mandates snap back into force? Will travel restrictions return? Will the economic recovery be interrupted? Will the pandemic remain a leading fault line in U.S. politics, particularly as the nation approaches a key midterm election?

The public, for its part, appears to recognize that a swift return to life as it was before the pandemic is unlikely. Even before the omicron variant tore through the country, a majority of Americans expected that it would be at least a year before their own lives would return to their pre-pandemic normal. That included one-in-five who predicted that their own lives would never get back to the way they were before COVID-19.

Lead photo: Luis Alvarez/Getty Images.

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A Year After Coronavirus: An Inclusive ‘New Normal’

Six months into a new decade, 2020 has already been earmarked as ‘the worst’ year in the 21st century. The novel coronavirus has given rise to a global pandemic that has destabilized most institutional settings. While we live in times when humankind possesses the most advanced science and technology, a virus invisible to the naked eye has massively disrupted economies, healthcare, and education systems worldwide. This should serve as a reminder that as we keep making progress in science and research, humanity will continue to face challenges in the future, and it is upon us to prioritize those issues that are most relevant in the 21st century.

Even amidst the pandemic, Space X, an American aerospace manufacturer, managed to become the first private company to send humans to space. While this is a tremendous achievement and prepares humanity for a sustainable future, I feel there is a need to introspect the challenges that we are already facing. On the one hand, we seem to be preparing beyond the 21st century. On the other hand, heightened nationalism, increasing violence against marginalized communities and multidimensional inequalities across all sectors continue to act as barriers to growth for most individuals across the globe. COVID-19 has reinforced these multifaceted economic, social and cultural inequalities wherein those in situations of vulnerability have found it increasingly difficult to get quality medical attention, access to quality education, and have witnessed increased domestic violence while being confined to their homes. 

Given the coronavirus’s current situation, some households have also had time to introspect on gender roles and stereotypes. For instance, women are expected to carry out unpaid care work like cooking, cleaning, and looking after the family. There is no valid reason to believe that women ought to carry out these activities, and men have no role in contributing to household chores. With men having shared household chores during the lockdown period, it gives hope that they will realize the burden that women have been bearing for past decades and will continue sharing responsibilities. However, it would be naïve to believe that gender discrimination could be tackled so easily, and men would give up on their decades' old habits within a couple of months. Thus, during and after the pandemic, there is an urgent need to sensitize households on the importance of gender equality and social cohesion.

Moving forward, developing quality healthcare systems that are affordable and accessible to all should be the primary objective for all governments. This can be done by increasing expenditure towards health and education and simultaneously reducing expenditure on defence equipment where the latter mainly gives rise to an idea that countries need to be prepared for violence. There is substantial evidence that increased investment in health and education is beneficial in the long-term and can potentially build the basic foundation of a country. 

If it can be established that usage of nuclear weapons, violence and war are not solutions to any problem, governments (like, for example, Costa Rica) could move towards disarmament of weapons and do their part in building a more peaceful planet that is sustainable for the future. This would further promote global citizenship wherein nationality, race, gender, caste, and other categories, are just mere variables and they do not become identities of individuals that restrict their thought process. The aim should be to build responsible citizens who play an active role in their society and work collectively in helping develop a planet that is well-governed, inclusive, and environmentally sustainable.

 ‘A year after Coronavirus’ is still an unknown, so I think that our immediate focus should be to tackle the complex problems that have emerged from the pandemic so that we make the year after coronavirus one which highlights recovery and acts as a pathway to fresh beginnings. While there is little to gain from such a fatal cause, it is vital that we also use it to make the ‘new normal’ in favour of the environment and ensure that no one is left behind.   

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Article Contents

Coronavirus disease as a catalyst for change: an early arrival of the future of work, the differential impact of coronavirus disease on the labor market, coronavirus disease and wlb: a mixed picture, forecasting key trends for the labor market and wlb, discussion and conclusion, conflict of interest.

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“New normal” at work in a post-COVID world: work–life balance and labor markets

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Lina Vyas, “New normal” at work in a post-COVID world: work–life balance and labor markets, Policy and Society , Volume 41, Issue 1, March 2022, Pages 155–167, https://doi.org/10.1093/polsoc/puab011

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The coronavirus pandemic has interrupted labor markets, triggering massive and instant series of experimentations with flexible work arrangements, and new relationships to centralized working environments. These approaches have laid the basis for the “new normal,” likely extending into the organization of work in the post-pandemic era. These new arrangements, especially flexible work arrangements, have challenged traditional relationships with employees and employers, work time and working hours, the work–life balance (WLB), and the relationship of individuals to work. This paper investigates how labor markets have been interrupted due to the pandemic, focusing especially on manual (blue-collar) and nonmanual (white-collar) work and the future of the WLB, along with exploring the projected deviations that are driving a foreseeable future policy revolution in work and employment. This paper argues that although hybrid and remote working would be more popular in the post-pandemic for nonmanual work, it will not be “one size fits all” solution. Traditional work practices will remain, and offices will not completely disappear. Manual labor will continue current work practices with increased demands. Employers’ attention to employees’ WLB in the new normal will target employees’ motivation and achieving better WLB. These trends for the labor market and WLB are classified into three categories—those that are predicated on changes that were already underway but were accelerated with arrival of the pandemic (“acceleration”); those that represent normalization of what were once considered avant-garde ways of work (“normalization”); and those that represent modification or alteration of pre-pandemic set-up (“remodelling”).

Technological, social, and political transformations are powerful forces that radically shape many aspects of our lives, including the world of work, where societies are often forced to take proactive steps to adapt in order to remain competitive and survive. One notable example is the Industrial Revolution, which reshaped societies and economies in lasting ways and drastically changed the way people work, live, and establish a work–life balance (WLB). The ongoing coronavirus disease pandemic is similarly producing fundamental changes in work, work practices, the relationship of workers to co-workers, companies, and localities, as well as WLB. As part of the ongoing efforts to reduce the transmission of coronavirus disease and help protect the health and safety of employees, public and private organizations have generally adopted remote work arrangements, social distancing measures, staggered working hours, and other methods to reduce the presence of employees within work environments while also sustaining organizational activities ( International Labour Organization [ILO], 2020a ; World Health Organization [WHO], 2020 ).

While such practices are now widespread, they have not been uniform, varying between countries not only in terms of the intensity of their adoption and practice, but also in terms of their application across labor markets. For example, white-collar office workers, or those engaged in activities associated with mental work, have enjoyed the health protections of remote work options, while those engaged in physical work activities (consumer and business services, manufacturing, assembly, transportation, and related activities) have had to maintain their physical presence at work, often exposing them to greater health risks ( ILO, 2020c ).

Post-pandemic recovery must address the interruptions in the labor markets around the world, interruptions that have given rise to numerous experimentations with remote work, flexible work arrangements, and new relationships to centralized working environments. However, as far as the long-run diagnosis is concerned, there is a debate on whether coronavirus disease is a unique devastation, after which the work environment will return back to its “old normal” pre-coronavirus disease state, or whether the world is undergoing a sweeping disruption that will give rise to a “new normal,” with researchers and governments speculating about a complete series of different “new normal” future states of the world. Such changes bring up a discussion on what the new normal would be like and what can be foreseen in the post-pandemic world, particularly in the world of work. Therefore, this paper investigates the “new normal” in terms of two key themes—the labor market and WLB. The paper looks at how coronavirus disease has impacted work and the resultant effect on the labor market and WLB currently and in the future (see Figure 1 ). The labor market is explored in terms of the divaricate pathways between blue-collar and nonmanual workers.

Coronavirus pandemic and the labor market.

The goal of this paper is twofold. First, the paper attempts to clarify how coronavirus disease has been a mechanism for change in how work is conducted. The intention is to examine both positive and negative impacts of coronavirus disease on the labor market and WLB. Second, the paper sketches or maps forward an image of the post-coronavirus disease “new normal”, the likely composition of the future labor market, and what WLB might look like, highlighting possible trends and directions. These trends can be classified into one or more of three categories: acceleration, normalization, and remodelling. Acceleration represents those developments that were already underway in the work-world but were thrust onto a higher trajectory because of the unique conditions of the pandemic. Normalization represents the widespread acceptance and adoption of those practices that were once considered to be the exclusive preserve of a few or considered to be novel and rarely used. Remodelling refers to a modification or alteration of the existing pre-COVID set-up in line with the changes ushered in by the pandemic.

This paper is structured in the following manner: it begins with a description of the changes catalyzed by the pandemic in the labor market and with respect to WLB. It then forecasts seven key trends for these. This is followed by a conclusion.

Emergencies are frequently regarded as catalysts for change. The recent coronavirus disease pandemic is no exception. Many policy changes have been initiated to cope with the challenges that accompanied the crisis. While many welcomed the changes in the labor market, others regard them as emergency-induced changes—as something we should not be too positive about. Recalling pre-pandemic life, for decades working in an assigned workspace has been a standard pattern of work in many countries, while conversely, before the pandemic struck, work from home (WFH) was considered as a privilege for certain employees. The ongoing pandemic has become an unexpected catalyst for remote work and forced a reconsideration of work in terms of the designated workplace location and workplace practices ( de Lucas Ancillo et al., 2020 ; Kniffin et al., 2021 ; Ratten, 2020 ; Savić, 2020 ) on a global scale never seen before. It is worth pointing out that many of workers worldwide had never worked from home before. Although there was a slow but gradual increase in the number of remote workers before the pandemic, the world of work has fundamentally changed because of the coronavirus disease pandemic: WFH in pyjamas has become commonplace, and meeting virtually is increasingly mainstream.

In the days when severe acute respiratory syndrome (SARS) swept across the globe in 2003, home working was not an option for most workers worldwide, as the majority of them did not have access to essential devices and equipment to carry out their work at home. This is quite different from working in the current coronavirus disease pandemic era, with technology now providing more options for work practices. In Hong Kong, for example, WFH was not an option for the workforce during SARS ( Labour Department, 2003 ). However, in the midst of the ongoing coronavirus disease pandemic, such work arrangements were adjusted based on the severity of the local epidemic situation ( Vyas & Butakhieo, 2021 ). Now more than a year into the pandemic, companies worldwide are still pondering the workplace practice that best suits their own needs, and there is no doubt that the lively debate on remote working will continue. Yet this trial run of remote working has shed some light on the future of the workplace, ranging from the telework capacity of the economy to the public attitudes toward remote working. All this is owing to the pandemic as an impetus for a massive and unprecedented change. The pandemic is causing an early arrival of the future of work that was initially envisioned by policymakers around the world.

The pandemic has affected occupations and segments of the labor market differentially ( ILO, 2020b ). White-collar workers in particular have been affected by the pandemic, experiencing significant changes in working practices. WFH arrangements have been widespread, with various repercussions in terms of productivity, locality, working hours, and the traditional separation of work and home environments ( Caringal-Go et al., 2021 ; Wong et al., 2021 ). Typically, the home environment is one that allows the stresses of work to melt away, and permits workers to enjoy time with family separated from work pressures or activities. The conversion of the home environment into a work environment has tended to corrupt the sanctity of the home, with job-related issues fusing into the home and time previously free of work. Firmly demarcated work hours (which begin and end with arriving at and departing from a physical workplace) have disappeared, making it easy to carry on working out of hours and disrupt the home life and WLB.

By contrast, work and work conditions for blue-collar workers have largely remained unchanged outside of social distancing, sanitation, and related health measures. However, the focus here must not be on how the job has changed, but rather on the implications of continuing to work through the pandemic. Blue-collar workers have been forced to brave the health dangers of continued social contact, risking sickness with every interaction. The demands of the jobs would mean that those more vulnerable than others have no alternative safer option: For these workers, sitting at home means being unable to work, which incurs financial strain. Additionally, continuing to work outside the home may cause tension at home due to the workers being at risk of bringing the virus back and infecting loved ones. Both white-collar and blue-collar workers have been impacted; however, their work practices have changed in different ways because of the pandemic.

Having a harmonious balance between work and personal life (i.e., a good WLB) is critical to bringing a healthy and stress-free environment and allowing employees to unleash their full potential. However, striking a good WLB is a challenge for most workers, more so for those with caregiving responsibilities, particularly during the COVID-19 pandemic. It is also believed that creating a flexible and family-friendly workplace (e.g., having flexible work hours or offering remote work) can help to improve the well-being of the workforce ( Feeney & Stritch, 2019 ; Shagvaliyeva & Yazdanifard, 2014 ).

Many workers now work from their “workspace” of choice which includes home, office, and co-working spaces (depending on the work tasks they are entrusted with). Workers may thereby see better outcomes for their health, family, and overall well-being. While many have adjusted to and enjoyed this change, others have had challenges in drawing a line between working and non-working hours. The likelihood is high for a number of employees to experience increased working hours, as well as increased work-life conflict. For example, in today’s hyper-connected world, many remote working employees are expected to respond to urgent tasks as well as after-work emails, resulting in a blur between work and leisure. A recent study revealed that employees WFH during the pandemic experienced an increase in work-related fatigue and overlap between work and non-work life ( Palumbo, 2020 ).

Indeed, different scholars have different views on the impact of remote working on the WLB of workers. Some believe that WFH has positive impact on the WLB ( Pelta, 2020 ). On the contrary, there are adverse effects found in studies where a blur between work life and personal life is visible and it seems that home-based working may negatively impact WLB ( Grant et al., 2019 ; Nakrošienė & Butkevičienė, 2016 ; Palumbo et al., 2020 ). Putri and Amran (2021) studied the effect of WFH during the coronavirus disease on the WLB of employees in Indonesia and found that it had a positive impact. However, employees often are not able to balance their work and personal time as their working environment might be flexible, but their hours are increased. It has also been found that working from home or working remotely at least 1 day a week gave employees a better WLB ( BBC News, 2021a ). The trend seems to favor hybrid working over a completely remote working environment.

The paper flags seven key trends that will manifest themselves in the future. First, accelerating digital transformation will become critical for the workplace. Second, hybrid work would be a new normal at work in the post-pandemic era. Despite this, some work practices will not be eliminated. Thus, the third trend will be the continued existence of the “office” albeit in a modified form. Fourth, all of the above will induce changes in organizational infrastructure and labor mobility. Fifth, the challenges of performance management and atomistic tendencies at work may arise. Sixth, there may be a potential exacerbation of existing inequalities. Seventh, there will be increased focus on WLB in the future.

Of the aforementioned trends, some are predicated on changes that were already underway but were accelerated with the advent of the pandemic (“acceleration”). Other trends represent the normalization of what were once considered avant-garde ways of work (“normalisation”). Yet other trends represent a remodelling of the status-quo (“remodelling”). And some trends represent a combination of two or more of the above ( Table 1 ).

Forecasting key trends in the labor market and WLB.

Accelerated digital transformation

Changes in the labor markets to keep businesses running are inevitable in the post-pandemic era, and technological adoption is the most visible change in the labor market. It has been shown that digital technology was adopted in organizations prior to the emergence of the pandemic, and this adoption was accelerated during the pandemic ( Forman & van Zeebroeck, 2019 ; Murdoch & Fichter, 2017 ; Vargo et al., 2021 ). The pandemic has thus triggered a shift to a more digital society—or, to be more precise, the real world is gradually dying out, and the fast-paced technological world is rapidly replacing the old one. Digital transformation has, therefore, become an imperative for businesses across industries of all sizes for survival, and adequate digital infrastructure is essential for working in the future ( Gadhi, 2020 ; Melhem et al., 2020 ). The world of work is therefore heading a new way, in line with the changes in the business world. Thus, it could be said that digital and technological enhancements and transformations have an impact on several types of work. Nonmanual work, for example, would benefit more from this enhancement than manual labor, which requires on-site work. Employees with a high capability to work remotely will possibly have a reduced risk of perishing in the future labor market.

