dissertation topics about covid 19

Global Health (GHWG)

Content from global health (ghwg) working group, do you want to write a covid dissertation.

Professor Sophie Harman, a member of our Global Health Working Group, gives some advice about coming up with dissertation topics related to COVID.

Part of the joy and point of writing a dissertation is for students to come up with their own subject and research question. Both students and supervisors know this is often the most painful part of the process (second only to the week before deadline – start early, marathon not a sprint etc!). I know good supervisors can support students writing dissertations in all manner of subjects and this is what makes it so rewarding. However, in a year where we’re all dealing with increased pressure, demands on our time, and managing screen headaches, I thought I’d put my 15 years global health politics experience to good use and make some suggestions/pointers to help you when a student comes to you as says the inevitable: [1]

‘I was thinking of writing my dissertation on COVID-19’

Below are 10 suggested questions with suggested literature and methods, covering institutions, security, race, policy, vaccines, gender, aesthetics, expertise, knowledge. These by no means cover everything and by no means prescribe how I think a dissertation on that topic should be written. If helpful, see them as jump-off points to think about these topics. The only caution I have is make sure all projects are only focused on the start/first 6 months of COVID-19 – we are only at the end of the beginning. This is also a pre-emptive move to stop you getting your students to email me for ideas.

Institutions and global governance

1. Is the WHO capable of preventing and responding to major pandemics?

Literature: WHO, IHR, GOARN, global health security + previous outbreaks (Ebola, pandemic flu, HIV/AIDS)

Methods: Case Studies – look at the tools/instruments e.g. IHR, GOARN, Regional offices etc

2. Why did states pursue different responses to the COVID-19 outbreak?

Literature: Global health security, state compliance in IR, international law and international organisations

Methods: Pick two contrasting case studies e.g. England/Scotland, Canada/US, Germany/UK, Sweden/Denmark and then look at different levels of policy and decision making per chapter – Global, National, Regional/local and rationales behind decisions from – expert evidence, speeches, policy decisions, policy timelines

3. How can we understand the gender dimensions of COVID-19?

Literature: Gender and global health, Feminist IPE, Black Feminism, WPS (if looking at violence)

Methods: Explore 1 – 3 key themes from the literature – Care and domestic burden, Health Care Workers, Domestic violence in depth. Depending on networks and contacts, could run focus groups (ethics! And definitely NOT if doing violence), or analyse survey data – lots of surveys done on this and the raw data is always made available if have the skills to play with it.

Political economy

4. Are states the main barrier to vaccine equity?

Literature: Vaccine access and nationalism, access to treatment, IPE of health and trade, pharmaceutical companies, Bill and Melinda Gates Foundation

Methods: Look at the different stages of vaccine development for 2/3 trials and consider the role of States (where putting money, public statements, any actions e.g. email hacks), Researchers (where get money from, how collaborating, knowledge sharing), Institutions (CEPI, GAVI, WHO), and the Private Sector (pharma and foundations – who’s investing, what is their return – and private security companies – who protects the commodity?). Think: interests, investment, barriers/opportunities.

Security and foreign policy

5. Were state security strategies prepared for major pandemics prior to COVID-19? If not, why not?

Literature: Global health security, securitisation and desecuritisation of health

Methods: 2 – 3 state case studies or 1 in detail, think about Strategy, Training/Preparedness, Actors. Content analysis of security strategies and defence planning and budget allocations, speeches, training, simulations etc.

6. What is the role of images in responding to outbreaks?

Literature: Aesthetics and IR, behaviour change communication and images in public health

Methods: 3 case studies on different types of images in COVID-19, e.g. 1. Global public health messaging; 2. National public health messaging; 3. Community Expression – OR pick one of these options and explore in depth.

Race and racism

7. Could the racial inequalities of COVID-19 been foreseen and prevented?

Literature: Racism and global health, racism and domestic health systems, Black Feminism, Critical Trans Politics

Method: Option 1 – look maternal health as a proxy in three case study countries e.g. Brazil, US, UK; Option 2 – pick one country and look at three health issues prior to COVID-19 e.g. Maternal Health, Diabetes, Heart Disease.

Knowledge, discourse, and experts

8. Is COVID-19 the biggest global pandemic of a generation?

Literature: Postcolonial/decolonial theory, poststructuralism, Politics of HIV/AIDS, pandemic flu

Method: Discourse analysis around ‘once in a lifetime rhetoric’ – who says it, when, and why; contrast with discourse around COVID-19 from countries with previous outbreaks e.g. Sierra Leone, DRC, China, Indonesia, South Africa, Brazil (you’ll need to be selective as can’t measure discourse from all states! Think through why you make your choices here and how they relate to each other) OR contrast COVID-19 with a previous pandemic, e.g. HIV/AIDS

9. What knowledge counts in COVID-19?

Literature: Postcolonial/decolonial theory, post-structuralism, IR and Global Health, politics of experts

Methods: Review lessons learned from previous outbreaks (there are lots of source material on this after Ebola and SARS for example) and how they led to changes/what learned for COVID-19; Stakeholder mapping and/or network analysis – Who are the experts? Look at backgrounds, types of knowledge and expertise, did they work on the Ebola response/HIV/AIDS in the early 2000s for example?; Case Study – UK/US – where have high concentration of public health experts and institutions, export knowledge to low and middle income countries, evidence of importing knowledge from these countries, especially given the experience?

UK/State responses

10. How can we understand/explain the first 6 months of the US/UK/Sweden/Australia/South Africa/China/Brazil/you choose! response to COVID-19?

WARNING! This is the question that could descend into a polemic so approach with absolute caution. I would strongly advise against, but have included to give a clearer steer.

The key with this question is to remember you are not submitting a public health or epidemiology dissertation, so bear in mind you probably don’t have the skills and knowledge to assess what was a good/bad public health decision (other than obvious ones such as PPE stocks for example). What you do have the skills to do is to look at the politics as to  why  a decision was taken and  how  it was taken – investigate what the different recommendations/guidance suggested, who followed/ignored/subverted it and what outcomes this produced.

Literature: health policy, public policy, state compliance IR

Methods: 1. Global – map what global advice there was and how did the state follow (or not) in preparedness and response and what was the rationale for doing so – political circumstances at the time, stated rationale for decision, who was making decision; 2. National – key public health decisions, commodities, social-economic consequences – how were these planned for/overlooked and why. To look at these two levels may require mixed methods of global and national policy timelines, stakeholder analysis, content analysis of speeches and recommendations, mapping changes to data presentation and access.

[1]  For the first two years of my career I supervised countless projects loosely based around ‘Is the War in Iraq illegal?’ I’m hoping some of the variety here will stop two years of ‘Is the UK government’s respond to COVID-19 a national scandal?’ or ‘Is the WHO fit for purpose?’ – two great topics, but tiresome after a bit.

Reproduced with kind permission from Global Politics Unbound at QMU.

Photo by iMattSmart on Unsplash

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• Published: 04 June 2021

Coronavirus disease (COVID-19) pandemic: an overview of systematic reviews

• Israel Júnior Borges do Nascimento 1 , 2 ,
• Dónal P. O’Mathúna 3 , 4 ,
• Thilo Caspar von Groote 5 ,
• Hebatullah Mohamed Abdulazeem 6 ,
• Ishanka Weerasekara 7 , 8 ,
• Ana Marusic 9 ,
• Livia Puljak   ORCID: orcid.org/0000-0002-8467-6061 10 ,
• Vinicius Tassoni Civile 11 ,
• Irena Zakarija-Grkovic 9 ,
• Tina Poklepovic Pericic 9 ,
• Alvaro Nagib Atallah 11 ,
• Santino Filoso 12 ,
• Nicola Luigi Bragazzi 13 &
• Milena Soriano Marcolino 1

On behalf of the International Network of Coronavirus Disease 2019 (InterNetCOVID-19)

BMC Infectious Diseases volume  21 , Article number:  525 ( 2021 ) Cite this article

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Navigating the rapidly growing body of scientific literature on the SARS-CoV-2 pandemic is challenging, and ongoing critical appraisal of this output is essential. We aimed to summarize and critically appraise systematic reviews of coronavirus disease (COVID-19) in humans that were available at the beginning of the pandemic.

Nine databases (Medline, EMBASE, Cochrane Library, CINAHL, Web of Sciences, PDQ-Evidence, WHO’s Global Research, LILACS, and Epistemonikos) were searched from December 1, 2019, to March 24, 2020. Systematic reviews analyzing primary studies of COVID-19 were included. Two authors independently undertook screening, selection, extraction (data on clinical symptoms, prevalence, pharmacological and non-pharmacological interventions, diagnostic test assessment, laboratory, and radiological findings), and quality assessment (AMSTAR 2). A meta-analysis was performed of the prevalence of clinical outcomes.

Eighteen systematic reviews were included; one was empty (did not identify any relevant study). Using AMSTAR 2, confidence in the results of all 18 reviews was rated as “critically low”. Identified symptoms of COVID-19 were (range values of point estimates): fever (82–95%), cough with or without sputum (58–72%), dyspnea (26–59%), myalgia or muscle fatigue (29–51%), sore throat (10–13%), headache (8–12%) and gastrointestinal complaints (5–9%). Severe symptoms were more common in men. Elevated C-reactive protein and lactate dehydrogenase, and slightly elevated aspartate and alanine aminotransferase, were commonly described. Thrombocytopenia and elevated levels of procalcitonin and cardiac troponin I were associated with severe disease. A frequent finding on chest imaging was uni- or bilateral multilobar ground-glass opacity. A single review investigated the impact of medication (chloroquine) but found no verifiable clinical data. All-cause mortality ranged from 0.3 to 13.9%.

Conclusions

In this overview of systematic reviews, we analyzed evidence from the first 18 systematic reviews that were published after the emergence of COVID-19. However, confidence in the results of all reviews was “critically low”. Thus, systematic reviews that were published early on in the pandemic were of questionable usefulness. Even during public health emergencies, studies and systematic reviews should adhere to established methodological standards.

Peer Review reports

The spread of the “Severe Acute Respiratory Coronavirus 2” (SARS-CoV-2), the causal agent of COVID-19, was characterized as a pandemic by the World Health Organization (WHO) in March 2020 and has triggered an international public health emergency [ 1 ]. The numbers of confirmed cases and deaths due to COVID-19 are rapidly escalating, counting in millions [ 2 ], causing massive economic strain, and escalating healthcare and public health expenses [ 3 , 4 ].

The research community has responded by publishing an impressive number of scientific reports related to COVID-19. The world was alerted to the new disease at the beginning of 2020 [ 1 ], and by mid-March 2020, more than 2000 articles had been published on COVID-19 in scholarly journals, with 25% of them containing original data [ 5 ]. The living map of COVID-19 evidence, curated by the Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre), contained more than 40,000 records by February 2021 [ 6 ]. More than 100,000 records on PubMed were labeled as “SARS-CoV-2 literature, sequence, and clinical content” by February 2021 [ 7 ].

Due to publication speed, the research community has voiced concerns regarding the quality and reproducibility of evidence produced during the COVID-19 pandemic, warning of the potential damaging approach of “publish first, retract later” [ 8 ]. It appears that these concerns are not unfounded, as it has been reported that COVID-19 articles were overrepresented in the pool of retracted articles in 2020 [ 9 ]. These concerns about inadequate evidence are of major importance because they can lead to poor clinical practice and inappropriate policies [ 10 ].

Systematic reviews are a cornerstone of today’s evidence-informed decision-making. By synthesizing all relevant evidence regarding a particular topic, systematic reviews reflect the current scientific knowledge. Systematic reviews are considered to be at the highest level in the hierarchy of evidence and should be used to make informed decisions. However, with high numbers of systematic reviews of different scope and methodological quality being published, overviews of multiple systematic reviews that assess their methodological quality are essential [ 11 , 12 , 13 ]. An overview of systematic reviews helps identify and organize the literature and highlights areas of priority in decision-making.

In this overview of systematic reviews, we aimed to summarize and critically appraise systematic reviews of coronavirus disease (COVID-19) in humans that were available at the beginning of the pandemic.

Methodology

Research question.

This overview’s primary objective was to summarize and critically appraise systematic reviews that assessed any type of primary clinical data from patients infected with SARS-CoV-2. Our research question was purposefully broad because we wanted to analyze as many systematic reviews as possible that were available early following the COVID-19 outbreak.

Study design

We conducted an overview of systematic reviews. The idea for this overview originated in a protocol for a systematic review submitted to PROSPERO (CRD42020170623), which indicated a plan to conduct an overview.

Overviews of systematic reviews use explicit and systematic methods for searching and identifying multiple systematic reviews addressing related research questions in the same field to extract and analyze evidence across important outcomes. Overviews of systematic reviews are in principle similar to systematic reviews of interventions, but the unit of analysis is a systematic review [ 14 , 15 , 16 ].

We used the overview methodology instead of other evidence synthesis methods to allow us to collate and appraise multiple systematic reviews on this topic, and to extract and analyze their results across relevant topics [ 17 ]. The overview and meta-analysis of systematic reviews allowed us to investigate the methodological quality of included studies, summarize results, and identify specific areas of available or limited evidence, thereby strengthening the current understanding of this novel disease and guiding future research [ 13 ].