Digital technologies and the emergence of the coronavirus disease pandemic could be considered the most critical elements for accelerating the growth of remote working. Other factors, such as the pandemic-driven recession and the geopolitical contest between countries, are causing uncertainty in the future labor market outlook. The post-pandemic times will bring along a possible risk and challenge to organizational sustainability and human resource management.

Emergence of hybrid work

It is anticipated that the world of work will undergo a significant shift toward hybrid work in the post-coronavirus disease world, making hybrid working to some extent the “new normal” at work ( Ro, 2020 ). This is particularly likely for the highly educated and well-paid faction of the workforce. The potential of adopting remote work largely depends on whether a job has tasks and activities which do not require workers to be physically present on-site to get the work done ( Lund et al., 2020 ). Professions requiring in-person involvement such as agricultural work, restaurant, and hotel services are not able to adopt remote working ( Dingel & Neiman, 2020 ). In other words, the adoption of “new normal” work practices—remote working and WFH—will depend on the nature of the work, because not all tasks can be accomplished remotely. Given that, it would require significant rethinking about which jobs are suitable to perform remotely. In the long run, hybrid working has to be thoughtful and granular.

Well into the pandemic, the limitations and merits of remote work are more visible, and this give us reason to believe it will become a part of the future. Employees who WFH have higher flexibility and can adjust their working hours in line with their personal and family needs. While some people are returning to the workplace as many restrictions are being lifted, there are some pandemic-driven practices like hybrid work, WFH, remote work, flexible workplace/worktime, work anywhere, and work near home that persist. Businesses around the world will most likely continue to use them, particularly white-collar jobs. For example, two out of three white-collar workers in Hong Kong still want to WFH, and companies are considering redesigning office space to accommodate hybrid work ( Lam, 2021 ). Several examples around the world, including the BP oil company, have decided to implement a new hybrid model that will enable workers to WFH 2 days a week ( Ambrose, 2021 ). Another example is the nationwide decision in England to allow white-collar workers to work from anywhere, giving them more control over their lives ( BBC News, 2021a ). Some of the world’s most well-known firms, including Amazon, Apple, Google, Facebook, British Airways, Microsoft, and Siemens AG, are inclined to adopt remote working in post-pandemic times ( BBC News, 2020 ; Hartmans, 2020 ; Siemens AG, 2020 ). All the aforementioned examples involve nonmanual work, and it seems very likely that these companies will be willing to embrace remote working in the post-pandemic period.

Additionally, people working in global teams, particularly with white-collar jobs, have further endorsed the feasibility of flexible work that includes WFH and is not confined by standard business hours. The results of multiple surveys conducted around the world prove consistent with each other, suggesting that after coronavirus disease recedes, quite a number of office employees, regardless of nationality or race, would prefer to work remotely at least some days ( Kelly, 2021 ; PWC, 2021 ; Wong & Cheung, 2020 ).

The continued existence of the “office”

Previous studies have revealed that remote working can enhance productivity (e.g., Bloom et al., 2015 ; Grant et al., 2013 , 2019 ). However, it has been argued by scholars that working remotely amidst the pandemic has had both positive and negative impacts on productivity. On the one hand, some employees thought they were more productive when working from home because a flexible working arrangement allows them to manage their working time and place on their own. On the other hand, other employees experienced a difficulty in getting work done at home, caused by the interruption of family members and/or children at home ( Gibbs et al., 2021 ; Mustajab et al., 2020 ; Parker et al., 2020 ).

In a similar manner, several employees with either manual or nonmanual jobs believe that WFH is not the right fit for them. Manual types of work may not be able to adopt WFH due to the nature of the work. Some nonmanual workers prefer returning to the workplace after the pandemic. Working in an office can be more beneficial than working at home in terms of generating new ideas and socialising, and new employees can benefit from working in an office by learning about the organization and its culture ( BBC News, 2021d ; Vasel, 2021 ). WFH can keep new employees from gaining such knowledge. Employees also seem likely to resign if they are required to WFH full time and are not permitted to work in an office ( BBC News, 2021c ). Accordingly, traditional work practices, such as working in an office, are still needed.

Changes in organizational infrastructure and labor mobility

Businesses worldwide are seeing the merits of WFH or hybrid work, including but not limited to having a larger talent pool and saving money on rent ( de Lucas Ancillo et al., 2020 ). This will drive the recovering economy to rethink the need for office space, especially for nonmanual work types, with some companies considering reducing their office space or relocating from high-cost cities (i.e., London, New York, Paris, Hong Kong, etc.) to a more affordable place, and some adapting to a completely virtual office environment. Others are evaluating the possibility of renting co-working spaces. Companies are taking advantage of the demand for hybrid work to save the cost of renting an office ( BBC News, 2021b ). In addition to the relocation of workplaces from major cities to cheaper places, it is also believed that there will be a radical transition in urban life, where remote-working employees will migrate out of business capitals to cities with more affordable rentals and living costs ( Lund et al., 2021 ), owing largely to the prevalence of remote working. Such a transition will boost the economy of the cities concerned as well as their surrounding areas.

The challenges of performance management and atomistic tendencies at work

The “new normal” work practice would impact certain businesses and individuals or even work itself. For example, working mothers will be able to reduce commuting time and have more time to take care of their children. However, some managers feel that they cannot manage employees who are working remotely. Expectations for working objectives and output are not clear, and it is difficult to know whether employees are actively working ( ILO, 2020b ). Apart from that, some organizations have found it is difficult to switch to remote working for several reasons, such as a lack of digitized paperwork, information confidentiality concerns, and the fact that some organizations do not yet have in place guidelines and procedures for remote working ( ILO, 2020c ). The potential impacts of remote work practices should be given careful attention: For example, technology-related problems take longer to resolve remotely than in an office where employees might have technical support. Remote workers may encounter this problem, and such a problem could disrupt the working environment and work productivity.

Digital miscommunication, which is a lack of informal interaction and human interaction, could also be one of the potential impacts of remote working. This miscommunication might shape a work design that is more individual- than team-based, and make co-workers’ interaction and team building even more difficult.

Potential exacerbation of existing inequalities

Given the adoption of more digital technology, automation, and artificial intelligence (AI), as well as the “new normal” work practice in the post-pandemic labor force, certain types of occupations could be adversely affected (see Figure 1 ). The least educated, unskilled, and low-skilled workers may be replaced by automation ( Lund et al., 2021 ). Vulnerable workers will likely be the hardest-hit group; some of them might have to work multiple jobs (probably freelance jobs) to sustain a living. It is likely further to exacerbate existing inequalities in the world of work, and therefore reskilling and upskilling will become more necessary than ever before. Similarly, jobs such as personal care, on-site customer service, and leisure and travel have been severely disturbed by the pandemic. Businesses and policymakers can help workers in workforce transitions by additional training and education programs For example, businesses might analyze which tasks can be done remotely instead of looking at an entire occupation and possibly eliminating it. Policymakers might facilitate businesses in terms of digital infrastructure enhancement ( Lund et al., 2021 ). Work-related policy changes that will protect and support businesses and workers, including enhancing employees’ WLB in the post-pandemic, are also essential. The future trend of the labor market will be a challenging time for everyone and the labor policies will need to be improved and strengthened in order to thrive in the post-coronavirus disease world.

Managing WLB

As the trend seems to favor hybrid working over a completely remote working environment, whole or partial renegotiation and reorganization will be essential. Managers and HR will have to accommodate the changes in organizational strategies as well as in HR policies. A study by Kumar and Mokashi (2020) on WLB in the UK’s higher education institutions employees revealed that supervisor support during coronavirus disease helped employees enhance their living quality. Similar to previous studies, it has been reemphasized in coronavirus disease times that supervisors’ or managers’ support can help employees achieve a good WLB ( Julien et al., 2011 ; Talukder & Galang, 2021 ; Talukder et al., 2018 ).

Alternatively, governments may opt to implement specific policies in this regard. One notable example would be to adopt the “right-to-disconnect” law similar to that which is enforced in the Philippines and France, where employees have the right not to respond to work-related engagements and demands during nonworking hours ( Broom, 2021 ; Department of Labor and Employment, Philippines, 2017 ; Eurofound, 2019 ). Encouraging healthy work practices such as working within regular hours and taking regular breaks will help employees to draw a firm line between work and nonwork activities ( Adamovic, 2018 ; Chen & Fulmer, 2018 ). Optimizing personal and work life is not easy when adopting a “new normal” working model. Employees need to be disciplined and well-organized in their work and personal life management. This global health crisis has made people pay more attention to health and hygiene, which has also driven up the demand for healthy workplace cultures. However, to attain a WLB in the post-coronavirus disease world, employers may need to consider and plan a way forward such as providing clarity to employees and a variety of programs to support employees in their well-being as well as fostering a “trust- and outcome-based working culture” ( Sarin, 2020 ; Wolor et al., 2020 ). Employers’ attention to employees’ WLB will assist in keeping employees motivated and maintaining their performance. Therefore, WLB in the post-pandemic times should be brought to both employers’ and employees’ attention and should be considered when developing a plan for policy changes that would benefit both companies and employees.

This paper explores how the coronavirus disease has disrupted the labor markets, focusing on blue-collar and nonmanual (white-collar) work, the future of the WLB, what the “new normal” would be like, and what can be foreseen in the post-pandemic. As evident, the pandemic has created a health crisis and a labor market alarm, and led to many changes, particularly in the working world. These changes either “accelerated” the pace of developments that were already underway, and/or are contributing to a “remodelling” of the pre-pandemic work-world and/or have contributed to the “normalization” of what were considered to be experimental and novel ways of work.

In seeking a possible working solution during such difficult times, “acceleration” is seen in the increased use of technology to enable remote working arrangement initially as a stopgap measure and followed by a hybrid manner of work, with the exception of professions that require a physical presence. Resulting in a significant “normalization” of these practices. While various work procedures and habits have been followed, there has been a wide variation in their use worldwide and across different professions in the labor market. Workers with high educational attainment and those who work as white-collar office workers have had the privilege of working in a safe and protected environment, while those who are engaged in manual and physical work engagement have braved challenges and continued to work under high risk.

Many white-collar workers that were forced to WFH as an emergency response to the pandemic did not receive additional support from their organizations. They survived using their limited personal resources while carrying out the job requirements. Many such employees acquired skills suitable to the future WLB policy, such as, get used to remote working, manage stress and productivity, and carefully splitting work and family time. In doing so workers were “remodeling” pre-pandemic work practices alongside “normalization” of news ways. In the future, such employees should be supported with WFH arrangements ever after the pandemic, with admission from their organizations. Employers have experimented on the feasibility of such work practices and are focusing more on cost saving and higher profitability. Although there remains a conflict between the expectations of employers and employees, On the whole, hybrid working and staying flexible is likely to be in demand and could be the “new normal” in the post-COVID period. In this case, businesses worldwide will need to proactively craft a long-term remote or hybrid work strategy based on their own needs, as there is no “one-size-fits-all” solution. Similarly, governments worldwide need to revisit the current employment policies to have strict and proper employment laws in place and assure fair employee treatment.

The changes in the labor policy framework dramatically impacted the inequalities, representing both “acceleration” and “remodelling”. The work-types for manual workers and nonmanual workers have undergone changes and made it clear that the economy must transform into retail, where it is driven by the needs of customers for the best possible level of service. Due to the nature of the work, a WFH arrangement cannot be utilized for those who need to be physically present to offer their services. Moreover, vulnerable employees (e.g., low-paid, low-skilled workers, persons with disabilities, and migrant workers) have been hit particularly hard by the pandemic. Many of them have been put on furlough since the early stages of the pandemic, leading some to consider making a living in the gig economy, as there seems to be little prospect soon of an end to the recession caused by the pandemic. However, jobs in the gig economy—for example, project-based jobs and independent contractual jobs—appear to have weaker protection and lesser benefits for workers ( United Nations, 2020 ). Furthermore, automation tends to replace the least educated, unskilled, and low-skill labor. As such, it has the potential to exacerbate existing inequities.

In light of the aforementioned changes in the labor market, the development of future WLB policies must include a spectrum of directions, such as customization of working hours under WFH, ensuring trust and support for WFH employees, responding to the demands to work from the office, and guaranteeing equal pay and the right to disconnect. Thus, policymakers must chart out a proper plan of action and consider not only jobs and groups of people but also when and which people can work remotely or on-site. According to Boland et al. (2020) , there are four steps to reimagine work and the workplace in the post-pandemic working world. First, how is work done in the post-pandemic working world? Organizations should restructure their working processes and functions to perform work: For example, workers may chart out tasks to be performed in the formal office environment versus those that could be taken care of in a remote setting. Second, once reconstructing their work processes and identifying the tasks that can be done remotely, organizations should consider segments of workers and reclassify roles to identify employees’ suitability for exclusively WFH or hybrid remote working and on-site working. Third, to maintain productivity and collaboration organizations should design workspaces that support workers both remotely and on-site, with tools such as virtual whiteboards and videoconferences. Lastly, some organizations may shift from a big city to a small city to save on their rental costs. Co-working spaces, flexible leases, flex space, and remote work seem to be examples of post-coronavirus disease options. These four steps—restructuring the working process, identifying tasks, redesigning workspaces, and relocating offices—will help organizations get some idea of how to prepare for and foresee the future of work and the workplace.

WLB should take a central development in labor policy in the post-pandemic working world. Balancing work and personal life is challenging both for employers and employees. Although previous studies have emphasized that remote work, WFH, or flexible workplaces can enhance employees’ WLB ( Pelta, 2020 ), WFH during the pandemic showed that some employees encountered an imbalance between work and personal/family life (see Figure 1 ). There is demand for giving people deserved “holidays” as due to hybrid digital working, as some employees have been working 24/7 without weekend breaks. People are being deprived of both their personal space and weekly time off as their work is “omnipresent” and one can access the office from anywhere on any device, be it a phone, laptop, iPad, or other tool. In contrast, some employees were able to enhance their WLB through a WFH arrangement, with things such as flexible working hours and having more time to take care of young children and/or elderly parents, and thus were more motivated. During this WFH period, some employees were able to achieve a good WLB while others were not.

The coronavirus disease pandemic has demanded adjustments and changes from the workers, who are in supervision and managers’ positions. Previous studies have found that supervisors influence employees’ WLB, with supervisor trust and support enhancing the WLB of employees ( Kumar & Mokashi, 2020 ; Talukder & Galang, 2021 ). Organizations and policymakers may need to consider how work is supervised and appraised in order to help supervisors trust employees and provide support to help employees achieve a WLB in the post-coronavirus disease world,. Also, the importance of a workplace productivity culture should be better defined by the managers so that workers can choose to work within or outside of the formal work environment without any negative repercussions. For instance, in European countries some regulations and policies related to WLB and flexible work practices, such as the “right to disconnect”, promote teleworkers’ WLB such that workers can opt whether to work or not outside of working hours ( Eurofound, 2020 ). Hence, to help employees achieve their WLB in the post-pandemic world, organizations and policymakers might consider an emphasis on:

Allowing employees to customize their work commitment and working hours and thus make WFH employees motivated and productive;

Trust and support WFH employees to help them reduce stress (which may also lead to an increase in productivity and work commitment);

Enhancing work motivation and employees’ well-being, understand that some employees may be willing to WFH and others prefer to be in an office;

Guaranteeing employees both equal pay for remote working and the right to disconnect;

Reconstructing how work is done, and identify which work can be performed remotely and which requires an onsite work environment.

Although remote working is an important trend in the post-pandemic world, many crucial issues in terms of the well-being of remote employees, national laws and regulations, and cyber-security risks require monitoring and further solutions. Therefore, relevant parties at all levels of society, including policymakers and businesses, must work together to create a more sustainable model for “new normal” work practices.

Fundamental changes should apply to labor policy. How governments address the “new normal” of remote and hybrid working will affect both the WLB and workplace inequalities and abuse. It is essential to have policies that encourage employee protection and well-being. To sum up, the pandemic has awakened countless speculations, assumptions, and debates on what the impending labor market will look like. coronavirus disease has given rise to transformation, interruption, endurance, and ambiguity. Studying the post-pandemic paths, as they take the form of “acceleration,” “normalization,” and “remodelling.” is vital in anticipating the connection between workplace disruptions and a pathway to a “new normal.”

The research was supported by a “Departmental Small Research Grant” funded by Department of Asian and Policy Studies, Faculty of Liberal Arts and Social Sciences, The Education University of Hong Kong, Hong Kong.

None declared.

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BRIEF RESEARCH REPORT article

Adjustment to a “new normal:” coping flexibility and mental health issues during the covid-19 pandemic.

• 1 Department of Psychology, The University of Hong Kong, Hong Kong, China
• 2 Department of Psychology, The University of Oslo, Oslo, Norway
• 3 Modum Bad Psychiatric Hospital, Vikersund, Norway

The Coronavirus Disease 2019 (COVID-19) pandemic is an unprecedented health crisis in terms of the scope of its impact on well-being. The sudden need to navigate this “new normal” has compromised the mental health of many people. Coping flexibility, defined as the astute deployment of coping strategies to meet specific situational demands, is proposed as an adaptive quality during this period of upheaval. The present study investigated the associations between coping flexibility and two common mental health problems: COVID-19 anxiety and depression. The respondents were 481 Hong Kong adults (41% men; mean age = 45.09) who took part in a population-based telephone survey conducted from April to May 2020. Self-report data were assessed with the Coping Flexibility Interview Schedule, COVID-19-Related Perception and Anxiety Scale, and Center for Epidemiological Studies Depression Scale. Slightly more than half (52%) of the sample met the criteria for probable depression. Four types of COVID-19 anxiety were identified: anxiety over personal health, others' reactions, societal health, and economic problems. The results consistently revealed coping flexibility to be inversely associated with depression and all four types of COVID-19 anxiety. More importantly, there was a significant interaction between perceived likelihood of COVID-19 infection and coping flexibility on COVID-19 anxiety over personal health. These findings shed light on the beneficial role of coping flexibility in adjusting to the “new normal” amid the COVID-19 pandemic.

Introduction

The emergence of an atypical coronavirus, SARS-CoV-2, instigated a global outbreak of Coronavirus Disease 2019 [COVID-19; e.g., ( 1 )]. Following identification of the earliest cases of COVID-19 in December 2019, the World Health Organization ( 2 ) declared the viral outbreak a health emergency of international concern on January 30, 2020, and then a global pandemic <2 months later. The escalating pandemic has induced anxiety and panic reactions in the general public, and the emotional responses bear some resemblance to those observed amid the severe acute respiratory syndrome (SARS) outbreak in 2003 [e.g., ( 3 , 4 )]. For instance, the panic sell-off of stocks led to a plunge in the global stock market ( 5 ), and long lines for food and the irrational stockpiling of personal protection equipment such as facemasks and hand sanitizers have been widely seen ( 6 , 7 ).

Despite such resemblances, the COVID-19 pandemic is an unprecedented crisis in terms of the scope of its influence on both physical and mental health [e.g., ( 8 , 9 )]. To curb the transmission of this hitherto unknown virus, governments all over the world have enforced strict epidemic-control measures such as nationwide school closures, stay-at-home orders, and physical distancing regulations in public areas ( 10 ). Also, myriad public and private organizations have adopted teleworking policies mandating that their employees work from home ( 11 ). Although employees hold generally favorable attitudes toward home-based teleworking, the sudden drastic change in work mode left many unprepared ( 12 ). Previous research on the office-home transition has revealed major changes in the work environment to induce the most stress and anxiety in employees who feel the least prepared for this alternative work mode ( 13 ). Devastating problems arising from stressful life changes have been documented not only in adults but also in youngsters, with recent studies revealing a significant proportion of children and adolescents to have experienced psychological distress during the school-closure period ( 14 , 15 ). The COVID-19 pandemic has confronted people of all ages with fundamental life changes [e.g., ( 16 , 17 )].

To grapple with the “new normal” and deal with the considerable challenges brought about by the pandemic, individuals need a considerable degree of flexibility. Psychological resilience is a widely recognized mechanism underlying the adjustment process, with coping flexibility a core component [e.g., ( 18 )]. The theory of coping flexibility postulates that effective coping entails (a) sensitivity to the diverse situational demands embedded in an ever-changing environment and (b) variability in deploying coping strategies to meet specific demands ( 19 ). More specifically, psychological adjustment is a function of the extent to which individuals deploy problem-focused coping strategies (e.g., direct action) in controllable stressful situations and emotion-focused coping strategies (e.g., distraction) in uncontrollable ones. Inflexible coping, in contrast, has been linked to psychological symptoms. For example, individuals with heightened anxiety levels are characterized by an illusion of control [e.g., ( 20 , 21 )]. They tend to perceive all events in life as being under their control, and thus predominantly opt for problem-focused coping regardless of the situational characteristics. In contrast, individuals with depression are characterized by a sense of learned helplessness [e.g., ( 22 , 23 )]. They tend to view all events as beyond their control, and thus predominantly deploy emotion-focused coping across stressful events. Coping flexibility has been identified to foster adjustment to stressful life changes, which is indicated by a reduction in symptoms of anxiety and depression commonly experienced in stressful life transitions ( 24 ).

Applying these theories and findings to psychological adjustment during the COVID-19 pandemic, individuals higher in coping flexibility are predicted to experience lower levels of anxiety and depression than those lower in coping flexibility. Clinical trial findings on COVID-19 offer a mixture of promise and disappointment regarding the efficacy of SARS-CoV-2 vaccine candidates [e.g., ( 25 )], and the absence of a thorough understanding of the etiology and treatment of this atypical virus has elicited widespread public panic responses. According to the theory of psychological entropy ( 26 ), uncertainty is a crucial antecedent of anxiety. In accordance with that theory, studies conducted during the pandemic have revealed unusually high prevalence rates of mental health problems such as anxiety and depression, rates ~3-fold higher than both their pre-pandemic prevalence and lifetime prevalence over the past two decades ( 27 , 28 ).

In light of the transactional theory of stress and coping that highlights the importance of primary and secondary appraisals in the coping process ( 29 ), coping flexibility (secondary appraisal) is predicted to explain the association between context-specific health beliefs (primary appraisal) and mental health. Instead of perceiving the COVID-19 pandemic as aversive and uncontrollable, resilient copers tend to espouse a more complex view by recognizing both controllable and uncontrollable aspects of the pandemic. For instance, these individuals tend to take such positive actions as acquiring new information technology and digital skills to meet the demands of home-based teleworking, but engage in meditation to cope with the unpleasant emotions brought about by mandatory stay-at-home orders. Accordingly, coping flexibility is hypothesized to be inversely associated with anxiety and depression during the pandemic.

As individuals high in coping flexibility are characterized by cognitive astuteness in making distinctions in an array of stressful events ( 30 , 31 ), coping flexibility is also predicted to interact with context-specific health beliefs to have a conjoint influence on mental health in the pandemic context. Although COVID-19 shares similar characteristics with other atypical coronaviruses of SARS and Middle East respiratory syndrome (MERS), the case fatality rate of COVID-19 is much lower than the others ( 32 ). Among individuals high in coping flexibility, those who tend to perceive such differences may experience lower COVID-19 anxiety than their counterparts who do not hold this perception. In this respect, mental health experienced during the pandemic is a function of both context-specific health beliefs and coping flexibility.

The present study was conducted during the “second wave” of COVID-19 infections in Hong Kong. Although the first confirmed COVID-19 case was identified on January 23, 2020, with the first death recorded 2 weeks later ( 33 ), Hong Kong remained largely unscathed by the first wave, with only sporadic cases reported and a relatively flat epidemic curve (i.e., fewer than 100 confirmed cases). However, there was a sudden surge in confirmed cases in March, when the viral outbreak swept the globe ( 34 ). The Government of the Hong Kong Special Administrative Region (HKSAR) responded to the health emergency by enacting a travel ban on non-residents, issuing compulsory quarantine orders for residents returning from overseas, and tightening various physical distancing measures in late March and early April [e.g., ( 35 , 36 )]. Special work arrangements for government employees were also implemented, and many organizations followed suit. The psychosocial impact was thus so pervasive that all sectors of society were affected. A population-based survey was therefore deemed the most appropriate method for investigating the psychological reactions to the pandemic among residents of Hong Kong. The method yields heterogeneous community samples, which maximizes representativeness and minimizes sampling errors.

Materials and Methods

Sample size determination and power analysis.

The statistical power analysis showed that the minimum sample size was 276 in order to identify statistically significant associations among the study variables, but a larger sample size was recruited to meet the requirements for conducting principal component analysis (PCA). Considering the general rule of thumb of having at least 50 cases per factor and a maximum number of nine factors to be identified in the PCA, the pre-planned minimum sample size was 450.

Participants and Procedures

The respondents were 481 Hong Kong adults (41% men; mean age = 45.09, SD = 23.42), who were recruited from a population-based telephone survey conducted by a survey research center at the first author's university. Random digit dialing was used for identifying eligible households, and then the most recent birth day method was employed to select a household member. To be eligible for participation, respondents had to be aged 18 or older, a resident of Hong Kong, able to understand Cantonese, and willing to give consent. Participation was voluntary, and all respondents who completed the survey were entered into a lucky draw for a chance to win gift certificates worth 500 Hong Kong dollars (about 65 U.S. dollars).

Trained interviewers conducted the telephone interviews using a structured questionnaire with standard questions. To foster interviewer calibration and minimize measurement bias, the survey was piloted in a small group of respondents from April 2 to 10, 2020. The final set of survey questions was amended to enhance the clarity of a few items, and then the full survey was administered from April 20 to May 19, 2020.

The study was conducted according to the ethical research standards of the American Psychological Association, and the study protocol was reviewed and approved by the human research ethics committee of the first author's university before the survey began (approval number: EA1912046 dated March 4, 2020). All respondents gave verbal consent in accordance with the Declaration of Helsinki.

Instruments

Coping flexibility.

Coping flexibility was assessed by the revised Coping Flexibility Interview Schedule ( 37 ). This interview schedule was originally developed based on clinical samples ( 38 ), and was adjusted for use with heterogeneous non-clinical populations. In the pilot phase, some respondents reported difficulty in understanding the terms of primary and secondary approach coping that was currently used in our interview schedule. The interview questions were revised by combining the terms of primary and secondary approach coping into problem-focused coping and converting the term of avoidant coping style into emotion-focused coping. Problem-focused and emotion-focused coping were originally used in the transactional theory of coping ( 39 ) from which the Coping Flexibility Interview Schedule was derived. The respondents were asked to report their deployment of problem-focused (e.g., information seeking, monitoring) and emotion-focused (e.g., acceptance, relaxation) coping in controllable and uncontrollable stressful situations over the past month.

To obtain a composite score of coping flexibility indicating strategy-situation fit, the individual coping items were subsequently coded by two independent raters according to a coding scheme ( 40 , 41 ) based on coping theories ( 39 , 42 ). One point was given to the deployment of problem-focused coping strategies to handle controllable stressful events and/or the deployment of emotion-focused coping strategies to handle uncontrollable stressful events. Zero points were given otherwise. All of these scores were aggregated, and then averaged to obtain a composite score. Inter-rater agreement was evaluated using Krippendorff alpha coefficients ( 43 ), and the results showed no discrepancies because no subjective codings were required (Krippendorff alpha = 100%).

COVID-19-Related Perceptions

Both perceived likelihood and impact of COVID-19 infection were measured by a modified measure developed and validated during the SARS outbreak ( 44 ). To make this measure relevant to the present pandemic context, the context was altered from “SARS outbreak” to “COVID-19 pandemic.” Respondents gave four-point ratings to indicate their perception of the likelihood of contracting COVID-19 (1 = very unlikely , 4 = very likely ) and the impact of having it (1 = no impact at all , 4 = a large impact ). The measure has been found to display both criterion and predictive validity ( 44 , 45 ).

COVID-19 Anxiety

As the events that have occurred during the COVID-19 pandemic are unprecedented, our team conducted a qualitative study in March 2020 asking participants to list all of the issues that had made them feel anxious during the pandemic. Content analysis of the results revealed 16 distinct themes regarding anxiety-provoking issues experienced amid the pandemic (see Table 1 for details). These items were compiled into a context-specific measure for assessing COVID-19 anxiety. Respondents rated each item on a scale ranging from 1 ( not worried at all ) to 4 ( very worried ).

Table 1 . Four-factor promax-rotated factor solution for COVID-19 anxiety ( n = 481).

Depression was measured by the short form of the Center for Epidemiological Studies Depression Scale ( 46 ), which contains 10 items. The translated Chinese version was used in this study ( 47 ). Respondents rated each item on a four-point scale (0 = rarely or none of the time , 3 = most or all of the time ). In this study, we applied the recommended cut-off score of 10 as the classification scheme [e.g., ( 46 , 48 )].

Statistical Analysis

All statistical procedures were conducted using SPSS version 26.0 for Windows (IBM Corporation, 2019, Armonk, NY). Before hypothesis testing, PCA was performed to identify the factorial structure underlying the 16 anxiety-provoking issues. The components were rotated using the varimax method with Kaiser normalization to increase the interpretability of the findings. The number of factors extracted was determined by the Kaiser rule, with factors retained when the eigenvalue exceeded one. The total amount of variance accounted for by the factors needed to exceed 60%, a minimum criterion for factor selection widely adopted in PCA research ( 49 ). Both the Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy and Bartlett's test of sphericity were first examined to check the appropriateness for analyzing the dataset, with appropriateness indicated if the KMO index was >0.50 and the test of sphericity was significant. For PCA, items with a factor loading <0.45 or double loading were removed. Cronbach alpha was used to indicate internal consistency for the items within each factor, with an alpha >0.70 considered adequate.

The potential differences among demographic groups were examined. Differences in sex were detected using an independent-samples t -test, and age differences using Pearson zero-order correlation analysis. In addition to testing age as a continuous variable, we also adopted a generational approach proposed by the Pew Research Center that makes comparisons across four age cohorts: (a) Millennials, who were born in 1981 or after; (b) Generation X-ers, who were born between 1965 and 1980; (c) Baby Boomers, who were born between 1946 and 1964; and (d) Silent Gen'ers, who were born before 1946 ( 50 ). A general linear model (GLM) was employed to investigate the differences among the four generations, with post hoc Bonferroni tests conducted if generational differences were found in any of the study variables.

Pearson zero-order correlation analysis was conducted to obtain an overview of the inter-relationships among the study variables. The hypothesized beneficial role of coping flexibility on mental health was then tested using three-step hierarchical regression analysis. First, the two demographic variables (i.e., sex and age) were entered to control for their potential effects on the criterion in question. Second, the variables of perceived likelihood of COVID-19 infection, perceived impact of COVID-19 infection, and coping flexibility were entered simultaneously. Third, the Perceived Likelihood of COVID-19 Infection × Coping Flexibility interaction and the Perceived Impact of COVID-19 Infection × Coping Flexibility interaction were entered. To address the potential multicollinearity problem, all of the variables were centered before conducting these analyses. The procedures were identical for each mental health problem included as the criterion variable. To unpack significant interaction effects, post hoc simple effects analysis was employed to examine the effects of COVID-19-related perception on a criterion at each level of coping flexibility.