A reporting guideline for overviews of reviews is currently under development, i.e., Preferred Reporting Items for Overviews of Reviews (PRIOR) [ 18 ]. As the PRIOR checklist is still not published, this study was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 statement [ 19 ]. The methodology used in this review was adapted from the Cochrane Handbook for Systematic Reviews of Interventions and also followed established methodological considerations for analyzing existing systematic reviews [ 14 ].

Approval of a research ethics committee was not necessary as the study analyzed only publicly available articles.

Eligibility criteria

Systematic reviews were included if they analyzed primary data from patients infected with SARS-CoV-2 as confirmed by RT-PCR or another pre-specified diagnostic technique. Eligible reviews covered all topics related to COVID-19 including, but not limited to, those that reported clinical symptoms, diagnostic methods, therapeutic interventions, laboratory findings, or radiological results. Both full manuscripts and abbreviated versions, such as letters, were eligible.

No restrictions were imposed on the design of the primary studies included within the systematic reviews, the last search date, whether the review included meta-analyses or language. Reviews related to SARS-CoV-2 and other coronaviruses were eligible, but from those reviews, we analyzed only data related to SARS-CoV-2.

No consensus definition exists for a systematic review [ 20 ], and debates continue about the defining characteristics of a systematic review [ 21 ]. Cochrane’s guidance for overviews of reviews recommends setting pre-established criteria for making decisions around inclusion [ 14 ]. That is supported by a recent scoping review about guidance for overviews of systematic reviews [ 22 ].

Thus, for this study, we defined a systematic review as a research report which searched for primary research studies on a specific topic using an explicit search strategy, had a detailed description of the methods with explicit inclusion criteria provided, and provided a summary of the included studies either in narrative or quantitative format (such as a meta-analysis). Cochrane and non-Cochrane systematic reviews were considered eligible for inclusion, with or without meta-analysis, and regardless of the study design, language restriction and methodology of the included primary studies. To be eligible for inclusion, reviews had to be clearly analyzing data related to SARS-CoV-2 (associated or not with other viruses). We excluded narrative reviews without those characteristics as these are less likely to be replicable and are more prone to bias.

Scoping reviews and rapid reviews were eligible for inclusion in this overview if they met our pre-defined inclusion criteria noted above. We included reviews that addressed SARS-CoV-2 and other coronaviruses if they reported separate data regarding SARS-CoV-2.

Information sources

Nine databases were searched for eligible records published between December 1, 2019, and March 24, 2020: Cochrane Database of Systematic Reviews via Cochrane Library, PubMed, EMBASE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Web of Sciences, LILACS (Latin American and Caribbean Health Sciences Literature), PDQ-Evidence, WHO’s Global Research on Coronavirus Disease (COVID-19), and Epistemonikos.

The comprehensive search strategy for each database is provided in Additional file 1 and was designed and conducted in collaboration with an information specialist. All retrieved records were primarily processed in EndNote, where duplicates were removed, and records were then imported into the Covidence platform [ 23 ]. In addition to database searches, we screened reference lists of reviews included after screening records retrieved via databases.

Study selection

All searches, screening of titles and abstracts, and record selection, were performed independently by two investigators using the Covidence platform [ 23 ]. Articles deemed potentially eligible were retrieved for full-text screening carried out independently by two investigators. Discrepancies at all stages were resolved by consensus. During the screening, records published in languages other than English were translated by a native/fluent speaker.

Data collection process

We custom designed a data extraction table for this study, which was piloted by two authors independently. Data extraction was performed independently by two authors. Conflicts were resolved by consensus or by consulting a third researcher.

We extracted the following data: article identification data (authors’ name and journal of publication), search period, number of databases searched, population or settings considered, main results and outcomes observed, and number of participants. From Web of Science (Clarivate Analytics, Philadelphia, PA, USA), we extracted journal rank (quartile) and Journal Impact Factor (JIF).

We categorized the following as primary outcomes: all-cause mortality, need for and length of mechanical ventilation, length of hospitalization (in days), admission to intensive care unit (yes/no), and length of stay in the intensive care unit.

The following outcomes were categorized as exploratory: diagnostic methods used for detection of the virus, male to female ratio, clinical symptoms, pharmacological and non-pharmacological interventions, laboratory findings (full blood count, liver enzymes, C-reactive protein, d-dimer, albumin, lipid profile, serum electrolytes, blood vitamin levels, glucose levels, and any other important biomarkers), and radiological findings (using radiography, computed tomography, magnetic resonance imaging or ultrasound).

We also collected data on reporting guidelines and requirements for the publication of systematic reviews and meta-analyses from journal websites where included reviews were published.

Quality assessment in individual reviews

Two researchers independently assessed the reviews’ quality using the “A MeaSurement Tool to Assess Systematic Reviews 2 (AMSTAR 2)”. We acknowledge that the AMSTAR 2 was created as “a critical appraisal tool for systematic reviews that include randomized or non-randomized studies of healthcare interventions, or both” [ 24 ]. However, since AMSTAR 2 was designed for systematic reviews of intervention trials, and we included additional types of systematic reviews, we adjusted some AMSTAR 2 ratings and reported these in Additional file 2 .

Adherence to each item was rated as follows: yes, partial yes, no, or not applicable (such as when a meta-analysis was not conducted). The overall confidence in the results of the review is rated as “critically low”, “low”, “moderate” or “high”, according to the AMSTAR 2 guidance based on seven critical domains, which are items 2, 4, 7, 9, 11, 13, 15 as defined by AMSTAR 2 authors [ 24 ]. We reported our adherence ratings for transparency of our decision with accompanying explanations, for each item, in each included review.

One of the included systematic reviews was conducted by some members of this author team [ 25 ]. This review was initially assessed independently by two authors who were not co-authors of that review to prevent the risk of bias in assessing this study.

Synthesis of results

For data synthesis, we prepared a table summarizing each systematic review. Graphs illustrating the mortality rate and clinical symptoms were created. We then prepared a narrative summary of the methods, findings, study strengths, and limitations.

For analysis of the prevalence of clinical outcomes, we extracted data on the number of events and the total number of patients to perform proportional meta-analysis using RStudio© software, with the “meta” package (version 4.9–6), using the “metaprop” function for reviews that did not perform a meta-analysis, excluding case studies because of the absence of variance. For reviews that did not perform a meta-analysis, we presented pooled results of proportions with their respective confidence intervals (95%) by the inverse variance method with a random-effects model, using the DerSimonian-Laird estimator for τ 2 . We adjusted data using Freeman-Tukey double arcosen transformation. Confidence intervals were calculated using the Clopper-Pearson method for individual studies. We created forest plots using the RStudio© software, with the “metafor” package (version 2.1–0) and “forest” function.

Managing overlapping systematic reviews

Some of the included systematic reviews that address the same or similar research questions may include the same primary studies in overviews. Including such overlapping reviews may introduce bias when outcome data from the same primary study are included in the analyses of an overview multiple times. Thus, in summaries of evidence, multiple-counting of the same outcome data will give data from some primary studies too much influence [ 14 ]. In this overview, we did not exclude overlapping systematic reviews because, according to Cochrane’s guidance, it may be appropriate to include all relevant reviews’ results if the purpose of the overview is to present and describe the current body of evidence on a topic [ 14 ]. To avoid any bias in summary estimates associated with overlapping reviews, we generated forest plots showing data from individual systematic reviews, but the results were not pooled because some primary studies were included in multiple reviews.

Our search retrieved 1063 publications, of which 175 were duplicates. Most publications were excluded after the title and abstract analysis ( n = 860). Among the 28 studies selected for full-text screening, 10 were excluded for the reasons described in Additional file 3 , and 18 were included in the final analysis (Fig. 1 ) [ 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 ]. Reference list screening did not retrieve any additional systematic reviews.

PRISMA flow diagram

Characteristics of included reviews

Summary features of 18 systematic reviews are presented in Table 1 . They were published in 14 different journals. Only four of these journals had specific requirements for systematic reviews (with or without meta-analysis): European Journal of Internal Medicine, Journal of Clinical Medicine, Ultrasound in Obstetrics and Gynecology, and Clinical Research in Cardiology . Two journals reported that they published only invited reviews ( Journal of Medical Virology and Clinica Chimica Acta ). Three systematic reviews in our study were published as letters; one was labeled as a scoping review and another as a rapid review (Table 2 ).

All reviews were published in English, in first quartile (Q1) journals, with JIF ranging from 1.692 to 6.062. One review was empty, meaning that its search did not identify any relevant studies; i.e., no primary studies were included [ 36 ]. The remaining 17 reviews included 269 unique studies; the majority ( N = 211; 78%) were included in only a single review included in our study (range: 1 to 12). Primary studies included in the reviews were published between December 2019 and March 18, 2020, and comprised case reports, case series, cohorts, and other observational studies. We found only one review that included randomized clinical trials [ 38 ]. In the included reviews, systematic literature searches were performed from 2019 (entire year) up to March 9, 2020. Ten systematic reviews included meta-analyses. The list of primary studies found in the included systematic reviews is shown in Additional file 4 , as well as the number of reviews in which each primary study was included.

Population and study designs

Most of the reviews analyzed data from patients with COVID-19 who developed pneumonia, acute respiratory distress syndrome (ARDS), or any other correlated complication. One review aimed to evaluate the effectiveness of using surgical masks on preventing transmission of the virus [ 36 ], one review was focused on pediatric patients [ 34 ], and one review investigated COVID-19 in pregnant women [ 37 ]. Most reviews assessed clinical symptoms, laboratory findings, or radiological results.

Systematic review findings

The summary of findings from individual reviews is shown in Table 2 . Overall, all-cause mortality ranged from 0.3 to 13.9% (Fig. 2 ).

A meta-analysis of the prevalence of mortality

Clinical symptoms

Seven reviews described the main clinical manifestations of COVID-19 [ 26 , 28 , 29 , 34 , 35 , 39 , 41 ]. Three of them provided only a narrative discussion of symptoms [ 26 , 34 , 35 ]. In the reviews that performed a statistical analysis of the incidence of different clinical symptoms, symptoms in patients with COVID-19 were (range values of point estimates): fever (82–95%), cough with or without sputum (58–72%), dyspnea (26–59%), myalgia or muscle fatigue (29–51%), sore throat (10–13%), headache (8–12%), gastrointestinal disorders, such as diarrhea, nausea or vomiting (5.0–9.0%), and others (including, in one study only: dizziness 12.1%) (Figs. 3 , 4 , 5 , 6 , 7 , 8 and 9 ). Three reviews assessed cough with and without sputum together; only one review assessed sputum production itself (28.5%).

A meta-analysis of the prevalence of fever

A meta-analysis of the prevalence of cough

A meta-analysis of the prevalence of dyspnea

A meta-analysis of the prevalence of fatigue or myalgia

A meta-analysis of the prevalence of headache

A meta-analysis of the prevalence of gastrointestinal disorders

A meta-analysis of the prevalence of sore throat

Diagnostic aspects

Three reviews described methodologies, protocols, and tools used for establishing the diagnosis of COVID-19 [ 26 , 34 , 38 ]. The use of respiratory swabs (nasal or pharyngeal) or blood specimens to assess the presence of SARS-CoV-2 nucleic acid using RT-PCR assays was the most commonly used diagnostic method mentioned in the included studies. These diagnostic tests have been widely used, but their precise sensitivity and specificity remain unknown. One review included a Chinese study with clinical diagnosis with no confirmation of SARS-CoV-2 infection (patients were diagnosed with COVID-19 if they presented with at least two symptoms suggestive of COVID-19, together with laboratory and chest radiography abnormalities) [ 34 ].

Therapeutic possibilities

Pharmacological and non-pharmacological interventions (supportive therapies) used in treating patients with COVID-19 were reported in five reviews [ 25 , 27 , 34 , 35 , 38 ]. Antivirals used empirically for COVID-19 treatment were reported in seven reviews [ 25 , 27 , 34 , 35 , 37 , 38 , 41 ]; most commonly used were protease inhibitors (lopinavir, ritonavir, darunavir), nucleoside reverse transcriptase inhibitor (tenofovir), nucleotide analogs (remdesivir, galidesivir, ganciclovir), and neuraminidase inhibitors (oseltamivir). Umifenovir, a membrane fusion inhibitor, was investigated in two studies [ 25 , 35 ]. Possible supportive interventions analyzed were different types of oxygen supplementation and breathing support (invasive or non-invasive ventilation) [ 25 ]. The use of antibiotics, both empirically and to treat secondary pneumonia, was reported in six studies [ 25 , 26 , 27 , 34 , 35 , 38 ]. One review specifically assessed evidence on the efficacy and safety of the anti-malaria drug chloroquine [ 27 ]. It identified 23 ongoing trials investigating the potential of chloroquine as a therapeutic option for COVID-19, but no verifiable clinical outcomes data. The use of mesenchymal stem cells, antifungals, and glucocorticoids were described in four reviews [ 25 , 34 , 35 , 38 ].

Laboratory and radiological findings

Of the 18 reviews included in this overview, eight analyzed laboratory parameters in patients with COVID-19 [ 25 , 29 , 30 , 32 , 33 , 34 , 35 , 39 ]; elevated C-reactive protein levels, associated with lymphocytopenia, elevated lactate dehydrogenase, as well as slightly elevated aspartate and alanine aminotransferase (AST, ALT) were commonly described in those eight reviews. Lippi et al. assessed cardiac troponin I (cTnI) [ 25 ], procalcitonin [ 32 ], and platelet count [ 33 ] in COVID-19 patients. Elevated levels of procalcitonin [ 32 ] and cTnI [ 30 ] were more likely to be associated with a severe disease course (requiring intensive care unit admission and intubation). Furthermore, thrombocytopenia was frequently observed in patients with complicated COVID-19 infections [ 33 ].