PCA was performed because the KMO index was high (.87) and Bartlett's test of sphericity was significant (χ 2 = 3379.31, p < 0.0001). The results with the principal component weights of the 16 anxiety-provoking issues are presented in Table 1 . A four-factor solution was yielded, accounting for 63% of the total variance, with 38% explained by the first factor, personal health issues (e.g., “ COVID-19 infection in myself and my family members ”); 10% by the second factor, other people's undesirable reactions (e.g., “ discrimination ”); 8% by the third factor, societal health issues (e.g., “ government's lack of effort/ability to handle the pandemic ”); and 7% by the fourth factor, economic problems (e.g., “ pandemic's economic implications ”). It is noteworthy that one item (i.e., “ contact with a COVID-19 carrier ”) had a double loading with a difference of <0.10, and was thus discarded. All four factors displayed internal consistency (Cronbach alphas > 0.70), and were thus included in the subsequent analyses as indicators of COVID-19 anxiety.

The GLM results revealed a significant cross-generational difference only for anxiety over societal health, F (3, 477) = 33.92, p < 0.0001, partial eta squared = 0.18. Post hoc Bonferroni tests indicated that Silent Gen'ers aged over 74 ( M = 2.02, SD = 0.62) reported significantly less anxiety over societal health than did Millennials aged 18–39 ( M = 2.87, SD = 0.66) or Generation X-ers aged 40–55 ( M = 2.71, SD = 0.68), p s < 0.0001. However, there were no other differences regarding sex, generation, or the Sex × Generation interaction, p s > 0.05.

The descriptive statistics of and inter-relationships among the study variables are presented in Table 2 . The average depression score was 9.85, which was very close to the cut-off score for probable depression. Adopting the standard cut-off criterion of 10, slightly more than half (52%) of the respondents were categorized as having probable depression. The probable depression group ( M = 2.67, SD = 0.75) generally experienced a higher anxiety level over societal health issues than the no depression group ( M = 2.48, SD = 0.73), t = 2.72, p = 0.007. In addition, the probable depression group ( M = 0.50, SD = 0.21) also reported a generally lower degree of coping flexibility than the no depression group ( M = 0.58, SD = 0.21), t (479) = −3.95, p < 0.0001. However, no other significant differences in depression level were found for sex or generation, p s > 0.21.

Table 2 . Descriptive statistics of study variables ( n = 481).

Table 3 summarizes the results of hierarchical regression analysis for various mental health problems. As shown in the table, the pattern of results was highly consistent across the four types of COVID-19 anxiety; that is, all four types were positively associated with both the perceived likelihood and impact of COVID-19 infection and inversely associated with coping flexibility. There was also a significant interaction between perceived likelihood of COVID-19 infection and coping flexibility, and the results are presented in Figure 1 . For individuals higher in coping flexibility, those who perceived a lower likelihood of contracting COVID-19 reported less anxiety over their own health than their counterparts who perceived a greater likelihood of such contraction. For individuals lower in coping flexibility, however, such individual differences were absent and they generally reported greater anxiety over their own health than those higher in coping flexibility. In addition, the results revealed depression to also be inversely associated with coping flexibility, although its associations with the two types of COVID-19-related perception were non-significant. In short, these findings provide support for the hypothesized beneficial role of coping flexibility in dealing with mental health issues experienced during the COVID-19 pandemic.

Table 3 . Summary of hierarchical regression analysis by mental health problems ( n = 481).

Figure 1 . Simple effects analysis for significant interaction between perceived likelihood of COVID-19 infection and coping flexibility ( n = 481).

In addition to evaluating strategy-situation fit using composite coping flexibility scores, nuanced analysis was conducted to further examine the deployment of individual coping strategies and their associations with mental health problems. Most of the respondents (61%) reported deploying problem-focused coping to handle controllable stressful events during the pandemic, whereas just under half (45%) reported deploying that strategy to deal with uncontrollable stressful events. Fewer respondents said they had used emotion-focused coping to deal with controllable and uncontrollable stressful events (39 and 37%, respectively). Moreover, the deployment of problem-focused coping in controllable stressful events was inversely associated with anxiety over personal health and others' reactions, p s <0.0001, whereas the deployment of emotion-focused coping in controllable stressful events was positively associated with all four types of COVID-19 anxiety and depression, p s < 0.0001. However, neither problem-focused nor emotion-focused coping deployed in uncontrollable stressful events were significantly associated with any of the mental health problems, p s > 0.14.

The present study has investigated coping responses and mental health issues among the general public in Hong Kong amid the second wave of the COVID-19 pandemic. Recent studies have identified high prevalence rates of anxiety and depression among residents of COVID-19-affected regions all over the world [e.g., ( 28 , 51 )]. Our study expands this growing body of research by specifying four major factors of COVID-19 anxiety: personal health, others' reactions, societal health, and economic problems. Although the third factor is characterized primarily by societal health issues, it is interesting to note that a seemingly unrelated item “ progress of my work ” also loaded onto this factor. This perplexing finding may reflect the fact that employees' work progress has been affected more by societal factors (e.g., implementation of prevention and control disease regulations for business and premises, home-based teleworking policy) than personal factors during the pandemic.

A similar phenomenon is found for the fourth factor, economic problems. Most of the items loading onto it involved broad societal issues (e.g., economic recession, widening of health-wealth gap), but an item related to personal financial problems also did so. This finding similarly indicates that individuals' personal financial condition during the pandemic may be influenced to a great extent by the wider economy. Taken together, these interesting findings reflect the intricate interactions between the individual and society in times of crisis, thus attesting to the necessity of identifying anxiety-provoking issues specific to the pandemic in addition to assessing generic mental health issues that are context-free.

In addition to anxiety, our findings also show depression to have been prevalent among Hong Kong adults during the second wave of the pandemic, with slightly more than half the sample identified as having probable depression. Compared with respondents without depression, those with probable depression tended to experience greater anxiety related to societal health issues but not economic problems or personal health issues. These findings indicate that the unusually high prevalence of depression reported during the pandemic is largely related to health-related problems at the societal level (e.g., governmental actions to combat COVID-19, possible breakdown of local healthcare system) rather than personal health issues.

More importantly, the present study is the first to apply the theory of coping flexibility to the context of the COVID-19 pandemic, and the findings provide support for the hypothesized beneficial role of coping flexibility in relieving heightened anxiety and depression when handling the vicissitudes emerged during the pandemic. Astute strategy deployment to meet the specific demands of an ever-changing environment is essential for adjustment to the “new normal,” and a better strategy-situation fit is found to be inversely associated with both COVID-19 anxiety and depression. It is noteworthy that coping flexibility interacts with perceived susceptibility to COVID-19 infection to have a conjoint influence on COVID-19 anxiety. Even within individuals having a higher level of coping flexibility, those tend to experience fewer symptoms of COVID-19 anxiety over personal health if they display cognitive astuteness in assessing their possibility of contracting COVID-19. These novel findings provide support for the notion that the anxiety-buffering role of coping flexibility is highly context-specific ( 24 ), which is confined to infection susceptibility and anxiety over personal health in this stressful encounter. Such context-specificity is not surprising because subjective appraisals of the possibility of contracting a novel virus should be directly linked with concerns over personal health rather than other anxiety-provoking events related to non-health issues or to the society at large. Moreover, these findings further demonstrate that COVID-19 anxiety is not a unidimensional construct and should thus be studied using a multidimensional approach.

We further found the use of problem-focused coping to deal with controllable stressful events to be related to lower levels of anxiety over personal issues (i.e., personal health and others' reactions) rather than broader societal issues (i.e., societal health, economic problems). It is also noteworthy that the use of emotion-focused coping to handle controllable rather than uncontrollable stressful events was related to higher COVID-19 anxiety and depression, a finding consistent with previous studies on clinical samples of depression ( 22 ). Although the unprecedented COVID-19 pandemic is objectively an uncontrollable stressor due to its uncertain nature, the theory of coping flexibility highlights the importance of identifying aspects of life that are controllable and distinguishing these aspects from most other uncontrollable ones in a stressful encounter. For example, when a person high in coping flexibility fails to buy facemasks after visiting many stores, this person still regards the problem as controllable and keeps trying a variety of alternative means (e.g., placing orders in overseas online stores, seeking advice from members of WhatsApp groups). It is the cognitive astuteness in distinguishing between controllable and uncontrollable life aspects that fosters adjustment to stressful life changes.

Such situational differences in coping effectiveness indicate that neither problem-focused nor emotion-focused coping is inherently adaptive or maladaptive. The role of effective coping in mitigating mental health problems depends largely on the extent to which a deployed strategy meets the specific demands of the stressful encounter concerned. For instance, playing online games or browsing social network sites can be stress-relieving during leisure time ( 52 , 53 ), but prolonged gameplay or social media use can impair work or academic performance while working or studying from home ( 54 ). These findings are in line with the theory of coping flexibility, highlighting the beneficial role of flexible coping in soothing mental health problems experienced during the pandemic.

The present findings also have practical implications. Given the beneficial role of coping flexibility, clinicians may work with clients to enhance coping effectiveness with regard to strategy-situation fit. Stress management intervention may involve sharpening clients' skills for (a) distinguishing the key demands stemming from an array of stressful events; (b) assessing whether or not such demands are amendable to a change in effort (i.e., controllable or uncontrollable); (c) applying the meta-cognitive skill of reflection to evaluate strategies that best match the specific demands of diverse stressful situations; and (d) subsequently deploying the most appropriate strategy to handle each stressor. Such flexible coping skills are especially useful for dealing with the psychological distress elicited by a pandemic involving an assortment of stressful events.

Coping flexibility may also be valuable at a broader level because the unpredictable progression of the COVID-19 pandemic across successive waves presents varying challenges for public health authorities worldwide. For instance, the shortage of personal protection equipment aroused immense public anxiety in Hong Kong during the first wave owing to the sudden surge in demand for facemasks and hand sanitizer. After the supply of such equipment had been stabilized, however, new societal problems emerged. For example, during the second wave, public commitment to observing physical distancing measures began to wane owing to “pandemic fatigue” ( 55 ). Public health authorities may need to adopt a certain degree of flexibility in monitoring and identifying emerging issues to allow the timely adjustment of extant disease-control measures or the formulation of new ones to mitigate changing public health threats.

Despite its important findings, several study limitations must be noted. The survey was conducted during the second wave of the pandemic, when the epidemic curve climbed to a high level and then leveled off for a few months before reaching a further peak in the third wave in July and August, 2020 ( 34 ). As the COVID-19 pandemic continues to evolve in an unpredictable manner, some of the anxiety-provoking issues identified in this study may no longer elicit anxiety to the same extent in future waves. The list of issues eliciting COVID-19 anxiety should thus be updated in future research. Given the time sensitivity of these issues, pilot testing is essential to evaluate their relevance in particular phases of the pandemic.

Further, although our findings offer robust support for the hypothesized beneficial role of coping flexibility amid the pandemic, previous meta-analysis indicated that that beneficial role is more prominent in collectivist than individualist regions ( 19 ). A fruitful direction for future research would thus be to replicate the present design in individualist countries, allowing cross-cultural comparisons to be made. In addition to cultural differences, there may also be considerable variations among Chinese adults residing in different regions, as the epidemic trajectory has varied greatly among cities in the Greater Bay Area, such as Guangzhou and Macau ( 56 ). Greater effort can be made to compare the prevalence of psychological disorders and coping processes among Chinese residents of diverse regions.

Data Availability Statement

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

Ethics Statement

The studies involving human participants were reviewed and approved by the study protocol was reviewed and approved by the Human Research Ethics Committee of the University of Hong Kong (approval number: EA1912046 dated March 4, 2020). Written informed consent for participation was not required for this study in accordance with the national legislation and the institutional requirements.

Author Contributions

CC contributed to project design and administration, coordinated the data collection, performed the statistical analysis, and wrote the first draft of the manuscript. H-yW contributed to project design, survey creation, statistical analysis, and data interpretation. OE contributed to data interpretation and writing parts of the manuscript. All authors contributed to the article and approved the submitted version.

This research project was funded by the Public Policy Research Funding Scheme from the Policy Innovation and Co-ordination Office (Project Number: SR2020.A8.019) and General Research Fund (Project Number: 17400714) of the Government of the Hong Kong Special Administrative Region. The funders had no role in study design and administration, statistical analysis or interpretation, manuscript writing, or the decision to submit the paper for publication.

Conflict of Interest

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

Acknowledgments

The author would like to thank Sylvia Lam, Sophie Lau, Janice Leung, Yin-wai Li, Stephanie So, Yvonne Tsui, and Kylie Wong for research and clerical assistance.

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Keywords: coronavirus disease, resilience, coping, stress, psychological well-being, adaptation, Chinese, epidemic

Citation: Cheng C, Wang H-y and Ebrahimi OV (2021) Adjustment to a “New Normal:” Coping Flexibility and Mental Health Issues During the COVID-19 Pandemic. Front. Psychiatry 12:626197. doi: 10.3389/fpsyt.2021.626197

Received: 05 November 2020; Accepted: 01 March 2021; Published: 19 March 2021.

Reviewed by:

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

*Correspondence: Cecilia Cheng, ceci-cheng@hku.hk

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

Essay from The New Normal in Asia Series

The “new normal”: thoughts about the shape of things to come in the post-pandemic world.

Nicholas Eberstadt offers insights into the challenges to U.S. leadership in a post-pandemic world. This is the inaugural essay in the series “ The New Normal in Asia ,” which explores ways in which the Covid-19 pandemic might adjust, shape, or reorder the world across multiple dimensions.

Though we are as yet barely weeks into the Covid-19 pandemic, what should already be apparent is that it has precipitated the deepest and most fundamental crisis for Pax Americana that this set of global economic and security arrangements has faced in the past three postwar generations.

We are still very much in the “fog of war” phase of the calamity. The novel coronavirus and its worldwide carnage have come as a strategic surprise to thought leaders and political decision-makers alike. Indeed, it appears to be the intellectual equivalent of an unexpected asteroid strike for almost all who must cope in these unfamiliar new surroundings. Few had seriously considered the contingency that the world economy might be shaken to its foundations by a communicable disease. And even now that this has happened, many remain trapped in the mental coordinates of a world that no longer exists.

Such “prewar” thinking is evident everywhere right now in the earliest phase of what may turn out to be a grave and protracted crisis. Here in the United States, we watch, week by week, as highly regarded financial analysts from Wall Street and economists from the academy misestimate the depths of the damage we can expect—always erring on the side of optimism.

After the March lockdown of the country to “flatten the curve,” the boldest voices dared to venture that the United States might hit 10% unemployment before the worst was over. Four weekly jobless claims reports and 22 million unemployment insurance applications later, U.S. unemployment is already above the 15% mark: north of 1931 levels, in other words. By the end of April, we could well reach or break the 20% threshold, bringing us to 1935 levels, and 1933 levels (25%) no longer sound fantastical. Even so, political and financial leaders talk of a rapid “V-shaped recovery” commencing in the summer, bringing us back to economic normalcy within months. This is prewar thinking, and it is looking increasingly like the economic equivalent of talk in earlier times about how “the boys will be home by Christmas.”

This is moreover a global crisis, and vision has not yet focused on the new realities in other leading powers and major economies. If we try to take an unflinching measure of the impact globally, we can see both good news and bad news—although the two are by no means equally balanced.

The good news is that policymakers the world over have learned from the prewar Great Depression and are unlikely to repeat its exact mistakes. Instead of reducing the money supply and forcing bank collapses, the U.S. Federal Reserve this time is flooding the world with liquidity. Likewise, U.S. fiscal policy, far from attempting to impose further austerity on an already imploding economy through balancing budgets, is embracing Keynesianism with an abandon that might have startled Keynes himself. Given the “stimulus” packages already passed in the last month, this year’s U.S. budget deficit to GDP ratio is already certain to be of World War II scale. And, at least so far, no emanations of Smoot-Hawley-like impulses are on the policy horizon. Last time around, protectionism had devastating reverberations on an already severely stressed international trade and financial system. Confidence in U.S. and international economic management of the current crisis, at least for the time being, is reflected  inter alia  in the surprisingly sanguine valuations of the stock indices both in the United States and abroad.

The bad news, on the other hand, lies in the nature of the virus itself and in its implications for human life and socioeconomic arrangements. Covid-19 is an extremely contagious virus with high lethality for those exposed to it, and it can be transmitted by asymptomatic “super spreaders.” Further, since this disease is zoonotic (contracted from another species) and novel (our species has no preexisting immunity), the pandemic will roam the world in search of human quarry until an effective vaccine is invented and mass-produced—or until so many people are infected that herd immunity is conferred.

A Darwinian experiment to invite global herd immunity is unthinkable because it could entail untold millions of deaths. New vaccines, for their part, typically take many years to develop. Barring some miracle, even a crash program to perfect a vaccine is currently expected to take at least a year, and it could be a year and a half or longer before a serviceable serum is generally available to the public. Reports now emanating from South Korea, moreover, suggest that survivors might also be susceptible to reinfection. If so, the quest to come up with a lasting inoculation against Covid-19 may be all that much more daunting.

Consequently, societies the world over face the prospect of rolling lockdowns and quarantines until such time as a technological breakthrough rescues them from this condition. This would seem to mean that not just a single national lockdown of a country’s population and economy is in store to fend off mass contagion but rather quite possibly a succession of them—not just one mother-of-all-economic-shocks but an ongoing crisis that presses economic performance severely in countries all around the world simultaneously.

The potential downside of this crisis looks dire enough for affluent societies: even with excellent economic management, they may be in for gruesome recessions, both painful and prolonged. But the situation for the populations of low-income countries—and for least-developed, fragile states—could prove positively catastrophic. Not only are governments in these locales much less capable of responding to pandemics, but malnourished and health-compromised people are much more likely to succumb to them. Even apart from the humanitarian disasters that may result directly from raging outbreaks in poor countries, terrible indirect consequences may also lie in wait for these vulnerable societies. The collapse of economic activity, including demand for commodities, such as minerals and energy, will mean that export earnings and international remittances to poor countries are set to crash in the months ahead and remain low for an indefinite period. Entirely apart from contagion and lockdowns, this can only mean an unavoidable explosion of desperate need—and under governments least equipped to deal with this. While we can hope for the best, the worst could be much, much worse than most observers currently imagine.

Eventually, of course, we will emerge from the current crisis. Envisioning the post-crisis “new normal” is extraordinarily difficult at this early juncture—not that much less demanding, perhaps, than imagining what the postwar world would look like from the vantage point of, say, autumn 1939. Lacking clairvoyance, we can only peer through the glass darkly at what may be the shape of things to come in the post-pandemic order. Yet it is not too soon to offer one safe prediction about that coming order, and to identify three critical but as yet unanswerable questions, the answers to which promise to shape it decisively.

The safe prediction is that the Indo-Pacific, then as now, will be the locus of global economic, political, and military power—and will remain so for at least the coming generation, possibly much longer. Currently, countries belonging to the Asia-Pacific Economic Cooperation (APEC) account for as much as 60% of the world’s estimated GDP and close to half of global trade. If we add India, which is not an APEC member, to that roster, the economic predominance of the region looks even more overwhelming. APEC plus India likewise accounts for much—perhaps most—of the ongoing knowledge production in the world today. By such necessarily imprecise measures as publications in peer-reviewed scientific journals, authors from the APEC-plus-India region are responsible for about three-fifths of current global output. The only state with truly global military capabilities (the United States) is part of this region, as are the only other two governments entertaining global strategic ambitions (China and Russia). In addition to these countries, India and (alas) North Korea are nuclear weapons states. For the moment, the combined nuclear potential of all nuclear powers outside the APEC-plus-India region (France, Britain, Pakistan, and Israel) is dwarfed by the atomic arsenals within it.

Barring a catastrophe of truly biblical proportion (a formulation that may admittedly seem to be tempting fate, given current circumstances) it is impossible to see what configuration of states or regions could displace the Indo-Pacific as the epicenter of world power anytime soon. Someday Africa might in theory become a contender for geopolitical dominance, but that date looks so distant that such scenarios for now are perhaps best narrated by science fiction writers.

“Will the Covid-19 pandemic bring a brutal end to the second age of globalization that began in 1945, just as World War I heralded the cataclysmic death of the first globalization (1870–1914)?”

As for the questions that stand decisively to shape the coming global order, the first concerns the scope and character of what we have been calling “globalization” in the years and decades ahead. Will the Covid-19 pandemic bring a brutal end to the second age of globalization that began in 1945, just as World War I heralded the cataclysmic death of the first globalization (1870–1914)?

At this early point in the crisis, it would take a brave (or foolish) soul to assert confidently that an end to our current far-reaching arrangements for world economic integration simply could not happen. That said, at least for now, it would look as if a lot of things that have not yet gone wrong would have to go wrong, and at the same time sweep away the foundations (and memory plastic) for the networks of trade, finance, communications, technology, culture, and more that have come to deeply connect societies all around the world today. Not much less than a continuing, cascading, and unabated series of worldwide political blunders—not excluding military adventures—would be required to burn this edifice to the ground.

On the other hand, it is also hard to see how a post-pandemic world will pick itself up and carry on with commerce, finance, and global governance as if nothing much happened around the year 2020. Even under the optimistic assumptions—i.e., the assumptions wherein the second age of globalization survives Covid-19’s heavy blow—much will need to be dramatically different. Until the advent of some biometric, post-privacy future, the more or less free movement of peoples across national borders will be a nonstarter. “Davos” stands to become a quaint word, somewhat like “Esperanto,” as national interests and economic nationalism come roaring back. International supply chains will tend to be resourced domestically, notwithstanding the immediate apparent cost in terms of production and profits. At the same time, today’s crisis may explode and wipe out old inefficient business models that had already outlived their usefulness: the “big box” store and retail malls, the unproductive (but sociologically alluring) office, the law firm (with its Soviet-style valuations of its services on the basis of inputs rather than outputs), perhaps the cartelized, price-fixing university as well, and more.

On the positive side, the creative destruction the crisis will unleash will eventually offer immense opportunities for innovation and dynamic improvements in productivity, so long as resources from inefficient or bankrupt undertakings are reallocated to more promising new purposes. To give just one example, the returns on remote communications will likely be high, incentivizing impressive breakthroughs. Post-pandemic economies around the world will need all the productivity surges they can squeeze out of technological and organizational innovation, too—for they will almost certainly be saddled with a far higher burden of public debt than today. Moreover, given current demographic trends and the prospect of significantly less immigration, the shrinking of labor forces and the pronounced aging of national populations may be characteristic of a growing number of economies in the APEC-plus-India region and the rest of the world, and not just in high-income settings. Japan may become a model here, but not in a good way: avoiding “Japanification” could become a preoccupation of policymakers, pundits, and populaces in an epoch of diminished expectations for globalization.

A second huge question for the post-pandemic world concerns China: more specifically, how will the rest of the international community treat this increasingly powerful but intrinsically problematic state?

The world has yet to conduct the authoritative blue-ribbon scientific inquiry into the origins of the coronavirus pandemic that is obviously and urgently needed. However, there is little doubt that heavy responsibility for the global health and economic crisis we are now coping with falls on the Chinese Communist Party (CCP)—and to a lesser but by no means negligible degree, on China’s collaborators within the World Health Organization. Had the CCP placed its population’s health above its own—had it behaved like an open society or followed international transparency norms—there is no question that the global toll from the Covid-19 pandemic would only be a fraction of what has been exacted to date. Epidemiologists from the University of Southampton in the United Kingdom have suggested that the damage might have been contained to just 5% of what we have thus far suffered with an expeditious (and honest) response to the Wuhan outbreak. If that estimate is overly precise, it nonetheless gives a sense of the price the world has paid for the CCP’s priorities and standard operating procedure. We also already know of the complicity of the World Health Organization at its highest levels in buying time for Beijing as the regime figured out how to spin the story of what happened in Hubei Province.

“…the post-pandemic world will have no choice but to contend at last with a problem long in the making: the awful dilemma of global integration without solidarity.”

It would be one thing if this crisis were a one-off—dreadful as the tragedy would be. The problem, unfortunately, is that it is not a one-off, and in fact cannot be. At the heart of the tragedy is an uncomfortable but unavoidable truth: the CCP simply does not share the same interests and norms as the international community into which it has been so momentously and thoroughly integrated. Moreover, there is scant evidence that integration into the world economy and global governance has been “reforming” the Chinese regime, in the sense of bringing its politics and behavior into closer alignment with those acceptable to Western populations. Quite the contrary: in the Xi Jinping era, China’s politics have manifestly been moving away from convergence as the regime has concentrated on perfecting a surveillance state policed by “market totalitarianism” (a social credit system powered by big data, artificial intelligence, and more).

Thus, the post-pandemic world will have no choice but to contend at last with a problem long in the making: the awful dilemma of global integration without solidarity. China is deeply interlinked with every APEC-plus-India economy and with those of the rest of the world as well. Chinese interests are likewise deeply embedded in much of the institutional apparatus that has evolved to facilitate international cooperation. How will the rest of the countries in the international community manage to protect their interests (including health security interests, but by no means limited to this alone) in such a world? Will it be possible to accurately identify and carefully isolate all the areas in which win-win transactions with the CCP are genuinely possible and cordon off everything else? Or will the CCP’s authoritarian influence compromise, corrupt, and degrade these same institutions, and likewise constrain or poison opportunities for truly free international economic cooperation and development after the Covid-19 pandemic?

Last, but by no means least important, there is the question of the United States’ disposition in a post-pandemic world.

Even before the Covid-19 crisis, it was not exactly a secret that the United States—which is to say, Americans—was becoming increasingly reluctant to shoulder responsibility for world leadership in the global order that Washington had been instrumental in creating and that U.S. power was indispensable in supporting. The skepticism and disfavor with which American proponents of internationalism were increasingly greeted at home, however, was not entirely explained by the deep historical roots of isolationism in our country. Nor can it be dismissively described as yet another paroxysm of paranoia and anti-intellectualism on the part of the yahoos, as would-be Hofstadters from today’s chattering classes would like to have it.

Such discontent with our nation’s considerable international obligations skews strongly with socioeconomic status. For those in the bottom half of the country, grievances with the status quo (which not so incidentally includes a strong political commitment to Pax Americana) are by no means delusional. Over the past two generations, the American escalator has broken down for many. Just before the Covid-19 crisis, at the supposed peak of a business cycle, work rates for prime-age American men (the 25–54 age group) were slightly lower than they had been in 1939, near the end of the Great Depression. It is hardly reassuring that this alarming situation has attracted relatively little attention from the talking and deciding classes (many of whom are shielded from personal familiarity with how the other half lives by Charles Murray’s famous bubble).

Scarcely less disconcerting than the work rates for American men are the dismal trends in wealth formation for the less well to do. According to estimates by the Federal Reserve, the mean real net worth for the bottom half of households in the United States was lower in 2019 than it had been in 1989 when the Berlin Wall fell. By these estimates, in fact, the net worth of such households was at least a sixth lower in 2019 than it had been three decades before. Voters from these households might be excused if they were prompted to ask what the fabled “end of the Cold War” had done for them. Recall that these same Americans witnessed a decline in net household worth in a period when overall nominal net worth in the United States soared by almost $80 trillion—an average of almost $250,000 for every man, woman, and child in our country today. Since the arrival of Covid-19 on our shores, the net worth of the bottom half of Americans has dropped still further, as their indebtedness has risen and the value of their assets (mainly homes) declined. It could be quite some time before the balance sheets of those homes look as “favorable” as they did in 2019.

In the United States, the constitutional duty to obtain the consent of the governed obtains for the little people, too, even if they happen to comprise a majority of voters. And in a post-pandemic world, it may be even more difficult to convince a working majority that the globalized economy and other international entanglements actually work in their favor.

If U.S. leaders wanted to generate broad-based domestic support for Pax Americana, they need to devise a formula for generating prosperity for all. Such an agenda, of course, would win on its own merits, with or without an eye toward international security. Absent such a credible agenda, popular support for U.S. international leadership could prove increasingly open to question in the post-pandemic United States. The peril that declining domestic U.S. support poses to the current global order should not be minimized. If or when Pax Americana is destroyed, its demise may be due not to threats from without but rather to pressures from within.

Nicholas Eberstadt holds the Henry Wendt Chair at the American Enterprise Institute in Washington, D.C., and is a Senior Advisor to the National Bureau of Asian Research.

Correction (June 18, 2020): An earlier version of this essay stated that the real net worth for the bottom half of households was a third, rather than a sixth, lower in 2019.

Nicholas Eberstadt

American Enterprise Institute,

• United States
• globlization
• Chinese Communist Party (CCP)

Life after the COVID-19 vaccine: Envisioning the ‘new normal’

Uchicago experts examine impact of vaccine on our cities—and how we live, learn and work.

Since the COVID-19 virus was discovered, the world has waited for a vaccine that would help our lives return to some level of normalcy. Now that vaccine distribution has begun , what will this “new normal” look like?

In “Life After the Vaccine,”  from the producers of the Big Brains podcast , University of Chicago experts explore what the vaccine rollout has revealed about our cities, and how it will impact our lives within them—from our health care systems and businesses, to our educational and cultural institutions. 

Learn more about the topics and read the video transcripts below:

Our civic duty to keep each other safe

How vaccine passports could help businesses reopen, why health care must change to protect marginalized communities, leveraging data to direct public health efforts, tailoring education to students’ evolving needs, reimagining the work of cultural institutions, laurie zoloth, the margaret e. burton professor of religion and ethics at the divinity school.

“So the vaccine is a complex gift. It both gives you a sense that you are protected, but it ought not give you a sense that you’re free to do anything you want. The fact that you have the vaccine means that you’ve accepted the gift, and the gift comes with some strings attached.

It’s a privilege to live in the city, but it’s a kind of privilege that carries with it a deep responsibility, a duty that’s incumbent on each of us to make the city safe.

The nature of this pandemic is such that your personal choice affects the public realm. So when you say: ‘I’m not going to get a vaccine, but I want the right to continue to work. I want the right to get on an airplane and the right to go and hear the opera.’ What you’re doing is you’re imposing that risk on me, and on anyone in the community who might be more vulnerable.”

Anup Malani, the Lee and Brena Freeman Professor of Law; Professor at the Pritzker School of Medicine

“Even if people get vaccinated, there’s an issue of whether or not it’s safe to go back to work. Are the other people at work that you’re dealing with vaccinated? Do they feel comfortable that you’re vaccinated that they’ll interact with you?

What vaccine passports can do is eliminate that uncertainty and give people the confidence to engage in activity as they get vaccinated. That is, to say, keeping activity rising in proportion to vaccination rates. In urban areas, where a lot of economic activity hinges on people interacting with each other, and where population density really increases the risk of infection, I think immunity passports may play a more important role in encouraging people as the vaccination campaign continues, of encouraging people to actually engage in economic activity.”

Brenda Battle, Senior Vice President, Community Health Transformation; Chief Diversity, Inclusion, and Equity Officer at UChicago Medicine

“Civic leaders need to use their privilege to advocate for communities that have been marginalized and have suffered the disparities that we’ve seen unveiled through this COVID-19 vaccine.

The public health system has to be set up in such a way that every citizen in every urban area in every state is a part of how care gets delivered within our cities and states, and not with the system of separatism and fragmentation and two systems of health care—health care for the poor and health care for the affluent. We can’t operate a public health system that way.”

Kathleen Cagney, Professor of Sociology

“The use of spatial data can bring great insight into public health efforts and to deployment of the vaccine, in particular. We know, for instance, that low-income communities are at much greater risk, both for coming down with COVID-19, and for dying from COVID-19.