Chest imaging (chest radiography and/or computed tomography) features were assessed in six reviews, all of which described a frequent pattern of local or bilateral multilobar ground-glass opacity [ 25 , 34 , 35 , 39 , 40 , 41 ]. Those six reviews showed that septal thickening, bronchiectasis, pleural and cardiac effusions, halo signs, and pneumothorax were observed in patients suffering from COVID-19.

Quality of evidence in individual systematic reviews

Table 3 shows the detailed results of the quality assessment of 18 systematic reviews, including the assessment of individual items and summary assessment. A detailed explanation for each decision in each review is available in Additional file 5 .

Using AMSTAR 2 criteria, confidence in the results of all 18 reviews was rated as “critically low” (Table 3 ). Common methodological drawbacks were: omission of prospective protocol submission or publication; use of inappropriate search strategy: lack of independent and dual literature screening and data-extraction (or methodology unclear); absence of an explanation for heterogeneity among the studies included; lack of reasons for study exclusion (or rationale unclear).

Risk of bias assessment, based on a reported methodological tool, and quality of evidence appraisal, in line with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method, were reported only in one review [ 25 ]. Five reviews presented a table summarizing bias, using various risk of bias tools [ 25 , 29 , 39 , 40 , 41 ]. One review analyzed “study quality” [ 37 ]. One review mentioned the risk of bias assessment in the methodology but did not provide any related analysis [ 28 ].

This overview of systematic reviews analyzed the first 18 systematic reviews published after the onset of the COVID-19 pandemic, up to March 24, 2020, with primary studies involving more than 60,000 patients. Using AMSTAR-2, we judged that our confidence in all those reviews was “critically low”. Ten reviews included meta-analyses. The reviews presented data on clinical manifestations, laboratory and radiological findings, and interventions. We found no systematic reviews on the utility of diagnostic tests.

Symptoms were reported in seven reviews; most of the patients had a fever, cough, dyspnea, myalgia or muscle fatigue, and gastrointestinal disorders such as diarrhea, nausea, or vomiting. Olfactory dysfunction (anosmia or dysosmia) has been described in patients infected with COVID-19 [ 43 ]; however, this was not reported in any of the reviews included in this overview. During the SARS outbreak in 2002, there were reports of impairment of the sense of smell associated with the disease [ 44 , 45 ].

The reported mortality rates ranged from 0.3 to 14% in the included reviews. Mortality estimates are influenced by the transmissibility rate (basic reproduction number), availability of diagnostic tools, notification policies, asymptomatic presentations of the disease, resources for disease prevention and control, and treatment facilities; variability in the mortality rate fits the pattern of emerging infectious diseases [ 46 ]. Furthermore, the reported cases did not consider asymptomatic cases, mild cases where individuals have not sought medical treatment, and the fact that many countries had limited access to diagnostic tests or have implemented testing policies later than the others. Considering the lack of reviews assessing diagnostic testing (sensitivity, specificity, and predictive values of RT-PCT or immunoglobulin tests), and the preponderance of studies that assessed only symptomatic individuals, considerable imprecision around the calculated mortality rates existed in the early stage of the COVID-19 pandemic.

Few reviews included treatment data. Those reviews described studies considered to be at a very low level of evidence: usually small, retrospective studies with very heterogeneous populations. Seven reviews analyzed laboratory parameters; those reviews could have been useful for clinicians who attend patients suspected of COVID-19 in emergency services worldwide, such as assessing which patients need to be reassessed more frequently.

All systematic reviews scored poorly on the AMSTAR 2 critical appraisal tool for systematic reviews. Most of the original studies included in the reviews were case series and case reports, impacting the quality of evidence. Such evidence has major implications for clinical practice and the use of these reviews in evidence-based practice and policy. Clinicians, patients, and policymakers can only have the highest confidence in systematic review findings if high-quality systematic review methodologies are employed. The urgent need for information during a pandemic does not justify poor quality reporting.

We acknowledge that there are numerous challenges associated with analyzing COVID-19 data during a pandemic [ 47 ]. High-quality evidence syntheses are needed for decision-making, but each type of evidence syntheses is associated with its inherent challenges.

The creation of classic systematic reviews requires considerable time and effort; with massive research output, they quickly become outdated, and preparing updated versions also requires considerable time. A recent study showed that updates of non-Cochrane systematic reviews are published a median of 5 years after the publication of the previous version [ 48 ].

Authors may register a review and then abandon it [ 49 ], but the existence of a public record that is not updated may lead other authors to believe that the review is still ongoing. A quarter of Cochrane review protocols remains unpublished as completed systematic reviews 8 years after protocol publication [ 50 ].

Rapid reviews can be used to summarize the evidence, but they involve methodological sacrifices and simplifications to produce information promptly, with inconsistent methodological approaches [ 51 ]. However, rapid reviews are justified in times of public health emergencies, and even Cochrane has resorted to publishing rapid reviews in response to the COVID-19 crisis [ 52 ]. Rapid reviews were eligible for inclusion in this overview, but only one of the 18 reviews included in this study was labeled as a rapid review.

Ideally, COVID-19 evidence would be continually summarized in a series of high-quality living systematic reviews, types of evidence synthesis defined as “ a systematic review which is continually updated, incorporating relevant new evidence as it becomes available ” [ 53 ]. However, conducting living systematic reviews requires considerable resources, calling into question the sustainability of such evidence synthesis over long periods [ 54 ].

Research reports about COVID-19 will contribute to research waste if they are poorly designed, poorly reported, or simply not necessary. In principle, systematic reviews should help reduce research waste as they usually provide recommendations for further research that is needed or may advise that sufficient evidence exists on a particular topic [ 55 ]. However, systematic reviews can also contribute to growing research waste when they are not needed, or poorly conducted and reported. Our present study clearly shows that most of the systematic reviews that were published early on in the COVID-19 pandemic could be categorized as research waste, as our confidence in their results is critically low.

Our study has some limitations. One is that for AMSTAR 2 assessment we relied on information available in publications; we did not attempt to contact study authors for clarifications or additional data. In three reviews, the methodological quality appraisal was challenging because they were published as letters, or labeled as rapid communications. As a result, various details about their review process were not included, leading to AMSTAR 2 questions being answered as “not reported”, resulting in low confidence scores. Full manuscripts might have provided additional information that could have led to higher confidence in the results. In other words, low scores could reflect incomplete reporting, not necessarily low-quality review methods. To make their review available more rapidly and more concisely, the authors may have omitted methodological details. A general issue during a crisis is that speed and completeness must be balanced. However, maintaining high standards requires proper resourcing and commitment to ensure that the users of systematic reviews can have high confidence in the results.

Furthermore, we used adjusted AMSTAR 2 scoring, as the tool was designed for critical appraisal of reviews of interventions. Some reviews may have received lower scores than actually warranted in spite of these adjustments.

Another limitation of our study may be the inclusion of multiple overlapping reviews, as some included reviews included the same primary studies. According to the Cochrane Handbook, including overlapping reviews may be appropriate when the review’s aim is “ to present and describe the current body of systematic review evidence on a topic ” [ 12 ], which was our aim. To avoid bias with summarizing evidence from overlapping reviews, we presented the forest plots without summary estimates. The forest plots serve to inform readers about the effect sizes for outcomes that were reported in each review.

Several authors from this study have contributed to one of the reviews identified [ 25 ]. To reduce the risk of any bias, two authors who did not co-author the review in question initially assessed its quality and limitations.

Finally, we note that the systematic reviews included in our overview may have had issues that our analysis did not identify because we did not analyze their primary studies to verify the accuracy of the data and information they presented. We give two examples to substantiate this possibility. Lovato et al. wrote a commentary on the review of Sun et al. [ 41 ], in which they criticized the authors’ conclusion that sore throat is rare in COVID-19 patients [ 56 ]. Lovato et al. highlighted that multiple studies included in Sun et al. did not accurately describe participants’ clinical presentations, warning that only three studies clearly reported data on sore throat [ 56 ].

In another example, Leung [ 57 ] warned about the review of Li, L.Q. et al. [ 29 ]: “ it is possible that this statistic was computed using overlapped samples, therefore some patients were double counted ”. Li et al. responded to Leung that it is uncertain whether the data overlapped, as they used data from published articles and did not have access to the original data; they also reported that they requested original data and that they plan to re-do their analyses once they receive them; they also urged readers to treat the data with caution [ 58 ]. This points to the evolving nature of evidence during a crisis.

Our study’s strength is that this overview adds to the current knowledge by providing a comprehensive summary of all the evidence synthesis about COVID-19 available early after the onset of the pandemic. This overview followed strict methodological criteria, including a comprehensive and sensitive search strategy and a standard tool for methodological appraisal of systematic reviews.

In conclusion, in this overview of systematic reviews, we analyzed evidence from the first 18 systematic reviews that were published after the emergence of COVID-19. However, confidence in the results of all the reviews was “critically low”. Thus, systematic reviews that were published early on in the pandemic could be categorized as research waste. Even during public health emergencies, studies and systematic reviews should adhere to established methodological standards to provide patients, clinicians, and decision-makers trustworthy evidence.

Availability of data and materials

All data collected and analyzed within this study are available from the corresponding author on reasonable request.

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Acknowledgments

We thank Catherine Henderson DPhil from Swanscoe Communications for pro bono medical writing and editing support. We acknowledge support from the Covidence Team, specifically Anneliese Arno. We thank the whole International Network of Coronavirus Disease 2019 (InterNetCOVID-19) for their commitment and involvement. Members of the InterNetCOVID-19 are listed in Additional file 6 . We thank Pavel Cerny and Roger Crosthwaite for guiding the team supervisor (IJBN) on human resources management.

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Israel Júnior Borges do Nascimento & Milena Soriano Marcolino

Medical College of Wisconsin, Milwaukee, WI, USA

Israel Júnior Borges do Nascimento

Helene Fuld Health Trust National Institute for Evidence-based Practice in Nursing and Healthcare, College of Nursing, The Ohio State University, Columbus, OH, USA

Dónal P. O’Mathúna

School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland

Department of Anesthesiology, Intensive Care and Pain Medicine, University of Münster, Münster, Germany

Thilo Caspar von Groote

Department of Sport and Health Science, Technische Universität München, Munich, Germany

Hebatullah Mohamed Abdulazeem

School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia

Ishanka Weerasekara

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Ana Marusic, Irena Zakarija-Grkovic & Tina Poklepovic Pericic

Center for Evidence-Based Medicine and Health Care, Catholic University of Croatia, Ilica 242, 10000, Zagreb, Croatia

Livia Puljak

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IJBN conceived the research idea and worked as a project coordinator. DPOM, TCVG, HMA, IW, AM, LP, VTC, IZG, TPP, ANA, SF, NLB and MSM were involved in data curation, formal analysis, investigation, methodology, and initial draft writing. All authors revised the manuscript critically for the content. The author(s) read and approved the final manuscript.

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Supplementary Information

Additional file 1: appendix 1..

Search strategies used in the study.

Additional file 2: Appendix 2.

Adjusted scoring of AMSTAR 2 used in this study for systematic reviews of studies that did not analyze interventions.

Additional file 3: Appendix 3.

List of excluded studies, with reasons.

Additional file 4: Appendix 4.

Table of overlapping studies, containing the list of primary studies included, their visual overlap in individual systematic reviews, and the number in how many reviews each primary study was included.

Additional file 5: Appendix 5.

A detailed explanation of AMSTAR scoring for each item in each review.

Additional file 6: Appendix 6.

List of members and affiliates of International Network of Coronavirus Disease 2019 (InterNetCOVID-19).

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Borges do Nascimento, I.J., O’Mathúna, D.P., von Groote, T.C. et al. Coronavirus disease (COVID-19) pandemic: an overview of systematic reviews. BMC Infect Dis 21 , 525 (2021). https://doi.org/10.1186/s12879-021-06214-4

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Research Aim: This research analyzes the impact of COVID-19 on the emerging economies’ progress in CO_2 emission reduction goal to restart their economies. It will assess the effects of COVID-19 on emerging economies’ aggregate production and employment levels. Therefore, it will show whether to take aggregate output and employment back to pre-COVID levels, do emerging economies need to forgo their CO_2 emission reduction goals. Moreover, it will use successful cases to recommend small emerging economies to increase output and employment and carry on CO_2 emission reduction goals.

Topic 4: Who Won the COVID-19 Vaccine War? A Study on the Global Inequality in the COVID-19 Vaccination among Underdeveloped and Developing Countries

Research Aim: This research assesses the global inequality in the vaccination distribution among underdeveloped and developing countries. It will find the political and economic factors which influenced the distribution of the COVID-19 vaccine. Moreover, it will analyze the impact of inequality within underdeveloped and developing countries on vaccine distribution among the rich and poor. It will also find why underdeveloped and developing countries can’t vaccinate the entire population? How can they vaccinate the whole population, and what is the cost per individual?