If we can use the data, for instance, from the census, where we know if buildings are multi-dwelling, we know the density of a particular neighborhood. Do they need to use public transit to get to work? All of that information can be brought to bear on characterizing the risk of a community and in understanding how we meet that risk in terms of our public health efforts.”

Tanika Island Childress, Chief Executive Officer of University of Chicago Charter School

“Education is not one-size-fits-all. And we had an opportunity to think about how to support students who have a variety of needs, both academically, but also socially. And we were striving to meet those individual needs during the midst of this pandemic. I don’t want us to lose sight of that once we return to the schoolhouse.

The future of urban education needs to be centered on individualizing education as much as possible for our students through a variety of modalities and ensuring that we can meet students and families wherever they are.”

Angel Ysaguirre, Executive Director of Court Theatre

“Right now in the performing arts, about 70% of our employees aren’t working. As we think about our world after the vaccine, we’re thinking really, really carefully about the smartest, most impactful decisions that we can make to further our missions.

Arts organizations will not come back with the same speed that they had before. So I think the artistic decisions that people make will think a lot more about the impact of that work on our audiences, and I think we’ll think a lot less about entertainment.”

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Reimagining healthcare after covid-19: a new normal for medicine

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Godlee discusses the long road ahead after covid-19. 1 Is this an opportunity to reimagine healthcare and forge a “new normal” for medicine?

After the most extraordinary few weeks, WB Yeats’s memorable line comes to mind: “All changed, changed utterly.” Normally complex changes such as virtual care and major service reconfigurations have occurred at breathtaking pace. 2 Traditional barriers, institutional inertia, …

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COVID-19 Vaccination—Becoming Part of the New Normal

• 1 US Food and Drug Administration, Silver Spring, Maryland
• Viewpoint Principles Underlying ACIP Recommendations for Phased Implementation for COVID-19 Vaccination Beth P. Bell, MD, MPH; José R. Romero, MD; Grace M. Lee, MD, MPH JAMA
• Viewpoint A National Strategy for the “New Normal” of Life With COVID Ezekiel J. Emanuel, MD, PhD; Michael Osterholm, PhD, MPH; Celine R. Gounder, MD, ScM JAMA
• Medical News & Perspectives “Unfinished Business” Brings Robert Califf, MD, Back for a Second Stint as FDA Commissioner Rita Rubin, MA JAMA
• Medical News & Perspectives Deciding Whether and How to Update COVID-19 Vaccines to Target Variants Rita Rubin, MA JAMA
• Viewpoint Is Vaccination Approaching a Dangerous Tipping Point? Peter Marks, MD, PhD; Robert Califf, MD JAMA
• Medical News & Perspectives Combined COVID-19 and Flu Vaccines Could Be Available Next Year Rita Rubin, MA JAMA
• Original Investigation COVID-19 Vaccination and Estimated Public Health Impact in California Sophia T. Tan, BA; Hailey J. Park; Isabel Rodríguez-Barraquer, MD, PhD; George W. Rutherford, MD; Kirsten Bibbins-Domingo, MD, PhD; Robert Schechter, MD, MSc; Nathan C. Lo, MD, PhD JAMA Network Open

As the US emerges from the recent Omicron surge of the COVID-19 pandemic following close to a million deaths in the country attributable to COVID-19, many people are hoping that the worst is over. 1 Widespread vaccine- and infection-induced immunity, combined with the availability of effective therapeutics, could blunt the effects of future outbreaks. Nonetheless, it is time to accept that the presence of SARS-CoV-2, the virus that causes COVID-19, is the new normal. It will likely circulate globally for the foreseeable future, taking its place alongside other common respiratory viruses such as influenza. And it likely will require similar annual consideration for vaccine composition updates in consultation with the US Food and Drug Administration (FDA) Vaccines and Related Biological Products Advisory Committee (VRBPAC). A recent meeting of the VRBPAC on April 6, 2022, resulted in a lively discussion and agreement on many considerations for planning for upcoming approaches to COVID-19 vaccine strain composition decision-making, development, and recommendations.

COVID-19 vaccines, developed and deployed in record time based on foundational scientific and clinical research conducted over the preceding decade, have conservatively saved tens of thousands of lives in the US and many more across the globe. 2 Although data show that third doses of the mRNA COVID-19 vaccines provide more durable protection against the severe outcomes of hospitalization and death, only 45% of the US population has received a third vaccine dose, including only about 68% of those older than 65 years—the individuals at greatest risk of adverse outcomes from COVID-19. 3 Because fourth doses of the mRNA COVID-19 vaccines were only recently authorized for those older than 50 years, it is too early to assess their effects on protection against serious outcomes of COVID-19 in the US. However, robust observational data from Israel with a large sample size showed additional protection against hospitalization and death in that population. 4

During this coming fall-to-winter period, 3 factors may come together to place the country’s population at risk of COVID-19, particularly those who are unvaccinated or who are not up-to-date with vaccination. These factors include (1) waning immunity from prior vaccine or prior infection, (2) further evolution of SARS-CoV-2, and (3) seasonality of respiratory virus infection, waves of which are generally more severe in the fall to winter months when individuals move their activities indoors.

By summer, decisions will need to be made for the 2022-2023 season about who should be eligible for vaccination with additional boosters and regarding vaccine composition. Administering additional COVID-19 vaccine doses to appropriate individuals this fall around the time of the usual influenza vaccine campaign has the potential to protect susceptible individuals against hospitalization and death, and therefore will be a topic for FDA consideration.

Those at greatest risk who might benefit most from vaccination include immunocompromised individuals and people older than 50 years, given the prevalence of comorbidities that increase the risk of severe disease and death in this latter group. Additional groups that might benefit include those who are unvaccinated (including children) or not up-to-date with vaccination (eg, those who have received only 1 dose of a COVID-19 vaccine or have not received a booster dose). 5 The benefit of giving additional COVID-19 booster vaccines to otherwise healthy individuals 18 to 50 years of age who have already received primary vaccination and a first booster dose is not likely to have as marked an effect on hospitalization or death as in the other populations at higher risk (noted above). However, booster vaccinations could be associated with a reduction in health care utilization (eg, emergency department or urgent care center visits).

Around the same time that a decision is made regarding who should be eligible for vaccination, a decision will also need to be made on the COVID-19 vaccine composition. To provide maximal benefit across the entire age spectrum, careful consideration will need to be given to the choice of the SARS-CoV-2 variant(s) to cover in the COVID-19 vaccines for the fall and winter of the 2022-2023 season. This is because the variant(s) covered by the vaccine may have an important influence on both the extent and duration of protection against a future SARS-CoV-2 variant(s) that may circulate. Better alignment between the variant(s) covered by the vaccine and circulating variant(s) of SARS-CoV-2 might be expected to prevent a broader spectrum of disease, potentially for a longer time. In the event of a major fall or winter wave, a vaccine with optimal variant coverage might facilitate significant reductions in lost productivity and health care utilization from both acute and chronic complications of COVID-19, including postacute COVID-19 syndrome. 6 Of note, in the past, such an overall public health benefit in an otherwise healthy younger population has been considered during the annual influenza vaccine campaign. 7

In terms of practical considerations, at the recent meeting of the VRBPAC, there was relatively uniform agreement that a single vaccine composition used by all manufacturers was desirable and that data would be needed to inform and drive the selection of a monovalent, bivalent, or multivalent COVID-19 vaccine. 8 There was also general agreement that, should a new vaccine composition be recommended based on the totality of the available clinical and epidemiologic evidence, optimally it could be used for both primary vaccination as well as booster administration.

The timeframe to determine the composition of the COVID-19 vaccine for the 2022-2023 season, to use alongside the seasonal influenza vaccine for administration in the Northern Hemisphere beginning in about October, is compressed because of the time required for manufacturing the necessary doses. A decision on composition will need to be made in the US by June 2022. Because of this timing, the FDA, in consultation with the VRBPAC, will need to arrive at a recommendation for the future composition of the US COVID-19 vaccines for 2022-2023 based on the available evidence and predictive modeling, with the understanding that there will be some inherent residual uncertainty about the further evolution of SARS-CoV-2. To date, the original, or prototype, vaccine composition deployed has been reasonably good at protecting against severe outcomes from COVID-19. However, a greater depth and duration of protection might be achieved with a vaccine covering currently circulating variants.

As plans are being developed for the coming fall and winter, it is critical that patients and caregivers understand the profound benefit of a booster dose of the mRNA vaccines or a second vaccine dose of any kind after the Janssen/Johnson & Johnson vaccine and that this understanding leads to action now in the face of a current uptick in infection rates. Clinicians should not be susceptible to inertia and should continue to recommend that patients get their COVID-19 vaccination status up to date, meaning primary vaccination and relevant booster(s). There is no evidence that getting vaccinated now will have adverse effects or toxicity that would preempt the administration of an additional vaccine dose in the fall months if there is evidence of waning of immunity, a new variant, or an adverse seasonal pattern.

Vaccines, as public health interventions, have been responsible over the past century for reducing an unimaginable amount of morbidity and for saving millions of lives. The eradication of smallpox and near elimination of several other infectious diseases are an unambiguous triumph of modern medicine. During the 2022-2023 COVID-19 vaccine planning and selection process, it is important to recognize that the fall season will present a major opportunity to improve COVID-19 vaccination coverage with the goal of minimizing future societal disruption and saving lives. With the plan for implementation of this year’s vaccine selection process, society is moving toward a new normal that may well include annual COVID-19 vaccination alongside seasonal influenza vaccination.

Corresponding Author: Peter Marks, MD, PhD, Center for Biologics Evaluation and Research, US Food and Drug Administration, 10903 New Hampshire Ave, WO71-7232, Silver Spring, MD 20993 ( [email protected] ).

Published Online: May 2, 2022. doi:10.1001/jama.2022.7469

Conflict of Interest Disclosures: Related to roles held prior to his confirmation as FDA commissioner, Dr Califf reported receiving personal fees from Alphabet Inc (Google LLC and Verily Life Sciences LLC), Centessa Pharmaceuticals PLC, Clinetic Inc, Cytokinetics Inc, and Medicxi Ventures (UK) LLP outside the submitted work. No other disclosures were reported.

Additional Information: Dr Marks is director of the Center for Biologics Evaluation and Research, Dr Woodcock is principal deputy commissioner, and Dr Califf is commissioner, all at the US Food and Drug Administration.

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Marks P , Woodcock J , Califf R. COVID-19 Vaccination—Becoming Part of the New Normal. JAMA. 2022;327(19):1863–1864. doi:10.1001/jama.2022.7469

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COVID-19: Where we’ve been, where we are, and where we’re going

One of the hardest things to deal with in this type of crisis is being able to go the distance. Moderna CEO Stéphane Bancel

Where we're going

Living with covid-19, people & organizations, sustainable, inclusive growth, related collection.

The Next Normal: Emerging stronger from the coronavirus pandemic

Life after COVID-19: Making space for growth

In this time of grief, the theory of post-traumatic growth suggests people can emerge from trauma even stronger

Vol. 51, No. 4

In the traditional Japanese art of kintsugi, artisans fill the cracks in broken pottery with gold or silver, transforming damaged pieces into something more beautiful than they were when new. Post-traumatic growth is like kintsugi for the mind.

Developed in the 1990s by psychologists Richard Tedeschi, PhD, and Lawrence Calhoun, PhD, the theory of post-traumatic growth suggests that people can emerge from trauma or adversity having achieved positive personal growth. It’s a comforting idea in the best of times. But it holds particular appeal as we live through a pandemic that’s upending lives for people around the globe.

Growing from trauma isn’t unusual, says Tedeschi, now a professor emeritus at the University of North Carolina Charlotte and chair of the Boulder Crest Institute for Posttraumatic Growth in Bluemont, Virginia. “Studies support the notion that post-traumatic growth is common and universal across cultures,” he says. “We’re talking about a transformation—a challenge to people’s core beliefs that causes them to become different than they were before.”

And the COVID-19 pandemic may have the ingredients to foster such growth. “We’re still in the middle of this situation, and we don’t know yet what might happen—but there will be serious challenges to people’s lives,” Tedeschi says. While those effects may be devastating, it’s possible to emerge from such adversity for the better, he adds. “For some people, this event may be a shock to their core belief system. When that’s the case, it has the potential to result in s­ignificant positive changes.”

Resilience vs. post-traumatic growth

Research across a variety of disasters has shown that there are different trajectories for recovery, says Erika Felix, PhD, a psychologist at the University of California, Santa Barbara, who treats and studies trauma survivors. Some people need time to recover from a trauma before returning to normal functioning. A portion of people experience negative mental health impacts that become chronic, but the majority of people bounce back from a trauma pretty quickly, she says. “Most people will be resilient and return to their previous level of functioning.”

Resilience and post-­traumatic growth are not the same thing, however. In fact, people who bounce back quickly from a setback aren’t the ones likely to experience positive growth, Tedeschi explains. Rather, people who experience post-traumatic growth are those who endure some cognitive and emotional struggle and then emerge changed on the other side.

This experience is measured by Tedeschi and Calhoun’s Post­traumatic Growth Inventory (PTGI) ( Journal of Traumatic Stress , Vol. 9, No. 3, 1996), which evaluates growth in five areas: appreciation of life, relating to others, personal strength, recognizing new possibilities and spiritual change. It’s not necessary or even typical to show change in all five areas, Tedeschi says. But growth in even one or two of those realms “can have a profound effect on a person’s life,” he says.

Some psychologists say the evidence for post-traumatic growth isn’t yet as robust as it could be. For example, Patricia Frazier, PhD, at the University of Minnesota, and colleagues followed undergraduates before and after a trauma. They found that participants’ self-reported perceived growth didn’t align with actual growth as measured by the PTGI. And while actual growth was related to positive coping, perceived growth was not, suggesting the construct may not fully reflect the way people are transformed by trauma ( Psychological Science , Vol. 20, No. 7, 2009).

But other evidence suggests that people do grow from trauma. A 2018 book by Tedeschi and colleagues summarizes more than 700 studies related to post-traumatic growth, including Tedeschi’s own research and work from other scientists (“ Posttraumatic Growth: Theory, Research, and Applications ,” Routledge, 2018). “When you look at how people respond to traumatic events, post-traumatic growth seems to be fairly common,” he says.

Planting the seeds for positive change

Post-traumatic growth isn’t something psychologists can prescribe or create, Tedeschi says. But they can facilitate it. “We see it as a natural tendency that we can watch for and encourage, without trying to make people feel pressured or that they’re failures if they don’t achieve this growth,” Tedeschi explains.

Most evidence-based trauma treatments provide a “manualized approach” to alleviating stress and symptoms such as anxiety, Tedeschi says. The post-traumatic growth framework he uses is an integrated approach that includes elements of cognitive-behavioral therapy, along with other aspects that emphasize personal growth. “It has elements of narrative and existential aspects, too, because traumas often present people with existential questions about what’s important in life.”

One way to help clients see the possibilities for growth is to be an “expert companion” during their struggle, he says. “That’s someone who accompanies their trauma, listens carefully to their story and learns from them about what has happened in their lives. By being that kind of expert, people start to open up and look at the possibilities in their lives more thoroughly.”

Yet post-traumatic growth isn’t something that can be rushed, and it often takes a long time to come to fruition. “As a clinician, you can plant the seeds that may germinate later,” Tedeschi says.

As we emerge from the COVID-19 crisis, clinicians and their clients may have opportunities to help those seeds begin to sprout. “This situation presents a challenge to people’s lives, and some people will be able to emerge from this for the better,” Tedeschi says.