Topic 5: The International Political Economy (IPE) of COVID-19: A Study to Find the Potential Political and Economic Winners of COVID-19

Research Aim: This study investigates the International Political Economy (IPE) of COVID-19. It identifies the major political and economic winners of this pandemic. It will find how some political powers and businesses took advantage of the pandemic and increased their political and financial capital. It will analyze significant countries such as the US, China, Japan, etc. Large businesses such as Google, Apple, Amazon, Pizer, etc., took advantage of the pandemic by selling new products. Moreover, it will highlight some significant lessons from the pandemic, which can help small countries to prepare themselves for the future.

Coronavirus Covid-19 and Global Economy Research Topics – Editor’s Pick

Research to identify the impacts of coronavirus on the economy.

Research Aim: This study will focus on identifying the impacts of Coronavirus on the global economy.

Research to study the impacts of Coronavirus on the real estate sector

Research Aim: This research aims at identifying the impacts of coronavirus on the real estate sector. Is real estate a better option for investment during COVID-19?

Research to study the impacts of Coronavirus on the stock market.

Research Aim: This research aims at identifying the impacts of Coronavirus on the stock market.

Research to identify the impacts of Coronavirus on banking and the future of banking after the pandemic.

Research Aim: This research aims at identifying the impacts of Coronavirus on banking and the future of banking after the pandemic. What are the predictions? What challenges may come across? How to overcome those challenges?

More Coronavirus and World Economy Dissertation Topics

Topic 1: an assessment of the coronavirus outbreak in the world.

Research Aim: The research would assess how the Coronavirus has spread worldwide. This would include the source of the virus, which is Wuhan, China. Along with it, the factors responsible for the spread of the virus, such as physical contacting, sneezing, and coughing must be discussed. The current death toll that has occurred because of the blowout of the virus must be discussed along with the countries affected the most such as Italy. The research aims to study the spread and effect of viruses overall.

Topic 2: The economic suffering due to the plague of COVID-19

Research Aim: The research must assess the disruption that has been created by the spread of COVID-19 in the world. This must include the countries’ global lockdown and the shutting of industries, resulting in soaring unemployment rates and a dramatic decline in economic statistics. The research aims to look at the economic consequences generated by the outbreak of coronavirus COVID-19 in general.

Topic 3: The major sufferings in the economy as a result of the COVID-19 outbreak

Research Aim: The research must assess the reasons behind the rising suffering in the specific business sectors and industries, for instance, the supply chain is suffering because China has become the manufacturing hub, which has brought disruption in the supply chain of the whole industry due to complete lockdown in the country. The research aims to study majorly affected regions such as the entertainment sector, tourism industry, restaurant sector, etc.

Topic 4: Estimated changes in the economic statistics by the outbreak of Coronavirus

Research Aim: The recent expected changes by the professionals about the impact of COVID-19 on the global economic statistics must be discussed in the research such as the estimated growth rates of the world and China were predicted to be 0% and 1.6%, respectively, for the year 2020 by the Ethan Harris, head of global economic research in the Bank of America according to his recent interview. Similarly, articles from other professionals must be included in the research to focus on the effects of an outbreak on the economy.

Topic 5: The impact of Coronavirus recession on consumer activity and economy

Research Aim: The research must assess the impact that the outbreak of the virus would have on the economy and, specifically, consumer behaviour as they drive three-quarters of the economic activity and are declining at a great pace. The impact on both small and large business enterprises must also be discussed in the research. The research aims to see whether the spread of the virus would alter consumer behaviour and the behaviours consumers would adapt.

Topic 6: The good and bad impacts of COVID-19 on the economy

Research Aim: The research would assess both the bad and the good side of the economy created by the spread of coronavirus COVID-19, such as the recession caused by the outbreak of the virus which is the bad side of the economy. The positive side consists of a reduction in mass consumption and stronger domestic supply chains.

Topic 7: The major regions and business industries affected by the spread of COVID-19

Research Aim: The research would assess the regions (cities and countries) which are being affected by the spread of coronavirus COVID-19 and the major impacted business industries such as the food industries like the restaurants are completely locked down after the outbreak of the virus and the people that were engaged in those industries are unemployed now. The research aims to focus on such industries and the impact of their lowered productivity on the economy.

Topic 8: The consequential effect of COVID-19 on financial markets and the economy.

Research Aim: The financial markets, for example, stock markets, are a great indicator of the economy’s stability. The research aims to focus on the effect on the financial markets generated by the spread of coronavirus COVID-19 such as the crash of global financial market 28th of March’ 2020 must be discussed herein which the people throughout the world witnessed a dramatic decline in the global stock market. The effects of this incident on the economy must be included in the research.

Topic 9: Recession as a consequence of the Coronavirus outbreak

Research Aim: The research would assess the consequences and the recession, which has already hit some parts of the world and is likely to hit others. The research aims to study the types of recessions that the world is likely to face, such as real recession, financial crisis, and policy recession. The consequences and the likelihood of an economic recession must be discussed in the research.

Topic 10: The recovery of the economy from the Coronavirus shock

Research Aim: Once the virus has been eliminated from the world and the people are cured through medical assistance, it would now be a crucial responsibility of the governments to get the economies back to their original conditions. The research aims to look at the recovery paths, consisting of a V-shaped, U-shaped, and L-shaped recovery path based on the economy’s scenario and condition. The effects of each type of recovery path must be discussed along with the fiscal and monetary policies applied.

Topic 11: The time spam of economic consequences of COVID-19 outbreak

Research Aim: The research would assess the intensity of the economic consequences of Coronavirus as it would help assess how long they would last in the economy. The research aims to assess certain aspects affected by the recession, such as the wealth of the people, the performance of financial markets and the consumer’s behaviour, and the disruption in the supply chain. The lasting capability of the recession depends on the disturbance in these regions mainly.

Topic 12: Economic risks generated by COVID-19 outbreak and government intervention

Research Aim: The research must assess the economic disruptions created by the outbreak of COVID-19 and the government’s role in controlling those risks. The research aims to study the historical insights of the roles played by the leaders at the times of recessions in the economy and apply them to the present time. Leaders play a great role in controlling the recessionary period of the economy.

Topic 13: Could the World Health Organization (WHO) play a role in controlling the economic recession headed by COVID-19?

Research Aim: The research must first assess what WHO has described  COVID-19 and what precautions it has asked the people to take. The research aims to link the precautionary measures suggested by WHO for controlling the spread of the pandemic, which would eventually result in the betterment of the economy as people would return to their work and the industries would start to function again.

Topic 14: How has the COVID-19 outbreak shaped the working practices of business?

Research Aim: The research must assess the alternative working practices which the businesses have adopted. The research aims to study the ‘work from home’ strategy of the business, its advantages and disadvantages, and how it disrupts the smooth functioning of the businesses. The research may include the interviews or the views of people studying or working from home in the current situation.

Topic 15: Which business industry has been affected the most by the COVID-19 outbreak?

Research Aim: The research would assess the most affected industries: the ‘tourism industry’ and ‘food industry’. The research aims to study the companies in the respective industries and how they fail with their rapidly declining profits. The research must study the huge airline industries such as Emirates and international food chains such as McDonald’s and their losses in the current situation.

Topic 16: City lockdowns due to COVID-19 outbreak and their effects on the global economy

Research Aim: The research must assess the lockdowns currently occurring throughout the globe and which has jammed the economic wheel completely. The research aims to evaluate the factors responsible for the city lockdowns and the people’s alternative ways. This must include the scarcity of resources as people have started to hoard the frequently used items.

Topic 17: Likelihood of the recessionary phase of COVID-19 turning into depression

Research Aim: The research must assess the intensity of the recession created by the COVID-19 and its effects on the economy of the world. The research aims to get an insight into the government activities in this regard and the business industry, which would indicate the likeliness of the recessionary phase turning into depression. Recommendations could be made to point out what changes must be brought for controlling the economic situation.

Topic 18: Government role in controlling the spread of COVID-19 and eventually the economic meltdown

Research Aim: The research would assess the role the government of every country is playing to control the spread of Coronavirus, such as the medical aids given to the people with the role of the medical department of the countries. The research aims to look at the government’s role to save the people, ultimately saving the collapsing economy. The role of the World Health Organization must also be discussed in that regard.

Topic 19: COVID-19 economic recession and the changing business strategies

Research Aim: The research would assess the alternative ways businesses adapt to cope with the recession, such as creating a cross-functional response team for COVID-19, supply chain stabilization, and moving to online platforms to get closer to the customers. The research aims to look at how the companies know the people’s demands and fulfill their needs despite the difficult situation.

Topic 20: What must the businesses do to overcome the recessionary consequences of COVID-19.

Research Aim: The research aims to look at the historical records of how companies have coped while going through a recessionary phase, the strategies they adopted and kept the employees motivated. The research could use examples from the recession of 2008 and recommend strategies to the company.

The world currently needs to know what the economic condition is currently prevailing around the globe. There are several themes related to this topic that is not yet discovered. In the area of Coronavirus and the global economy, the topics mentioned above could make a significant contribution.

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Important Notes:

As an economics student looking to get good grades, it is essential to develop new ideas and experiment on existing covid-19 and the global economy – i.e., to add value and interest in your research topic.

The covid-19 and global economy fields are sure to become vast and interrelated to many other academic disciplines like civil engineering , construction , law , and even healthcare . That is why it is imperative to create a covid-19 and global economy topic that is articular, sound, and actually solves a practical problem that may be rampant in the field.

We can’t stress how important it is to develop a logical research topic based on your entire research. There are several significant downfalls to getting your topic wrong; your supervisor may not be interested in working on it, the topic has no academic creditability, the research may not make logical sense, there is a possibility that the study is not viable.

This impacts your time and efforts in writing your dissertation , as you may end up in the cycle of rejection at the initial stage of the dissertation. That is why we recommend reviewing existing research to develop a topic, taking advice from your supervisor, and even asking for help in this particular stage of your dissertation.

While developing a research topic, keeping our advice in mind will allow you to pick one of the best covid-19 and global economy dissertation topics that fulfill your requirement of writing a research paper and add to the body of knowledge.

Therefore, it is recommended that when finalizing your dissertation topic, you read recently published literature to identify gaps in the research that you may help fill.

Remember- dissertation topics need to be unique, solve an identified problem, be logical, and be practically implemented. Please look at some of our above sample covid-19 and global economy dissertation topics to get an idea for your own dissertation.

How to Structure your Dissertation

A well-structured dissertation can help students to achieve a high overall academic grade.

• A Title Page
• Acknowledgements
• Declaration
• Abstract: A summary of the research completed
• Table of Contents
• Introduction : This chapter includes the project rationale, research background, key research aims and objectives, and the research problems. An outline of the structure of a dissertation can also be added to this chapter.
• Literature Review : This chapter presents relevant theories and frameworks by analysing published and unpublished literature on the chosen research topic to address research questions . The purpose is to highlight and discuss the selected research area’s relative weaknesses and strengths whilst identifying any research gaps. Break down the topic and key terms that can positively impact your dissertation and your tutor.
• Methodology : The data collection and analysis methods and techniques employed by the researcher are presented in the Methodology chapter, which usually includes research design , research philosophy, research limitations, code of conduct, ethical consideration, data collection methods, and data analysis strategy .
• Findings and Analysis : Findings of the research are analysed in detail under the Findings and Analysis chapter. All key findings/results are outlined in this chapter without interpreting the data or drawing any conclusions. It can be useful to include graphs, charts, and tables in this chapter to identify meaningful trends and relationships.
• Discussion and Conclusion : The researcher presents his interpretation of results in this chapter and states whether the research hypothesis has been verified or not. An essential aspect of this section of the paper is to link the results and evidence from the literature. Recommendations with regards to implications of the findings and directions for the future may also be provided. Finally, a summary of the overall research, along with final judgments, opinions, and comments, must be included in the form of suggestions for improvement.
• References : This should be completed following your University’s requirements
• Bibliography
• Appendices : Any additional information, diagrams, and graphs used to complete the dissertation but not part of the dissertation should be included in the Appendices chapter. Essentially, the purpose is to expand the information/data.

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Frequently Asked Questions

How to find covid-19 and global economy dissertation topics.

To find COVID-19 and global economy dissertation topics:

• Examine the pandemic’s economic effects.
• Study sectors like tourism, health, and tech.
• Analyze policy responses worldwide.
• Explore supply chain disruptions.
• Investigate remote work trends.
• Consider long-term economic shifts.

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• Published: 30 May 2024

Longitudinal qualitative study on the psychological experiences of COVID-19 patients based on timing it right framework

• Liangyan Zhang 1 ,
• Chen Zhang 2 ,
• Kesang Li 1 &
• Yan Zhang 3  

Scientific Reports volume  14 , Article number:  12409 ( 2024 ) Cite this article

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Timing it right framework was used as a framework to explore the illness experiences of patients infected with COVID-19 and to analyze the patients' perceptions of the disease and their true inner feelings to provide a reference for the control of infectious diseases. This research adopted a phenomenological research approach to develop a longitudinal qualitative study. A purposive sampling method was used to select participants and 37 patients were recruited. Depending on the principle that participants should have maximum variation and sampling should cease when interviews content saturation is achieved, 16 COVID-19 patients in an isolation ward in Ningbo City, Zhejiang Province were finally included. Data were collected using semi-structured interviews, and the content of the interviews was analyzed by Colaizzi’s 7-step method. The themes of COVID-19 patients’ experiences at various phase were presented as follows: multiple emotions intertwined at the time of diagnosis (anxiety, stressful panic, facing the diagnosis calmly), multiple pressures during the hospitalization period (concerns about the disease, unable to adapt to the ward environment, worrying about future hardship), growth of positive illness experience during the isolation and observation period (sublimated outlook on life, affirmation of the government's anti-epidemic policy, more concerned about their own health), adjustment after returning to society (stigma, loss of previous living environment, problems caused by nucleic acid testing), and adaptation to social life (return to normal life, avoidance of illness experience, post-covid-19 syndrome). The illness experience of COVID-19 patients changed dynamically with time, but a sense of shame and uncertainty about recovery was present throughout the process. Interventions should be developed according to the needs of the patients at different times to inform subsequent optimization of care and management of infectious diseases.