One doesn’t necessarily need to experience trauma and existential struggle to learn from this crisis, however. For many people, the pandemic is shining a light on the things that are most important. “We might be making more time for things we find meaningful, simplifying our lives and making time for being connected in our relationships,” Felix says. “A stressor like this makes all of us think: What does this slowdown mean for our lives? We might be fundamentally changed in some ways that are beneficial.”

The Posttraumatic Growth Workbook Tedeschi, R.G., & Moore, B.A. New Harbinger Publications, 2016

The Posttraumatic Growth Inventory: A Revision Integrating Existential and Spiritual Change Tedeschi R.G., et al., Journal of Traumatic Stress , 2017

Do Levels of Posttraumatic Growth Vary by Type of Traumatic Event Experienced? An Analysis of the Nurses’ Health Study II Lowe, S.R., et al., Psychological Trauma , 2020

Resiliency and Posttraumatic Growth Despotes, A.M., et al. In Wilson, L.C. (Ed.)The Wiley Handbook of the Psychology of Mass Shootings, John Wiley & Sons, 2017

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Life before and after COVID-19: The 'New Normal' Benefits the Regularity of Daily Sleep and Eating Routines among College Students

Affiliations.

• 1 Department of Nutrition, Food Science, and Gastronomy, Food Science Torribera Campus, University of Barcelona, 08921 Barcelona, Spain.
• 2 Nutrition and Food Safety Research Institute, INSA-UB, 08921 Barcelona, Spain.
• PMID: 35057529
• PMCID: PMC8777903
• DOI: 10.3390/nu14020351

After the COVID-19 lockdown, a 'new normal' was established, involving a hybrid lifestyle that combined face-to-face with virtual activity. We investigated, in a case-control study, the impact of the 'new normal' on daily sleep and eating routines, compared with pre-pandemic conditions. To do this, we propose using social and eating jet lag as markers of the regularity in daily routines. Additionally, we studied whether the 'new normal' had an impact on the body mass index (BMI), diet quality, and other health-related variables. This study included 71 subjects in the pre-pandemic group, and 68 in the 'new normal' group (20-30 years). For all participants, we evaluated social and eating jet lag, BMI, diet and sleep quality, eating behaviors, physical activity, and well-being. General linear models were used to compare outcome variables between pre-pandemic and 'new normal' groups. The results revealed that the 'new normal' was associated with greater regularity in daily sleep and eating routines (-0.7 h of social jet lag (95% CI: -1.0, -0.4), and -0.3 h of eating jet lag (95% CI: -0.5, -0.1)), longer sleep duration on weekdays (1.8 h (95% CI: 1.5, 2.2)), and lower sleep debt (-1.3 h (95% CI: -1.7, -0.9)). Regarding BMI and other health-related variables, we observed that these variables were similar between 'new normal' and pre-pandemic groups. These findings indicate that the 'new normal' had a positive impact on daily sleep and eating routines. Additionally, our results indicated that the 'new normal' offered college students a more sustainable lifestyle, which was associated with more hours of sleep during the week and lower sleep debt. This, in the long run, could have a positive impact on BMI and overall health.

Keywords: COVID-19; daily routines; eating jet lag; meal timing; sleep; social jet lag.

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Back to School amidst the New Normal: Ongoing Effects of the Coronavirus Pandemic on Children’s Health and Well-Being

Elizabeth Williams Published: Aug 13, 2021

• Issue Brief

As millions of children across the nation prepare to go back to school this fall, many will face challenges due to ongoing health, economic, and social consequences of the pandemic. Children may be uniquely impacted by the pandemic, having experienced this crisis during important periods of physical, social, and emotional development, and some have experienced the loss of loved ones. Further, households with children have been particularly hard hit by loss of income, food and housing insecurity, and disruptions in health care coverage, which all affect health and well-being . Public health measures to reduce the spread of the disease also led to disruptions or changes in service utilization, difficulty accessing care, and increased mental health challenges for children. Young children are still not eligible for vaccination, and though children are likely to be asymptomatic or experience only mild symptoms, they can contract COVID-19. Children may face new risks due to the rapid spread of the Delta variant, and some children who contract COVID-19 experience long-term effects from the disease.  Many of these effects have disproportionately affected low-income children and children of color, who faced increased health and economic challenges even prior to the pandemic. This brief examines how the COVID-19 pandemic has affected the health and well-being of children, explores recent policy responses, and considers what the findings means for the back-to-school season amidst new challenges due to the recent increase in cases and deaths. Key findings include:

• During the pandemic, some children experienced disruptions in routine vaccinations or preventive care appointments and difficultly accessing care, particularly dental and specialized care. Use of telemedicine has increased but not enough to offset declines in service utilization overall.
• Children’s mental health service utilization declined amid elevated symptoms of depression, anxiety, and psychological stress for children and parents.
• Households with children have experienced significantly higher rates of economic hardships throughout the pandemic compared to households without children, leading to increased barriers to adequately addressing social determinants of health. Black, Hispanic, and other people of color have been disproportionately impacted by the pandemic’s economic effects.
• Though the risk of severe illness from COVID-19 is lower for children than adults, over 43,000 children are estimated to have lost a parent due to COVID-19, with Black children being disproportionately impacted by parent death.
• Most children are likely to be back in the classroom this fall, but many still face health risks due to their or their teachers’ vaccination status. Some states and school districts are beginning to announce mask or vaccine requirements while others are banning vaccine or mask mandates for schools.

Recent policy developments, most notably the American Rescue Plan Act and the American Families Plan, attempt to alleviate some of the existing and pandemic-induced issues impacting children’s health and well-being. However, there is still uncertainty around what back to school will look like this fall, and the transition to “the new normal” may be more difficult for some. Schools, parents, and policymakers may face additional pressure to address the ongoing effects of the pandemic on children.

Children’s Health Care Disruptions and Mental Health Challenges

The pandemic has led to delays in child vaccinations and preventive care. KFF analysis of the Household Pulse Survey from June 23 – July 5, 2021 estimates 25% of households with children have a child who has missed, delayed, or skipped a preventive appointment in the past 12 months due to the pandemic (Figure 1). Preliminary Medicaid administrative data confirms this pattern, showing that when comparing March 2020 – October 2020 to the same months before the pandemic in 2019, there were approximately 9% fewer vaccinations for children under 2 and 21% fewer child screening services. Rates for primary and preventative care among Medicaid beneficiaries show signs of rebounding in more recent months with service use reflecting pent-up demand, but it is unclear whether this trend will continue and make up for the millions of services missed early in the pandemic. Another recent study similarly reports vaccinations for all children declined sharply after March 2020. The study also finds vaccinations have completely recovered for children under 2 but have only partially recovered for older children.

Figure 1: Children have missed or delayed preventive appointments and utilized telehealth during the pandemic

Children also experienced difficulty accessing and disruptions in specialty and dental care. Parents have reported delaying dental care or difficulty accessing dental care for their child, and there were 39% fewer dental services for Medicaid/CHIP beneficiaries under 19 when comparing the pandemic months March 2020 – October 2020 to the same months in 2019. Children with special health care needs experienced difficulties accessing specialized services , especially services that could not be conducted via telehealth.

Children’s utilization of telemedicine services has increased since the pandemic, but the increase has not offset the decreases in service utilization overall. Preliminary data suggest that telehealth utilization for Medicaid/CHIP beneficiaries under 19 increased rapidly in April 2020 and remains higher than before the pandemic. 23% of households with children surveyed by the Household Pulse Survey from June 23 – July 5, 2021 reported a child having a telehealth appointment in the past 4 weeks (Figure 1). Throughout the pandemic, the federal government and states have taken action to expand access to telehealth services. While telehealth utilization has increased, the increase has not offset the decreases in service utilization overall, and barriers to accessing health care via telehealth may remain, especially for low-income patients or patients in rural areas.

Children’s mental health and mental health service utilization has worsened since the start of the pandemic. The pandemic caused disruptions in routines and social isolation for children, which can be associated with anxiety and depression and can have implications for mental health later in life. Also, research has shown that as economic conditions worsen, children’s mental health is negatively impacted. Parents with young children reported in October and November of 2020 that their children showed elevated symptoms of depression, anxiety, and psychological stress and 22% experienced overall worsened mental or emotional health. Recent studies by the Centers for Disease Control and Prevention (CDC) find children’s emergency department visits increased during the pandemic for mental health-related emergencies and suspected suicide attempts by children ages 12 to 17. At the same time, mental health service utilization has declined, with preliminary data for Medicaid/CHIP beneficiaries suggesting there have been approximately 34% fewer mental health services when comparing the pandemic months March 2020 – October 2020 to the same months in 2019. Private mental health care claims also decreased  from 2019 to 2020. There has been an increase in access to mental health care through telehealth, but there remain technological and privacy barriers to accessing mental health services via telehealth for some children.

Parental stress and poor mental health due to the pandemic can negatively affect children’s health. A previous KFF analysis finds economic uncertainty has led to increased mental health challenges, especially for adults in households with children and specifically mothers in those households. Further, 46% of mothers who reported a negative mental health impact due to the pandemic were not able to access needed mental health. Parental stress  can negatively affect  children’s emotional and mental health,  harm the parent-child bond , and have  long-term behavioral implications . Maternal depression can worsen child health status and lead to less preventative care. Additionally, parental stress and financial hardship can lead to an increased risk of child abuse and neglect. Early evidence shows declines in child abuse during the pandemic, though it is unclear if that is due to decreased reporting or due to social policy interventions during the pandemic. Children’s existing and pandemic-induced mental health challenges may have implications for the transition back to school and indicate children may need additional mental health support when they return to school.

Pandemic-related challenges in children’s access to health care built on a system that was sometimes not meeting needs even before the pandemic, especially for low-income children . In 2019, 23% of children living in households with incomes below 100% of the federal poverty level (FPL) were estimated to have not received a preventative check-up in the past 12 months and 26% did not see a dentist for a preventive visit during the past 12 months (Figure 2). Some children with mental health needs were not receiving care, with an estimated 29% of the lowest income children who needed mental health services not able to access care (Figure 2). The pandemic may have made it even more challenging for children already experiencing difficulties accessing care and likely worsened existing disparities in access to needed care for children of color, children with special health care needs, children in low-income households, and children living in rural areas.

Figure 2: Even before the pandemic, some children were not receiving preventive care or mental health care

The Economic Downturn and Children’s Well Being

Following the onset of the COVID-19 pandemic, many families with children were faced with unemployment and income loss and continue to face economic hardship. Throughout the pandemic, households with children were consistently more likely to report job or income loss, with more than half of households with children reporting losing income between March 2020 and March 2021. 1 While national indicators signaling job and income loss have moderated in recent months, they are still not at pre-pandemic levels. KFF analysis of the Census Bureau’s  Household Pulse Survey from June 23 – July 5, 2021 found 12% of adults with children in the household applied for Unemployment Insurance (UI) benefits and 23% experienced loss of income in the past 4 weeks (Figure 3). These rates were significantly higher compared to adults without children in the household.

Figure 3: Households with children are experiencing higher rates of job or income loss compared households without children

Loss of family income affects parents’ ability to provide for children’s basic needs.  KFF analysis of the Census Bureau’s  Household Pulse Survey also found that among adults reporting income loss in the past 4 weeks, 91% of adults with children in the household reported difficultly paying for expenses in the past week, 20% reported not having confidence in their ability to make their next month’s housing payment, and 32% reported food insufficiency (Figure 4). All of these rates are significantly higher for adults living in households with children than adults living in households without children. A large body of research shows that economic instability is a social determinant of health outcomes for children.

Figure 4: Among households experiencing income loss, households with children are experiencing higher rates of hardship

Further, Black, Hispanic , 2 and other households of color have been disproportionately impacted by the pandemic and its economic effects. In 2019, Black and Hispanic children were nearly three times more likely to be living in poverty than Asian and White children, and food insufficiency rates before the pandemic were three times higher for Black households and two time higher for Hispanic households when compared to White households. A recent report found Hispanic and Black households with children have experienced almost double the rate of economic or health-related hardships during the pandemic compared to White and Asian households with children. Overall, child poverty rates children have increased during the pandemic, especially among Hispanic and Black children.

Job and income loss may lead to disruptions in children’s health coverage, though increased coverage through Medicaid and CHIP is likely offsetting much of that decline. Roughly 2 to 3 million people between March and September 2020 have lost employer health benefits, a trend that built on years of coverage losses among children. From 2016 and 2019, the rate of uninsured children in the US started to increase despite reaching the lowest rate in history (4.7%) in 2016, with the rate of uninsured Hispanic children increasing more than twice as fast as the rate for non-Hispanic youth. Loss of coverage or coverage interruptions can negatively impact children’s ability to access needed care. 3 , 4 , 5 During the pandemic, Medicaid and CHIP provided a safety net for many children. Administrative data for Medicaid show that children’s enrollment in Medicaid and CHIP has increased between February 2020 and February 2021, a total increase of 3.2 million enrollees, or 9.1%, from child enrollment in February 2020 (Figure 5).

Figure 5: Child Medicaid/CHIP enrollment has increased since the pandemic

Children’s Health and COVID-19

While likely to be asymptomatic or experience only mild symptoms, children can contract COVID-19. Preliminary data through July 29, 2021 show there have been over 4 million child COVID-19 cases, and children with underlying health conditions may be at an increased risk of developing severe illness. Though a small percentage, some children who tested positive for the virus are now facing long haul symptoms , with multisystem inflammatory syndrome in children (MIS-C) the most-common complication that has impacted 4,000 children as of June 2, 2021 . It is unclear how long symptoms will last and what impact they will have on children’s long-term health. Cases have risen in recent weeks due to the Delta variant, and children are making up an increasing share of new cases, with children making up 19.0% of cases for the week ending in July 29 compared to 14.3% since the pandemic began. Hospitalizations of children with COVID-19 have also been rising since early July, reaching 216 children, on average, being admitted to the hospital every day for the week of July 31 – August 6, 2021.

Eligible children have lower vaccination rates than the adult population, and some children remain ineligible for a vaccine. Children 12 and up are now able to be vaccinated against COVID-19, which reduces the risk of adolescents contracting, spreading, or experiencing severe symptoms from COVID-19. Approximately 37% of children ages 12-15 and 48% of children ages 16-17 have received at least one vaccine dose as of July 26, 2021. These rates are lower than the adult population, which reached 70% as of August 2, 2021. There is currently no COVID vaccine for children under the age of 12, so  some risk remains for that population to contract and spread the virus. Vaccine clinical trials are currently underway for children under 12, with authorization expected by the end of 2021. The KFF COVID-19 Vaccine Monitor recently reported that almost half of parents of children ages 12-17 say their child has received a COVID-19 vaccine or they intend to get them vaccinated right away. The report also found that parents’ vaccination intentions for their children are largely correlated with their own vaccination status and those who say their child’s school provided information on or encouraged COVID-19 vaccines are more likely to report their child has received a vaccine. The KFF COVID-19 Vaccine Monitor also found that parents are more cautious when it comes to vaccinating their child under 12, with about a quarter saying they would get their child between the ages of 5 and 11 vaccinated right away once the vaccine is authorized and four in ten saying they would wait and see.

Some children have experienced COVID-19 through the loss of one or more family members due to the virus. A study estimates that, as of Feb. 2021, 43,000 children in US have lost at least one parent to COVID-19. The study also finds Black children represent only 14% of children in the US but 20% of children who have lost a parent, and low-income communities and communities of color overall experienced higher COVID-19 case rates and deaths . Losing a parent can have long term impacts on a child’s health, increasing their risk of substance abuse, mental health challenges, poor educational outcomes , and early death . Further, the death of a loved one from COVID-19 may have occurred amid increased social isolation and economic hardship due to the pandemic. Estimates indicate a 17.5% to 20% increase in bereaved children due to COVID-19, indicating an increased number of grieving children who may need additional supports as they head back to school in the fall.