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Introduction.

The ongoing global epidemic of coronavirus disease 2019 (COVID-19) has had a significant impact on human society, primarily in terms of public health. As of 2 February 2023, the reported cumulative number of confirmed cases worldwide is approximately 753 million, with approximately 6,814,900 deaths 1 . Importantly, the actual number of infections worldwide may be higher than the reported data due to factors such as limited testing capacity. The Omicron and Delta strains are variants of coronaviruses with high loads, high infectivity, short incubation times, and antigenic escape 2 . Patients experience long viral nucleic acid conversion times and are more likely to develop severe and critical illnesses, with long periods of hospital isolation and medical observation 3 . Studies have shown 4 that patients with COVID-19 who stay in isolation are prone to psychological problems such as anxiety, depression, and fear. The study 5 showed that infected patients had problems such as fatigue, sleep difficulties, and anxiety after discharge from the hospital, and those with severe lung damage during hospitalization were even more likely to be in the target population for long-term rehabilitation interventions after discharge; however, the study was conducted on patients at the beginning of the 2019 outbreak, and the characteristics of the coronavirus variants can cause various psychological experiences in infected patients. There are currently few studies exploring mild COVID-19 patients' experiences during hospitalization and after reintegration into society 6 . The Timing it Right (TIR) framework was proposed by Cameron et al. 7 in the study of stroke care; it divides the process of disease development into five phases: diagnosis, stabilization, preparation, implementation and adaptation. At present, a number of scholars have used different research methods to study the dynamic needs of patients and caregivers with the TIR framework, and have achieved initial results 8 . Based on the TIR framework, it is possible to understand the changes in the experience of COVID-19 patients at different stages of illness, and formulate corresponding support plans, so that the intervention timing and intervention content can match the needs of patients at the current phase of disease 9 , 10 . Therefore, based on the five phases of disease development in the TIR framework, this research explore the illness experiences of COVID-19 patients in a longitudinal study to provide a reference for the subsequent care of patients with infectious diseases and the development of epidemic prevention and control strategies.

Design and participants

This study utilized a phenomenological research approach to develop a longitudinal qualitative study using the TIR framework. To conduct a longitudinal qualitative study, it is necessary to select specific time points for data collection, and the chosen time frame should be adequate for observing changes in the phenomenon under investigation 11 . In this study, the time frame for data collection was established through two interviews. The first interview (T1) took place during the period when the infected individuals were isolated, and the second interview (T2) occurred 6 months after their reintegration into society. The study employed a purposive sampling method to select patients who had been diagnosed with COVID-19 and were admitted to an isolation ward in Ningbo City, Zhejiang Province, between January and October 2022. The inclusion criteria were as follows: (1) confirmed COVID-19 infection; (2) age above 18 years; and (3) voluntary participation in this study and providing informed consent. The exclusion criteria were as follows: (1) those who were seriously ill and unable to communicate and (2) those with serious psychological or cognitive dysfunction. Those who automatically withdrew or were lost to follow-up during the interview were dropped from the study. A total of 37 patients were recruited for the study, and the sample size of the study was determined based on information saturation of the interviewees 12 . The specificity of the sampling was measured by demographic characteristics and the Self-Rating Depression Scale (SDS) 13 . Sampling ceased when interviews content saturation was achieved. Finally, 16 cases of representative infected patients were included in the study, including patients with no depression (9 cases, 56%), suspected mild depression (1 case, 6%), and suspected moderate depression (6 cases, 37.5%), numbered "N1" to "N16". In this study, two in-depth interviews were conducted with the infected patients, one during their isolation period and another after 6 months of reintegrating into society. Notably, during the second interview, two of the participants exhibited evasive behavior. For example, one participant was very talkative in the first interview, and he was able to talk more about his true feelings and describe them in more details based on the experience of the illness. However, in the second interview, he spoke less and only answered yes, no or fine, showing an evasive attitude. In order to fully understand the thoughts of the participants and enhance the integrity and continuity of the study, after obtaining informed consent, the interviewer supplemented the interview content by contacting their relatives, and returned the transcript of the interview content to the participants for confirmation, so as to ensure the authenticity of the content. The basic information of the study participants is shown in Table 1 .

Data collection

The participants provided informed consent and completed the demographic scale and SDS scale assessment before the interview. The interview outline was designed according to the five phases of diagnosis, stabilization, preparation, implementation and adaptation in the TIR framework. Longitudinal qualitative studies require researchers to use the insights gained from previous interviews to inform the focus of subsequent data collection 14 . The researcher preinterviewed two infected individuals prior to the formal interview and amended the interview outline. The interview outline was as follows. During Phase 1 (T1), the following questions were asked: ① How did you feel when you were diagnosed with COVID-19? ② What was your initial feeling after arriving at the isolation ward? ③ What are your needs and feelings during hospitalization? ④ How do you feel when you go to the quarantine point for medical observation? ⑤ How will the Spring Festival affect you? ⑥ If you are cured and returned to society, what expectations or concerns do you have? During Phase 2 (T2), the following questions were asked: ① What was your mood at the beginning of reintegration? Give an example of 1–2 things that were particularly impressive at that time. ② How do you feel now? How has your life changed? ③ Is there anything particularly troubling you at present? How do you solve these troubles? Do you have any hopes or suggestions? Due to the requirements of epidemic prevention and control, the interview was conducted by telephone, and the interview time was 15–60 min.

Data analysis

The interview content was analyzed by Colaizzi’s 7-step method. The steps are as follows: (1) two researchers carefully read all the original data; (2) they independently identify significant statements that were repeated by multiple participants and were important and meaningful to the research question; (3) they code repetitive and meaningful views by temporarily "suspending" their assumptions and value judgments; (4) they gather ideas after coding to form the prototype of the theme; (5) they write a detailed typical original description; (6) they identify similar ideas and condense them into themes; and (7) they return the topic structure to the participants for verification. The results of the SDS questionnaire were descriptive statistical analyzed by SPSS 25.0.

Quality control

SDS questionnaire collection: during hospitalization, a researcher issued and collected the questionnaire, explained the questions appropriately, and checked the completeness of the answers on the spot. (2) Interview data collection: all researchers in the study received professional training in qualitative research, and all interview data collection was completed by the first author (isolation ward nurse). The researcher kept in touch with the participants during the follow-up period to establish trust and friendly relationships. The researcher used the daily chat information as supplementary information. At the end of each interview, the researcher transcribed the audio-recorded information within 24 h and recorded the tone of voice, pitch change and other information of the participants. (3) Data analysis: data collection and analysis were carried out in parallel, with each of the 2 researchers listening to the audio-recordings and reading the textual information repeatedly, independently summarizing statements of significance, and summarizing the text of the statements. And the themes and subthemes extracted from the collected data were repeated to the participants by instant messaging software to further confirm whether they had the same feeling or experience and record any possible supplemental information. It was explained to the participants at the first interview that the preliminary results would be reported back to them for verification.

This study was reviewed and approved by the Ethics Committee of Ningbo No.2 Hospital (YJ-NBEY-KY-2022-102-01). All methods were performed in accordance with the relevant guidelines and regulations such as ethical standards of the institutional ethics committee and with the Declaration of Helsinki. All participants signed informed consent forms.

An interpretive understanding of the illness experiences of patients infected with COVID-19 was constructed in this study. The analysis yielded five categories and fifteen sub-categories (Table 2 ).

Theme 1: multiple emotions intertwined at the time of diagnosis

Due to different personality characteristics and understanding of the disease, infected patients showed the following emotional changes in the early stage of diagnosis.

Anxiety: since most infected patients learned about their infection suddenly, most of them had significant fidgeting, irritability, insomnia, and felt inexplicably nervous and worried when they were diagnosed or preparing for medical isolation. N5-T1: "I was so anxious when I was diagnosed that I felt like the sky was falling." N9-T1: "Since that time I have not been able to sleep well at night, I wake up after an hour of sleep." N2-T1: "I felt like it was going by so slowly and every day felt like years. Before the quarantine, I was worried that I wouldn't eat or sleep well, and that was true." Some of the infected patients felt upset when they were first diagnosed, as they received many calls for epidemiological investigations from various departments and organizations. N6-T1: "The initial phase has been very busy. I was the first to be infected, and there was a particular focus on me. At that time, my sleep was disturbed."

Stressful panic: the knowledge that there was no effective treatment, the uncertainty of the sequelae and the possibility of recurrence all put the infected patients in fear of the disease at the time of diagnosis, with three infected patients displaying more pronounced despair. N12-T1: "At that time, I was lying in bed for two days feeling like I was going to die. It was bad anyway. I was scared, scared of the after-effects, scared for my life (emotional)." N9-T1: "[Messages on my mobile phone] made me think nonsense. If the virus in my body had stayed, I would have been locked up forever. It gave me a feeling of panic."

Facing the diagnosis calmly: some of the infected patients were not so afraid of the diagnosis because people around them had already been infected. N1-T1: "The mood was a bit panicky, not particularly panicky. Because my in-laws have already been diagnosed, I already have a general idea in my mind." Some infected patients had a more comprehensive understanding of the corresponding symptoms of infection and were more receptive. N11-T1: "Not afraid of the disease. I have read the news that most of the foreign countries are infected, so I am calm." N3-T1: "It was mild… and curable, so I just didn't have much stress anyway."

Theme 2: multiple pressures during the hospitalization period

When patients were hospitalized, the disease itself, positivity for 2019-nCoV nucleic acid, and the specificity of the isolation environment made them feel deeply stressed.

Concerns about the disease: the threat to COVID-19 patients' lives and safety during hospitalization was stressful for those infected, either because of their own experiences of repositivity or because they witnessed others experiencing repositivity. N11-T1: "The biggest concern was that I didn't know how long it would take to be discharged from the hospital, how long it would take to recover … I didn't know if there were any after effects and whether there would be a relapse." N5-T1: "(After being repositive for the third time) I cried all the time during those 2 days when I was isolated again. The last 2 days were fine, (my mood) calmed down, and today I'm a little bit annoyed again, my wife and my youngest daughter they don't seem to have a good nucleic acid result. That aspect is affecting me a lot, a lot of stress (speaking faster)." N14-T1: "There is a feeling of fear in my heart. This is the first time I've had a repositive, and I've heard that there are a lot of repositive people, and I'm scared in my heart." Due to the special nature of COVID-19 patients, the vast majority of them chose to conceal their condition to avoid worrying about their families. N3-T1: "I didn't dare to make a video call to my mother. I was afraid that if my mother knew I was inside the hospital, she would have to worry about me."

Unable to adapt to the ward environment: most infected patients were transferred to isolation wards for medical observation and treatment, and the unfamiliar and confined environment often made them feel uncomfortable. N4-T1: "It feels unreal to be here, the air is treated and the rooms are airtight." Meanwhile, due to the shortage of beds, most isolation wards housed many people, to which some infected patients are not accustomed, and some infected patients were deeply stressed about secondary infections. N2-T2: "I don't like to sleep with other people in the same room. But, since I was a child, I have been timid and I am afraid to sleep alone. I am not used to sleeping in the hospital." N12-T1: "I was worried about my problems and whether sleeping in the same ward would spread the virus to each other, so I never took off my mask." Isolation also prevents infected patients from spending time with their families. During the festive season, which symbolizes reunion, they had to spend time alone. N10-T1: "The arrival of Chinese New Year had an impact on me. There are so many things I can't do because (I can't) be reunited with my family."

Worrying about future hardship: because the whole family was quarantined or because they themselves were the main laborer in the family, most infected patients reported that the long period of isolation had affected their financial income and were worried about the future. N5-T1: "There has been no income for a few months now, which means that life may be hard in the future." Due to the release of information from epidemiological surveys, infected patients are often worried about having the disease known to their acquaintances. N5-T2: "[The flow survey information] would be better to change that column where the surname is written to a number. Because we are the only ones infected in the factory, it is easy for others to guess." Infectious patients worry about social discrimination brought about by the disease and about whether they will still be able to have a suitable learning environment, job, and residence in the future. N5-T1: "I worry about whether it will affect my youngest daughter's ability to go to a better kindergarten." N10-T1: "I feel that I will not be able to find a job if people know about my disease. … I am sure I will be treated differently." "N2-T1: "We are renting a house outside, the landlord knows about it and may not let us stay in this place. What should we do?"

Theme 3: growth of positive illness experience during the isolation and observation period

Patients were under medical isolation and observation during this period. There is deeper thinking after enduring pressure from all sides, and some patients gain growth.

Sublimated outlook on life. Some infected patients were grateful for the dedication of healthcare workers. N1-T1: "Really, I feel that you are all very good. Doctors have it so hard. I didn't feel it before." Some patients thanked the teachers for caring for their children during the infection. N1-T2: "The teachers and classmates are very caring for my daughter. In particular, her class teacher was really nice. There was no one to look after her when she first came out (family members were quarantined for infection). My daughter was alone at home, and I was worried. Her teacher let my daughter go to her house. The teacher said I am not afraid." Some infected patients also said that during the isolation period, they had time to calm down and question their souls and thought more about life. N6-T1: "Actually, when I was in the isolation ward, I had more time and space to think, and then I might think more deeply about something, like the meaning of life. I would find so many things that I just naturally realized."

Affirmation of the government's anti-epidemic policy. N6-T1: "I think our government departments are very committed because our national situation is different from that of foreign countries, with a large population. If our country really doesn't care about controlling the epidemic at all, the medical resources can't keep up." N9-T1: "I fully comply with the rules and regulations of the isolation ward. The country invests a lot of resources. We eat and live medically for free."

More concerned about their own health. The experience of falling ill has made more patients pay more attention to their own health, and they actively participate in sports and pay attention to physical checkups and rest. N11-T1: "It's better to have a medical checkup to see if this virus has any other effects on your body. In the future, I will have regular medical check-ups once every six months or a year. Now, I also started to run (during the quarantine phase), I didn't run much before."

Theme 4: adjustment after returning to society

The infected often return to society in a state of fear and with a deep sense of stigma. Some infected patients have lost their former jobs and living environments, and their finances and lives have been greatly affected. At the same time, the nucleic acid test also brought troubles to their lives after returning to society.

Stigma: infected patients often have a heavy self-psychological burden when they return to society. They are afraid of being rejected and treated differently. The main manifestations are fear of stigma and concealment of medical history. N1-T2: "We definitely have to report to the community when we go back. We have to explain the situation. After explaining the situation, the people in the village will be scared to death, they will ostracize them (brother, parents), and then it will definitely have an impact on my parents and my brother's lives, so we didn't dare to go back." Some infected patients were worried that they would cause others to become infected, causing them to be quarantined as well. N16-T1: "I'm worried that if I go back to being positive in the future, I will infect others, even if it doesn't hurt, will I have to quarantine people for so many days?" With the shame of the disease, many infected patients were unable to go home to their families. N1-T2: "I would love to go back to my hometown. Because my parents are also 70 years old, and I can't take care of them when I'm out of town. But, now I can't go back to my hometown."

Loss of previous living environment. Some infected patients lost their original living and working environments after returning to society. Some COVID-19 patients moved away from their original environments of their own initiative because they were afraid that others would know that they had been infected by COVID-19. N1-T2: "We moved home. But, we are still afraid of bumping into people we know: "Some infected patients were asked not to go to work or to change their working environments for fear of mutual infection in their workplaces. N2-T2: "We were not allowed to go to work in the factory at that time because the other employees didn't agree to let us go to work." N9-T2: "She used to work in Department 5, but the original department didn't want her anymore." A new environment means a new start, which leads to greater pressure on the lives of infected patients. N1-T2: The pressure on my husband's life is too great. I also went to look for a job. After looking for a few days, I felt very sad and found that I could only do more flexible work like takeaway. Life is difficult, we've borrowed a lot of money now, and there's a lot of financial pressure and mental stress."

Problems caused by nucleic acid testing. Because of previous infections, policies require infected patients to have a separate nucleic acid test. This often meant that they had to spend time and effort looking for a separate site where they could do a separate nucleic acid test. N1-T2: "My child can't do a separate nucleic acid test at school anyway, so we have to find a nucleic acid test site by ourselves." When doing the nucleic acid test alone, they were split into two teams, separate from the people doing the mixed nucleic acid test, and the people in their team were faced with more inquiries about infection, which put more pressure on them." N1-T2: "When we went to do the nucleic acid test, the security guard at the door asked once, then the person who checked the identity after the questioning asked again, and the sampler asked again. I had nightmares every day." In addition, they were concerned that doing the nucleic acid test alone would increase the risk of reinfection. N5-T2: "When we do the nucleic acid test alone, we are with people who are at high risk. The book they have registered in we touch it again, register it again and go with them. If I get infected again, I reckon I'm going to go mad." Because of the fear of repositivity, infected patients are extremely concerned about the results of their own and their family's nucleic acid tests." N3-T2: "To be honest, some people, like my wife, have repeated repositive and go to quarantine sites over and over again. Very upset and depressed. I'm worried about my own and my wife's nucleic acid test results."

Theme 5: adaptation to social life

Six months after returning to society, most of the infected patients returned to normal life with the support and tolerance of society, but some of them still avoided infection and concealed their status as recovered persons. Some of the infected patients developed post-COVID-19 syndrome.

Return to normal life. Some infected patients integrated into society with the tolerance of colleagues and friends around them. N2-T2: "Still working as normal. My friends and I still play well and sit together for meals." N8-T2: "I was a bit afraid that my colleagues would laugh at me in various ways before I came to work. But, none of them did." Nucleic acid testing is also gradually becoming less frequent. N7-T2: "In the beginning, it was a single test, now it's all mixed." Some infected patients said that they no longer avoided the fact that they were infected under self-regulation and gradually returned to normal life. T12-N2: "When I first came out of quarantine, whenever people talked about this stuff, I wanted to avoid it and didn't want to hear about it. Now, when people talk about doing nucleic acids, I seem to slowly be able to accept it."

Avoidance of illness experience. Some infected patients still avoided infection and concealed their identities as a recovered person. N16-T2 Husband added: "Whoever mentions this, she is anxious about it. Some old folks called me and asked about this, and she was also a little anxious in her heart. There is nervousness in her heart, and she doesn't want to talk about it anymore." During the interview with N5-T2, the infected patient herself said, "I don't feel anything, it doesn't affect me at the moment. Everything is fine. Don't want to think about it." However, interviewing his lover, he said, "He used to look like a child, he used to laugh and joke around, but now he looks sad every day. He doesn't talk much in his free time." This experience has changed his personality.

Post-COVID-19 syndrome. Some infected patients still have residual weakness, chest tightness, loss of smell, sleep disorders, etc. N14-T2: "The body is a bit different anyway. I'm more tired than I used to be at work, and I'm not as fit as I used to be. Sleep has been bad, easy to wake up. I have no sense of smell." N15-T2: "I feel a bit breathless sometimes when I walk a few steps. I feel tired."

This study conducted a longitudinal exploration of COVID-19 patients' experience based on the TIR framework. In general, the TIR framework has played a good guiding role in the exploration of COVID-19 patients' illness experience. During the diagnosis phase, COVID-19 patients were usually very concerned about their own health problems, and due to great pressure caused by isolation, they were prone to psychological problems. The stabilization and preparation phase of COVID-19 patients were in the long isolation treatment. Patients gradually adapted to isolation treatment and started to plan their life after discharge. They were worried about discrimination and worried that they would never go back to the original life. In addition, because COVID-19 patients were kept in isolation for a long time, some patients began to reflect on the experience of the disease and the past life status, and thus gained growth. The stigma of COVID-19 patients was felt throughout the course of the illness, but it was particularly evident during the implementation and adaptation phase. Due to the stigma and discrimination, some patients actually made great changes to their work and life during this two phase. At this time, social support was particularly important for patients to reintegrate into society. The following discussion provides detailed analysis of the above phenomena.

The results of this study showed that all infected patients diagnosed for the first time had psychological problems such as anxiety, fear, and sleep disorders, and seven patients (43.75%) were suspected of having mild to moderate depression according to the SDS scores, which is similar to the results of the study by Deng et al. 15 . This may be due to the highly contagious nature of COVID-19 and the lack of specific treatment, resulting in infected patients being prone to excessive stress, panic, and even psychological stress disorder at the early stage of diagnosis 16 . At the same time, 14 cases (87.5%) of the infected patients expressed concern about the possibility of "repositivity" after recovery and the existence of sequelae. A related study found that noninfectious viral RNA persisted in most of the "repositive" cases, which may be due to slow disease regression 17 . A positive test does not always mean that the patient is infectious, as it may detect fragments of viral nucleic acid 18 . However, most patients know little about this and develop more anxiety and fear. In contrast, those patients who have knowledge of the new coronavirus tend to have less fear and worry. Cheng Hualing et al. 19 meta-integrated the psychological experience of COVID-19 patients in China and found that more information provided by medical personnel to infected patients about the treatment and prognosis of the disease could eliminate the anxiety caused by the patients' lack of knowledge. Therefore, health promotion should be strengthened, and patients should be encouraged to acquire knowledge of the disease in various aspects, including transmission channels, protective measures, symptom classification, prognosis, etc. Patients’ questions should be patiently answered based on their own conditions, and they should be encouraged to obtain correct information through official authoritative channels to avoid "information panic" 20 .

Four infected patients (25%) in this study indicated that the relatively confined environment and instruments in the isolation area caused feelings of loneliness and helplessness. The isolation treatment measures separated the patients from the outside world, as they left their familiar working and living environments to enter a state of isolation, confinement and monotony. The patients' original lifestyles were completely disrupted, and certain financial losses were incurred. The unfamiliar environment and medical equipment increased the patients' fear and loneliness while also hindering the discharge of their negative emotions. This is consistent with the findings of Wang et al. 20 and Shaban et al. 21 . A retrospective study 22 found that isolation may cause unexpected mental trauma for patients and may even lead to self-injurious behaviors such as suicide. These effects persisted 3 years after desegregation. Psychological disorders can lead to low immunity and reduced motivation for treatment, thus negatively affecting disease recovery 23 . Currently, the treatment and care of patients in isolation wards are mainly focused on the disease itself, with relatively little attention given to the physical and psychological effects of isolation. Improving the treatment environment in isolation areas, providing as much stimulation as possible during the normal routine of work and rest, establishing a good lifestyle, and diversifying hospital activities are of great significance in relieving emotional tension, breaking psychological barriers, and promoting disease recovery 24 . Studies have shown that having sufficient sunlight is particularly effective for psychological relief 25 . Isolation areas should be set up to face south, and lighting measures should be strengthened. Public corridors can be set up in the isolation area so that infected patients can stagger their activities appropriately. Healthcare workers who are fully "armed" can paste their names on their protective clothing to improve communication between doctors and patients and reduce patients' sense of isolation. There are also studies 26 suggesting the use of the Rosenthal effect, that is, using praise, trust and expectation, and other psychological hints to help patients regain confidence and obtain positive motivation to change their own behaviors. By communicating with patients to understand their psychological needs, sources of negative emotions and specific factors affecting their emotions, healthcare professionals, in collaboration with teams from various disciplines, can encourage infected patients to cope positively and provide social support and psychological guidance to improve their quality of life 27 . The patients in this study were often in a state of confusion and worry before discharge and were also often unable to adjust to a good rhythm of life within a short period after discharge. Healthcare professionals can help patients develop a postdischarge transition plan during inpatient isolation so that they can quickly return to their original lives. At the same time, a scale of social reintegration behavior of infected patients with infectious diseases that is suitable for our country should be developed to prospectively investigate the current status of social reintegration of infected patients and to understand the changes in social reintegration behaviors in different periods to take corresponding measures to help such people adapt to their situations as soon as possible.

As a contagious disease, COVID-19 can lead to fear among the population as well as stigma and discrimination against specific groups of people 28 , and patients develop a sense of shame about their illness as a result. The results of this study show that patients often want to keep their experience of the disease confidential. The vast majority of infected patients in this study chose to conceal their illness from their family members. Due to the existence of a sense of shame, patients not only kept their disease experience secret but also often consciously reduced their mobility after discharge from the hospital to avoid infecting others. Patients may actively distance themselves from their friends and relatives, resulting in the loss of an important source of social support and a sense of isolation 29 . There were also patients who did not actively conceal their condition, but friends and colleagues of the infected patients intentionally chose to distance themselves from the infected patients out of fear and rejection after learning of their condition. Six patients (37.5%) in this study were thus forced to leave their original places of residence or work, causing them to develop more negative emotions. On the other hand, the infected patients who indicated that their colleagues and friends treated them no differently than before reported that they resumed normal life more quickly after returning to society. Yuan et al. 19 showed that the social support system of infected patients is an important factor in their posttraumatic growth. Social support based on kinship is the main way for most Chinese people to obtain social support. If this basic relationship is damaged, it prevents infected patients from obtaining the understanding and support of others, which can have a great impact on their physical and mental health 30 . The establishment of a good social support system will enhance psychological health; in contrast, the accumulation of negative emotions will lead to a variety of psychological problems 31 . Healthcare workers in the diagnosis and treatment of COVID-19 patients not only need to give the necessary treatment measures but also need to comprehensively assess the degree of understanding of the disease and social support system of infected patients. Healthcare workers should encourage infected patients to inform their families of their illnesses through daily communication, collaborate with their families to provide relevant psychological care, and improve the level of posttraumatic growth of patients 32 . In addition, the limitations of the public's knowledge of the disease will increase the individual's self-psychological burden, which will deepen the self-perception and experience of public stigma, resulting in the internalization of stigma 33 . Therefore, it is necessary to strengthen the information dissemination of infectious diseases, set up relevant policies for social groups such as communities and companies to avoid the public's rough treatment of infected patients returning to society, to protect the normal work and lives of infected patients and to reduce economic losses. This study shows that the policy benefits given by the government make infected patients believe in the national epidemic prevention policy and thus have confidence in the diagnosis and treatment of the disease. Therefore, state policy supports the reintegration of COVID-19 patients into society through macrocontrol.