Policy Responses

Several policies passed during the pandemic provided financial relief for families with children. To address the economic fallout of the pandemic, the federal government passed relief bills that included direct financial relief for families, and evidence suggests material hardships that affect health, such as food insufficiency and financial instability, declined following stimulus payments. In addition, the March 2021 American Rescue Plan Act (ARPA) included targeted aid to families with children through the Child Tax Credit (CTC). The ARPA is projected to decrease the number of children living in poverty by over 40%, with the expanded CTC now reaching children previously too poor to qualify and giving families in the lowest quintile an average income boost of $4,470. Alleviating child poverty is associated with improved child health outcomes such as healthier birthweights, lower maternal stress, better nutrition, and lower use of drugs and alcohol.

Other recent policies directly target children’s health coverage or access to health care. To address health care coverage, the ARPA extended eligibility to ACA health insurance subsides for people with incomes over 400% of poverty and increased the amount of assistance for people with lower incomes. The ARPA also included incentives for states to expand Medicaid for low-income adults under the ACA and extend Medicaid postpartum coverage for up to 12 months, both of which could benefit the health and well-being of families. 6 , 7 The Child Tax Credit, expanded by the ARPA, is not taxable income, so expanding the tax credit will not count toward Medicaid eligibility . To address access to health care challenges, the federal government and many states are making policy changes to permanently expand access to telehealth services. In their most recent report to congress , the Medicaid and CHIP Payment and Access Commission (MACPAC) recommended more coordinated efforts by agencies to address the design and implementation of benefits and improve access to home and community-based behavioral health services for Medicaid/CHIP children with significant mental health needs. In addition, the Biden Administration created a program to provide relief for COVID-19 related funeral costs, but targeted services for bereaved children were not included.

Back to School

Most children are likely to be back in the classroom this fall, but many still face health risks due to their or their teachers’ vaccination status and increasing transmission due to the Delta variant. The vast majority of schools, 88% of schools with 4 th grade and 89% of schools with 8 th grade, in the U.S. offered hybrid or full-time, in-person learning in Spring 2021, according to a federal survey . Most of these schools, as well as others, are likely to be in-person in fall 2021. While many states allow for in-person learning decision to be made at the local level, nine states have mandated schools return to in-person learning for the 2021-22 school year as of June 2021. No states are requiring the COVID-19 vaccine for school attendance at this time, and some states have enacted legislation to ban vaccine mandates for school attendance. However, due to concerns over the Delta variant and rising cases, some local districts are beginning to require the COVID-19 vaccine for teachers and staff. There have been legal challenges to vaccine mandates, with a federal District Court in Texas recently upholding a Hospital’s mandatory COVID-19 vaccination policy for employees. The CDC recently updated their guidance for COVID-19 in schools, recommending masks for all staff and students regardless of vaccination status for in-person learning in the fall. While some states and school districts will require students and staff to wear masks at school, at least nine states have passed legislation to ban mask mandates for schools as of late July 2021. Recent KFF polling shows that about half the public overall supports K-12 schools requiring COVID-19 vaccination, but most parents are opposed, with divisions along partisan lines.

While returning to in-person learning can support children’s development and well-being, the transition back to school in the fall may be challenging for some children. Experts notes that in-person learning is beneficial for children’s social, emotional, and physical health and can provide access to important health services and address racial and social inequities. However, this school year will look different for many children due to COVID-19 prevention strategies and transitioning back to “the new normal” may be difficult for some, especially those who have adapted to new routines and virtual learning in the past year . Children’s mental health has worsened during the pandemic , which could make the transition back to school more challenging. Additionally, young children who have been home with parents during the pandemic may experience separation anxiety as they transition back to school or day care.

Schools and proposed policies may provide additional supports for children and families as they transition back to school. The increased Child Tax Credits began July 15 th and will continue monthly, but the enhanced CTC was only adopted for 2021. The American Families Plan put forth by the White House proposes to extend the CTC expansion through 2025 and make the credit permanently available to families with no earnings. The American Families Plan also proposes expanding school meals and access to healthy foods, making the summer EBT program permanent, and expanding SNAP eligibility for formerly incarcerated individuals. The American Families Plan also proposes a national paid family and medical leave program and universal pre-kindergarten, both of which research has shown have benefits for children’s health outcomes. 8 , 9  President Biden and congressional Democrats also recently released a reconciliation budget resolution that includes expanded child tax credits and investments in universal pre-k, child care, paid leave, and education. Other policy actions at the local level can also address children’s well-being. For example, schools and school districts can support students as they transition back to school by creating a safe in-person learning environment , providing staff and resources to support students having difficulty transitioning, ensuring staff and teachers have access to mental health resources, and developing a trauma-informed plan to respond to COVID-19 related trauma.

COVID-19 and the health care disruptions, mental health challenges, and economic hardships stemming from COVID-19 all have implications for children’s health and their transition back to school in the fall. While returning to in-person learning can support children’s development and well-being, uncertainty remains around what in-person learning will look like as cases rise due to the Delta variant and the transition to “the new normal” may be difficult for some children and their families. Recent policy developments attempt to address the ongoing effects of the pandemic on children, and schools, parents, and policymakers may face additional pressure to support children during this time.

• Coronavirus (COVID-19)
• Coronavirus

news release

• Children Head Back to School Amid an Ongoing Pandemic That Has Had Significant Effects on Their Health and Well-Being

Also of Interest

• Mental Health and Substance Use Considerations Among Children During the COVID-19 Pandemic
• The Next Stage of COVID-19 Vaccine Roll-Out in United States: Children Under 12
• KFF COVID-19 Vaccine Monitor: Parents and the Pandemic

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The New Normal after Covid-19 will Pave the Way to the New Future!

• Updated on  
• Dec 7, 2020

This pandemic has made us all experience something which we never thought we would. From spending months inside our homes without being able to go out to thinking twice even before stepping out, our worlds have definitely changed. Most of us believed that it’s just a matter of a month or two but now it has extended to almost a year now, shattering all our hopes of getting back into our normal routine. But as the Corona crisis is still at its peak around the world, claiming the lives of many, there is a conversation going around these days about how this will be the “new normal” now. That makes us wonder if this restrictive way of life can ever be considered normal and what exactly does terming such turbulent times would lead to a new normal after Covid-19 and what would it really mean.

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The World Amidst the Pandemic 

The extremity of this pandemic could be only understood when you look at the numbers. As a fact, there are 33.7 million confirmed cases and over one million deaths to date. And these numbers signify the threat that Corona is posing to the world. But that’s just one side of the story. The other side of this is how it has threatened the livelihood of people across the world. During the periods of subsequent lockdowns, a majority of the population shifted to working from their homes, students resorted to online learning but there was a part of the population which was not privileged enough to have such access. People lost their jobs, the economy crashed and every country was battling with just one question, what’s the way forward to the new normal after Covid-19?

The New Normal

Once the questions started looming around about the new future or the new world all of us have entered during the pandemic, that’s when this idea of the “New Normal” started making rounds. The economic and social aspect of this new phase is that the government and individuals need to work together to restart the economy while simultaneously making efforts to minimise transmission. The world is not ready for another lockdown, so we need to maintain social and economic activities while taking all the necessary precautions to control the spread of the disease. 

But when after months of the lockdown the economy finally reopened, within weeks the Covid-19 cases reached a new height. All the efforts to contain it were proved to be not enough. And this was our reality check. That as a nation we were not able to mould ourselves into a system where we could get on with our normal lives in a way which prevented the spread of the Corona. The trend that we witnessed was that the control measures were relaxed and the risk perception steadily declined. As a result, the disease started to spread throughout the transmission. It became really difficult to imagine a world where we can find a new normal after covid-19.

Even though the elder generation and the children continued to stay inside the safety of their homes, they were exposed to the virus through other members of their family. Also, with asymptomatic cases, it became impossible to keep track of the actual cases. This recent rise in cases and undetected transmission among younger and healthier populations exposes the reality that the COVID-19 outbreak will likely continue for the foreseeable future until a vaccine becomes widely available. And we need to accept that till then things will not go back to normal. And therefore we need to accept this present scenario as our “new normal” and make our journey towards a new future after Covid-19.

This Present Crisis Demands a “New Future”

More than anyone this “new future” lies within the hands of the government and the policymakers. They need to come up with “more sustainable and targeted response models that proactively work to suppress new COVID-19”.  And this foundation to the “new future” can be laid by improving our healthcare systems. As we know that constant testing could help first in the detection and then containing the spread of the disease. So, the reach of the healthcare system should be expanded and every person should have access to it. In the last few months, there were instances where people died because of lack of treatment. As we lead towards a new normal after Covid-19, there shouldn’t be any space for such incidents. Every region of the world should have a strong public health and healthcare system equipped with all the necessary resources to tackle events of such scale. 

The second thing that the “New Future” will have to ensure is that every student from both the urban and rural milieu has access to online learning. Schools are not going to open anytime soon and therefore it’s the responsibility of the government that no child should suffer because of inaccessibility. So, this envisioned “New Normal after Covid-19” needs to bring a strong healthcare and educational infrastructure to increase its reach and avoid any kind of disparity in terms of access to healthcare or education. 

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How Normal is this “New Normal”?

There’s actually nothing normal about this “new normal”. More than anything it’s about the acceptance that the present scenario is not going to change any time sooner and therefore we need to make adjustments to resume our normal life in the best possible manner. Sanitisers, social distancing and face masks are what this “new normal” is made up of. What you need to do is accept that things are not the way they were once and that you and your family is under the risk of being a victim of this virus. As they say “prevention is better than cure”. So, you need to adopt all the necessary preventive measures and get used to this way of life at least until the vaccine arrives and that’s how we can build upon this new normal after Covid-19 is eliminated.

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But one needs to understand that this new normal whether it’s now or after Covid-19, it shouldn’t be about normalising suffering but about a hope that we are strong enough to survive. What we need right now is to stay strong as a community and fight it together. It’s not going to be easy but we have no other option but to fight it. And that’s the only way that we can pave a way towards a new future which will be better in terms of resistance to any such future calamities. Stay tuned to Leverage Edu as we bring you more such informative and educational updates on how the world and the academic sphere is tackling the new normal!

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A New Normal After the COVID‐19 Pandemic

Midway through the second year of the coronavirus disease 2019 (COVID‐19) pandemic, the increasing number of people vaccinated against this devastating disease gives hope that the pandemic will be controlled and allow a return to normal life. Although we are understandably weary of restrictions, working from home (for the privileged) or working under fear of exposure and infection, the social disruptions, and economic instability, a return to life as usual before COVID‐19 would miss many opportunities to learn from this pandemic and work toward increased equity and health for all. In a post‐pandemic United States, we need to think differently about infectious diseases.

The foundation for prevention of and response to infectious diseases begins with a robust public health infrastructure. The quality and quantity of the US response to the COVID‐19 pandemic varied greatly across counties, states, and regions because of inadequate funding, lack of planning, and limited support from the federal government. Although the United States spends more per capita on health care than any other country, only 1.5% to 2.5% is spent on public health. 1 As COVID‐19 infections increased during the spring of 2020, stockpiles of personal protective equipment rapidly depleted, leaving frontline health care workers underprotected and facing dilemmas on how to balance patient care with personal risk. Guidelines to protect health care workers varied by institution, changed frequently, and deviated from long‐established approaches for protection against airborne illnesses. Greater coordination across public health systems and sharing best practices can avoid wasted effort. The initial response was delayed from a false sense of safety that the pandemic was under control or isolated to other locations. But we live in a connected world where the ease of international travel facilitates the rapid global spread of infection. Because of all these factors, we need to increase funding and coordination among public health agencies across the United States and renew support for international public health through the World Health Organization and other agencies.

This continuing education issue of the Journal of Midwifery & Women's Health ( JMWH ) focuses on infectious disease in midwifery practice; these articles can help us orient toward infectious disease management in new ways and to give infections the attention needed to better protect patients as individuals and on the population level. I would like to highlight 3 recommendations for focusing on efforts to address infectious diseases in this country: (1) increase use of effective practices to prevent transmission of viral infections, (2) use a health equity lens in prevention and treatment, and (3) use innovative approaches to increase access to health care.

A remarkable consequence of social distancing, mask wearing, and increased hand hygiene has been the dramatic drop in influenza cases, hospitalizations, and deaths during the 2020 to 2021 influenza season. Influenza surveillance by the Centers for Disease Control and Prevention has found that the incidence of influenza has been approximately 1% of a typical year. 2 In anticipation of the 2021 to 2022 influenza season, we should renew our efforts to encourage influenza vaccination, use of hand hygiene, and mask wearing. Even when effective vaccines are available, there are significant barriers to acceptance of vaccines by the public. 3 This issue of JMWH provides different insights into addressing this problem. Vines 4 outlines how midwives can address the trust gap in communities of color about health care and vaccinations through active listening, motivational interviewing, storytelling, and increased workforce diversity. Dehlinger 5 describes a quality improvement project to increase influenza vaccination rates in a multisite urban academic health care facility during the 2019 to 2020 influenza season. The case study by Kraus 6 demonstrates how vaccine hesitancy can lead to perinatal measles infection. We also need to increase utilization of prevention strategies for diseases like HIV for which no vaccines exist. Ruppe 7 discusses how pre‐exposure prophylaxis for HIV infection is an underutilized yet feasible approach to protect individuals at higher risk of HIV infection. The articles by Pesch about cytomegalovirus 8 and by Hunter about parvovirus B‐19 9 highlight the importance of hygiene practices in protection against perinatal transmission through body fluids and respiratory droplets.

Strategies to prevent infectious diseases need to incorporate a health equity lens and engagement with communities of color, who are most affected by disparities in infectious diseases. Communities of color have faced disproportionate COVID‐19 infection rates, hospitalizations, and deaths. 10 The cause for these health disparities is likely multifactorial and includes a greater burden of chronic disease; employment in lower‐paying, public‐facing occupations like restaurants and grocery stores; crowded housing; and racism inside and outside of the health care system. 11 It is time to move from recognition of health disparities to positive action to address these differences through bold public policy. There are many low‐wage workers who cannot afford to stay home if they or family members are ill because they risk lost wages or termination. Many workers understandably choose to work when they are ill, putting themselves and their coworkers at risk. When health care workers come to work sick, they also risk the health of their patients. During the past year, many employers have excluded workers with any symptoms suggestive of COVID‐19, undoubtedly excluding those with more benign respiratory illnesses. This has likely contributed to reduced transmission of all respiratory illnesses. Universal paid sick leave and employment protections would protect us all, but especially employees with lower wages and at the greatest risk.

Many midwifery practices increased the use of telehealth visits for routine prenatal care to protect staff and patients from COVID‐19 transmission. We do not know how this shift in care has impacted health outcomes, although qualitative studies have demonstrated that patients felt less connected and reassured by these types of visits. 12 When in‐person care returns to normal levels, health care systems should examine how telehealth can be used as a strategy to increase access to care when appropriate and acceptable to patients, rather than as a way to restrict in‐person care. Policies need to support appropriate payment for telehealth services and prohibit charges for 2 visits when the need for in‐person care is identified at a telehealth visit. It is especially important to maintain access for partners and support people, who advocate for patients of color and mitigate the power differentials inherent in prenatal care. The COVID‐19 pandemic has increased innovative approaches to bring health care into communities as demonstrated by licensing many types of health care workers as vaccinators, including pharmacists, dentists, and retired workers. These innovations need to be extended in creative ways to make health services more accessible to all communities.

In the coming months, as pandemic restrictions are lifted, consider how you can develop a new normal rather than returning to pre–COVID‐19 routines. Although this editorial focuses on infectious disease implications, there are so many other aspects of life we may want to assess as we anticipate the return to “normal.” Our ability to adapt to the many challenges of the COVID‐19 pandemic shows that we can change systems and behaviors when there is a sense of urgency and desire to do better.

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