Six months after returning to the community, some of the patients in this study still had sequelae of COVID-19, such as malaise, insomnia, chest tightness, and loss of smell. A recent study published in The Lancet 34 also confirmed this phenomenon. Similar studies have shown that the acute phase of COVID-19 and subsequent health damage involves multiple systems, such as the respiratory, neurological, and cardiovascular systems 18 . Given that infected patients at this stage need professional guidance to avoid delaying their illness, we call for greater collaboration among scholars from different countries to share experiences in the treatment of the disease to improve the physical and mental health of the population in the face of the postinfection syndrome caused by the global pandemic of COVID-19 patients.

This study found that there is a lack of clarity in the division of labor between departments and duplication of investigations by various departments in the process of epidemiological investigation.. It is recommended that the relevant departments should strengthen the integration and sharing of information by using big data and increase training in epidemiological investigation to improve efficiency 26 . Knowing the benefits of epidemiological investigation and personal information protection can reduce the uneasiness of infected patients, it is recommended that the media increase the scientific knowledge of epidemiological investigations and, at the same time, hide patients’ last names in the publication of epidemiological investigation information to protect the privacy of infected patients, and prohibit malicious human searches and other behaviors.

Limitations

While the study has its merits, it also has its limitations. First, this study interviewed COVID-19 patients only in Ningbo and did not include patients from multiple regions and centers. Second, this study was conducted during the control phase of the epidemic in China, and except for filling out the SDS scale, which was face-to-face, both interviews were conducted over the phone, and preventing the use of visual aids.

Conclusions

The objective of this study was to explore the perceptions and comprehension of patients infected with COVID-19 during the Chinese new coronavirus epidemic. COVID-19 patients encounter numerous psychological challenges while simultaneously experiencing physical discomfort, isolation, a sense of shame, and uncertainty regarding recovery. While some patients eventually adapt to their circumstances, not all are able to do so. Therefore, it is crucial for healthcare providers and families to provide support in order to facilitate patient adjustment to normal life. Interventions should be tailored according to the specific needs of patients at different stages, informing subsequent optimization of care and management strategies for infectious diseases.

Data availability

The datasets generated and analysed during the current study are not publicly available due privacy protection but are available from the corresponding author on reasonable request.

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This research was supported by Medical Scientific Research Foundation of Zhejiang Province under Grant No. 2023KY1091; Zhejiang Provincial Natural Science Foundation of China under Grant No. LY22H160006.

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Liangyan Zhang organized interviews and collected the data. Liangyan Zhang and Chen Zhang analyzed the data and wrote the main manuscript text. All authors reviewed the manuscript.

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Zhang, L., Zhang, C., Li, K. et al. Longitudinal qualitative study on the psychological experiences of COVID-19 patients based on timing it right framework. Sci Rep 14 , 12409 (2024). https://doi.org/10.1038/s41598-024-63215-4

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DOI : https://doi.org/10.1038/s41598-024-63215-4

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Marie Skłodowska-Curie Actions

Developing talents, advancing research

Projects researching COVID–19, SARS-CoV-2 and related topics

The current COVID-19 outbreak has not caught EU-funded research off guard. The Marie Skłodowska-Curie Actions (MSCA) of the European Commission are supporting outstanding researchers in finding solutions to challenges posed by the novel coronavirus disease COVID-19 and other infectious diseases.

This page will be regularly updated with MSCA projects, results and testimonials relevant to COVID-19, SARS-CoV-2 and related topics.

DIAGNOSTICS AND TREATMENTS (including vaccines)

Diabetic nephropathy modelling in hesc-derived 3d kidney organoids.

EPIORGABOLISM is studying how SARS-Co-V2, the coronavirus responsible for the 2019 novel coronavirus disease (COVID-19), interacts with and infects kidney cells. Together with the lung, the kidney is one of the main organs affected by the COVID-19 disease. Dr Carmen Hurtado, researcher of EPIORGABOLISM, is currently generating human kidney organoids from human pluripotent stem cells.

The use of human organoids allows to test treatments against coronavirus in an agile way, dramatically reducing the time human drug trials take. Hurtado is part of international research team has identified a drug capable of blocking the effects of the SARS-CoV-2 virus. The findings have been partially supported by EPIORGABOLISM and published in the journal ‘Cell’.

Find out more

• Trial drug shows promise in fighting coronavirus
• Watch the testimonial of Carmen Hurtado , researcher of the EPIORGABOLISM project.

Host switching pathogens, infectious outbreaks and zoonosis; a Marie Sklodowska-Curie Training Network

HONOURs is teaching 15 talented young researchers, including coronavirologists, to become “preparedness-experts”. The project involves 11 laboratories, all at the forefront of novel virus investigations and characterizations. HONOUR reacted in January 2020, immediately after the emergence of COVID-19, by starting work on SARS-CoV-2. A synthetic biology virus culture system was developed to swiftly evaluate therapy options, next to rapid tests to determine virus shedding on location. The quality of protective immunity was evaluated, and a search started on the most suitable animal model to battle the virus and provide therapy options. HONOURs is devoting its expert knowledge to fight this coronavirus and provide therapy options.

• HONOURs: Virus Outbreak Preparedness and COVID-19
• Visit the HONOURs website

INnate-ImmunomeTabolIsm as Antiviral TargEt

The global COVID-19 pandemic highlights an urgent need for innovation in the development of novel antiviral strategies and therapies. INITIATE has recruited 15 young PhD candidates to become experts in the field of antiviral immunometabolism, with a focus on RNA viruses – including coronaviruses. While it is clear that viral replication, metabolic pathways, and host immune responses are tightly interconnected, the host molecular pathways that impact viral pathogenesis are not well-defined. With the emergence of COVID-19, eight of the INITIATE projects have included SARS-CoV-2 in their research programs to understand coronavirus molecular virology, the role of the host immune response in driving COVID-19 immunopathogenesis and the potential of targeting host metabolism as therapeutic strategies.

Organoids for Virus Research - An innovative training-ETN programme

ORGANOVIR  is contributing to COVID-19 research in a variety of ways, and several of its researchers are currently working on the development of new antivirals to combat the disease. Researchers at KU Leuven (Belgium) are studying the way in which coronaviruses evolve, and are searching out possible targets for further remedies. The project also investigating active substances – or a combination of them – in existing medicines that could be effective against SARS-CoV-2. ORGANOVIR is also conducting pre-clinical tests for a vaccine against COVID-19 using a technology based on the yellow fever vaccine.

In parallel, a group of researchers at the Jagiellonian University (Poland) is studying the infection on the single-cell and tissue level in different organs and cell types, working on virus inhibitors and collaborating with companies to create a point of care diagnostics based on different platforms. The group is also studying the course of the pandemic in Poland and monitoring the virus variability in the country.

ORGANOVIR’s coordinators have been intensively working on clinical and diagnostic tasks and set up new COVID-19 research at the Amsterdam UMC (The Netherlands). This has resulted in the launch of COVID-KIDS, a study on immunity in children, and the use of 3D culture models for COVID-19 studies.

• Read about the COVID-19 activities of ORGANOVIR partners
• Read the testimonial of Mariana Guedes , researcher for the OrganoVir project
• Read the testimonial of Thuc Do , researcher for the OrganoVir project
• Air-liquid interface cultures of nasal epithelial cells to investigate factors critical for viral entry into host cells

MECHANISMS OF INFECTION, IMMUNE REACTIONS AND HOST-PATHAGEN INTERACTION

Unravelling species barriers of coronaviruses.

COV RESTRIC  targeted the precise mechanisms that allow coronaviruses to jump across species. Dr Stephanie Pfänder, researcher of COV RESTRIC, worked on various virological aspects of emerging viruses – with a focus on emerging coronaviruses. Her work has the potential to lead to novel strategies to protect cells against coronavirus infection. This is crucial to fight the COVID-19 pandemic – and to help insulate society against future coronavirus outbreaks.

• Read the testimonial of Stephanie Pfänder , researcher of the COV RESTRIC project.
• Host proteins involved in species barriers of viral infections

DIGITAL TOOLS, DATA AND MODELLING

Research and innovation staff exchange network of european data scientists.

The NeEDS  consortium is currently focusing on the emerging data challenges that come with the COVID-19 pandemic. In Spain, the first cases of the COVID-19 pandemic were confirmed late February 2020 and data started to be collected daily by the different regions. Data and Data Science tools turned out to be crucial to assist decision makers in this highly uncertain context. NeEDS and the scientific collaborations they enjoy were fundamental to create a working group of data scientists from different European universities, which has developed an Artificial Intelligence tool to provide short-term predictions of the pandemic’s evolution. With this novel methodology, NeEDS as contributed to the cooperative efforts coordinated by the Spanish Commission of Mathematics to support data-driven decision making related to the COVID19 pandemic. In a recent interview , Project Coordinator Dolores Romero Morales has reflected on the potential of the NeEDS expertise and the efforts of tackling these data challenges within the team. The consortium is tackling other important Data Science questions, e.g., using spatial data to support COVID19 information apps or addressing the pressing data privacy needs.

• Read about the COVID-19 activities of NeEDS and its partners
• On Sparse Ensemble Methods: An Application to Short-Term Predictions of the Evolution of COVID-19
• Read the testimonials of Remedios Sillero, Cristina Molero and Sandra Benitez , seconded researchers for the NeEDS project.

Pan-genome Graph Algorithms and Data Integration

Researchers involved in PANGAIA  are investigating how massive amounts of genome sequence data can be ordered and analysed for their use in biomedicine. Their work has important implications in areas such as bacteria and virus research, investigation of drug resistance mechanisms and vaccine development: big data technology can help to identify the characteristics of new strains of viruses such as SARS-CoV-2 and bacteria by comparing their genomes.

• Identifying large data sets to help coronavirus research
• Identifying pathogenic genes in virus strains at a glance

Modelling Infectious Diseases in Dynamic, relocated, refugee populations

In order to assist policy-makers in mitigating outbreaks, MIDIDP  has created realistic models to simulate the spread of infectious diseases in under-vaccinated refugee populations in Europe and neighbouring countries. Dr Hasan Güçlü, researcher of MIDIDP, has created a model that simulates the spread of COVID-19 in populations with variable demographics.

• Read the testimonial of Hasan Güçlü , researcher of the MIDIDP project.

PUBLIC HEALTH, PREPAREDNESS AND RESPONSE

Disability and disease during the 1918 influenza pandemic: implications for preparedness policies.

As the current COVID-19 pandemic shows, people with disabilities are at increased risk for complications and death as they are often neglected in epidemic responses. Dr Jessica Dimka, researcher of DIS2 , is exploring disability as a risk factor in pandemics. Using the 1918 Spanish influenza pandemic as a model, the project seeks to promote more equitable public health plans and interventions. Dimka points out that people with disabilities must be considered in all pandemic strategies: their lives, livelihoods and rights are not expendable.

• Read the testimonial of Jessica Dimka , researcher of the DIS2 project.

MULTIDISCIPLINARY PROJECTS

Protecting human rights and public health in global pandemics.

THEMIS is an interdisciplinary research project that reacts to the increasing occurrence of global pandemics, like the caused by the present COVID-19 disease, and restrictive public health measures taken to respond to these threats. Using a rights-based approach, Dr Patrycja Dąbrowska-Kłosińska, researcher of THEMIS, intends to create a better understanding of how to prepare for, and respond to, global pandemics.

The project seeks to offer a vital reference for policy-making at national, regional and global levels – one that prioritises fair pandemic preparedness to cross-border health threats. The project has offered critical guidance during the current COVID-19 pandemic, which has required a previously unimagined scale of coordinated, public health-control measures as well as consideration of human-rights implications worldwide.

• Read the testimonial of Patrycja Dąbrowska-Kłosińska , researcher of the THEMIS project.

Martí I Franquès COFUND

Since the emergence of COVID-19, several fellows involved in the Martí Franquès Programme (MFP) have been working on solutions to the current crisis. Researchers are developing an epidemiological mathematical model that infers the status of the epidemic, thereby monitoring and estimating the impact of interventions on the spread of COVID-19.

In parallel, another group of researchers is implementing an original virtual screening protocol to reposition approved drugs. This would allow predicting which of them could inhibit the main protease of the virus (M-pro), a key target for antiviral drugs given its essential role in the virus replication.

• Read the testimonial of Benjamin Steinegger , whose research is developing a mathematical framework to monitor and estimate the impact of interventions on the COVID-19 pandemic.

Project outcomes

• Modelling the impact of interventions on the spread of COVID-19
• Prediction of novel inhibitors of the main protease of SARS-CoV-2
• See all the results relevant to COVID-19 produced by MFP fellows

The launch of a new industrial PhD programme at EPFL

Several fellows involved in the EPFLinnovators  project are working on solutions to COVID-19 since the start of the crisis. Teams of researchers are developing subunit vaccines against the SARS-CoV-2 virus, investigating the potential use of cyclodextrin derivatives to prevent and treat the infections caused by SARS-CoV-2, and analysing the mechanical aspects of SARS-CoV-2 entry into cells.

• Read the testimonial of Xiaomeng Hu , researcher of the EPFLInnovators project.
• Subunit vaccines against SARS-CoV-2
• Non-toxic cyclodextrin derivative against viruses at micromolar concentration
• Variations in clathrin mediated endocytosis on a mammalian cell membrane

SOCIAL BEHAVIOUR AND IMPACT

Leading fellows.

Over the last decade, the reliance on online products and services has steadily increased, but since the beginning of the COVID-19 pandemic it has escalated to an unprecedented level. Dr Matthew Dennis, researcher of the LEaDing Fellows COFUND project at TU Delft (the Netherlands), examines the ethical implications and value trade-offs as societies attempt to transition across the digital divide. His project highlights that an ethical reflection on this digital transition is urgently needed, as digital solutions to problems generated by COVID-19 may create winners and losers – likely disproportionately affecting vulnerable users. By addressing these issues, the pandemic may foster the kind of social and political interconnectedness that was envisioned at the start of the crisis.

• Read the testimonial of Matthew James Dennis , researcher of the LEaDing Fellows project.

MSCA on social media

The MSCA social media are continuously updated with testimonials of MSCA fellows, supervisors, coordinators and projects working to find solutions to challenges posed by COVID-19 and other infectious diseases.

• MSCA on Twitter
• MSCA Facebook page

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The dissertation journey during the COVID-19 pandemic: Crisis or opportunity?

Affiliation.

• 1 The International Master's Program of Tourism and Hospitality, National Kaohsiung University of Hospitality and Tourism, No. 1, Songhe Rd., Xiaogang Dist, Kaohsiung City, 812, Taiwan.
• PMID: 35221798
• PMCID: PMC8858711
• DOI: 10.1016/j.jhlste.2022.100374

Despite dissertation's significance in enhancing the quality of scholarly outputs in tourism and hospitality fields, insufficient research investigates the challenges and disruptions students experience amidst a public health crisis. This study aims to fill the research gaps and integrate attribution and self-efficacy theories to understand how the COVID-19 pandemic influences students' decision-making and behaviours during the dissertation writing process. Qualitative exploration with 15 graduate students was conducted. The results indicate that adjustment of data collection approaches was the most shared external challenge, while students' religious background and desire for publishing COVID related topics were primary internal motivations.

Keywords: Attribution theory; COVID-19; Dissertation writing; Pandemic; Self-efficacy theory.

© 2022 Elsevier Ltd. All rights reserved.

The link between poor housing conditions and COVID-19 infection

Robb, Katharine, Rowana Ahmed, John Wong, Elissa Ladd, and Jorrit de Jong. “ Substandard housing and the risk of COVID-19 infection and disease severity: A retrospective cohort study. ” SSM - Population Health 25 (March 2024): 101629.

Faculty Authors

Jorrit de Jong

What’s the issue.

Following the peak of the COVID-19 pandemic, researchers continue to investigate the factors related to the spread of disease—and how city leaders can better respond before, during, and after such crises. Housing conditions, for example, can play a role in infectious disease risk. Substandard housing—which might feature poor ventilation, overcrowding, and dampness—can create an environment favorable to respiratory disease.

So, did poor housing conditions lead to more—and more severe—cases of COVID-19 infection during the pandemic?  

What does the research say?

Researchers from the Bloomberg Center for Cities at Harvard University and the MGH Institute of Health Professions studied the connections between poor housing conditions and COVID-19 infection and severity during the first year of the pandemic. They combined city housing data with healthcare data for residents of Chelsea, Massachusetts—a densely populated city with high levels of substandard housing.

The researchers found that:

• Living in substandard housing was linked to higher COVID-19 infection risk, even after adjusting for factors like age, income, and race.
• This increased risk was only observed during lockdown and early reopening; after stay-at-home restrictions lifted there was no difference in COVID-19 risk between residents of substandard versus adequate housing.
• Substandard housing was not linked to greater risk of severe COVID-19 disease.
• Leaders can leverage city housing data for pandemic response and longer-term solutions.

They conclude, “The results demonstrate the value of combining cross-sector datasets to yield new insights and solutions. Existing city data can be leveraged to identify and prioritize 1) high-risk areas for future pandemic response activities, and 2) for longer-term solutions that address social determinants of health through safe and affordable housing.”  

More from HKS

Media narratives have generally blamed democrats for housing crises in cities. research suggests that is not the full story., advancing progress in cities around the globe, doctors’ political beliefs influence covid-19 treatment recommendations, study suggests.

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The Impact of COVID-19 on the Careers of Women in Academic Sciences, Engineering, and Medicine (2021)

Chapter: 8 major findings and research questions, 8 major findings and research questions, introduction.

The COVID-19 pandemic, which began in late 2019, created unprecedented global disruption and infused a significant level of uncertainty into the lives of individuals, both personally and professionally, around the world throughout 2020. The significant effect on vulnerable populations, such as essential workers and the elderly, is well documented, as is the devastating effect the COVID-19 pandemic had on the economy, particularly brick-and-mortar retail and hospitality and food services. Concurrently, the deaths of unarmed Black people at the hands of law enforcement officers created a heightened awareness of the persistence of structural injustices in U.S. society.

Against the backdrop of this public health crisis, economic upheaval, and amplified social consciousness, an ad hoc committee was appointed to review the potential effects of the COVID-19 pandemic on women in academic science, technology, engineering, mathematics, and medicine (STEMM) during 2020. The committee’s work built on the National Academies of Sciences, Engineering, and Medicine report Promising Practices for Addressing the Underrepresentation of Women in Science, Engineering, and Medicine: Opening Doors (the Promising Practices report), which presents evidence-based recommendations to address the well-established structural barriers that impede the advancement of women in STEMM. However, the committee recognized that none of the actions identified in the Promising Practices report were conceived within the context of a pandemic, an economic downturn, or the emergence of national protests against structural racism. The representation and vitality of academic women in STEMM had already warranted national attention prior to these events, and the COVID-19

pandemic appeared to represent an additional risk to the fragile progress that women had made in some STEMM disciplines. Furthermore, the future will almost certainly hold additional, unforeseen disruptions, which underscores the importance of the committee’s work.

In times of stress, there is a risk that the divide will deepen between those who already have advantages and those who do not. In academia, senior and tenured academics are more likely to have an established reputation, a stable salary commitment, and power within the academic system. They are more likely, before the COVID-19 pandemic began, to have established professional networks, generated data that can be used to write papers, and achieved financial and job security. While those who have these advantages may benefit from a level of stability relative to others during stressful times, those who were previously systemically disadvantaged are more likely to experience additional strain and instability.

As this report has documented, during 2020 the COVID-19 pandemic had overall negative effects on women in academic STEMM in areas such productivity, boundary setting and boundary control, networking and community building, burnout rates, and mental well-being. The excessive expectations of caregiving that often fall on the shoulders of women cut across career timeline and rank (e.g., graduate student, postdoctoral scholar, non-tenure-track and other contingent faculty, tenure-track faculty), institution type, and scientific discipline. Although there have been opportunities for innovation and some potential shifts in expectations, increased caregiving demands associated with the COVID-19 pandemic in 2020, such as remote working, school closures, and childcare and eldercare, had disproportionately negative outcomes for women.

The effects of the COVID-19 pandemic on women in STEMM during 2020 are understood better through an intentionally intersectional lens. Productivity, career, boundary setting, mental well-being, and health are all influenced by the ways in which social identities are defined and cultivated within social and power structures. Race and ethnicity, sexual orientation, gender identity, academic career stage, appointment type, institution type, age, and disability status, among many other factors, can amplify or diminish the effects of the COVID-19 pandemic for a given person. For example, non-cisgender women may be forced to return to home environments where their gender identity is not accepted, increasing their stress and isolation, and decreasing their well-being. Women of Color had a higher likelihood of facing a COVID-19–related death in their family compared with their white, non-Hispanic colleagues. The full extent of the effects of the COVID-19 pandemic for women of various social identities was not fully understood at the end of 2020.

Considering the relative paucity of women in many STEMM fields prior to the COVID-19 pandemic, women are more likely to experience academic isolation, including limited access to mentors, sponsors, and role models that share gender, racial, or ethnic identities. Combining this reality with the physical isolation stipulated by public health responses to the COVID-19 pandemic,

women in STEMM were subject to increasing isolation within their fields, networks, and communities. Explicit attention to the early indicators of how the COVID-19 pandemic affected women in academic STEMM careers during 2020, as well as attention to crisis responses throughout history, may provide opportunities to mitigate some of the long-term effects and potentially develop a more resilient and equitable academic STEMM system.

MAJOR FINDINGS

Given the ongoing nature of the COVID-19 pandemic, it was not possible to fully understand the entirety of the short- or long-term implications of this global disruption on the careers of women in academic STEMM. Having gathered preliminary data and evidence available in 2020, the committee found that significant changes to women’s work-life boundaries and divisions of labor, careers, productivity, advancement, mentoring and networking relationships, and mental health and well-being have been observed. The following findings represent those aspects that the committee agreed have been substantiated by the preliminary data, evidence, and information gathered by the end of 2020. They are presented either as Established Research and Experiences from Previous Events or Impacts of the COVID-19 Pandemic during 2020 that parallel the topics as presented in the report.

Established Research and Experiences from Previous Events

___________________

1 This finding is primarily based on research on cisgender women and men.

Impacts of the COVID-19 Pandemic during 2020

Research questions.

While this report compiled much of the research, data, and evidence available in 2020 on the effects of the COVID-19 pandemic, future research is still needed to understand all the potential effects, especially any long-term implications. The research questions represent areas the committee identified for future research, rather than specific recommendations. They are presented in six categories that parallel the chapters of the report: Cross-Cutting Themes; Academic Productivity and Institutional Responses; Work-Life Boundaries and Gendered Divisions of Labor; Collaboration, Networking, and Professional Societies; Academic Leadership and Decision-Making; and Mental Health and Well-being. The committee hopes the report will be used as a basis for continued understanding of the impact of the COVID-19 pandemic in its entirety and as a reference for mitigating impacts of future disruptions that affect women in academic STEMM. The committee also hopes that these research questions may enable academic STEMM to emerge from the pandemic era a stronger, more equitable place for women. Therefore, the committee identifies two types of research questions in each category; listed first are those questions aimed at understanding the impacts of the disruptions from the COVID-19 pandemic, followed by those questions exploring the opportunities to help support the full participation of women in the future.

Cross-Cutting Themes

• What are the short- and long-term effects of the COVID-19 pandemic on the career trajectories, job stability, and leadership roles of women, particularly of Black women and other Women of Color? How do these effects vary across institutional characteristics, 2 discipline, and career stage?

2 Institutional characteristics include different institutional types (e.g., research university, liberal arts college, community college), locales (e.g., urban, rural), missions (e.g., Historically Black Colleges and Universities, Hispanic-Serving Institutions, Asian American/Native American/Pacific Islander-Serving Institutions, Tribal Colleges and Universities), and levels of resources.

• How did the confluence of structural racism, economic hardships, and environmental disruptions affect Women of Color during the COVID-19 pandemic? Specifically, how did the murder of George Floyd, Breonna Taylor, and other Black citizens impact Black women academics’ safety, ability to be productive, and mental health?
• How has the inclusion of women in leadership and other roles in the academy influenced the ability of institutions to respond to the confluence of major social crises during the COVID-19 pandemic?
• How can institutions build on the involvement women had across STEMM disciplines during the COVID-19 pandemic to increase the participation of women in STEMM and/or elevate and support women in their current STEMM-related positions?
• How can institutions adapt, leverage, and learn from approaches developed during 2020 to attend to challenges experienced by Women of Color in STEMM in the future?

Academic Productivity and Institutional Responses

• How did the institutional responses (e.g., policies, practices) that were outlined in the Major Findings impact women faculty across institutional characteristics and disciplines?
• What are the short- and long-term effects of faculty evaluation practices and extension policies implemented during the COVID-19 pandemic on the productivity and career trajectories of members of the academic STEMM workforce by gender?
• What adaptations did women use during the transition to online and hybrid teaching modes? How did these techniques and adaptations vary as a function of career stage and institutional characteristics?
• What are examples of institutional changes implemented in response to the COVID-19 pandemic that have the potential to reduce systemic barriers to participation and advancement that have historically been faced by academic women in STEMM, specifically Women of Color and other marginalized women in STEMM? How might positive institutional responses be leveraged to create a more resilient and responsive higher education ecosystem?
• How can or should funding arrangements be altered (e.g., changes in funding for research and/or mentorship programs) to support new ways of interaction for women in STEMM during times of disruption, such as the COVID-19 pandemic?

Work-Life Boundaries and Gendered Divisions of Labor

• How do different social identities (e.g., racial; socioeconomic status; culturally, ethnically, sexually, or gender diverse; immigration status; parents of young children and other caregivers; women without partners) influence the management of work-nonwork boundaries? How did this change during the COVID-19 pandemic?
• How have COVID-19 pandemic-related disruptions affected progress toward reducing the gender gap in academic STEMM labor-force participation? How does this differ for Women of Color or women with caregiving responsibilities?
• How can institutions account for the unique challenges of women faculty with parenthood and caregiving responsibilities when developing effective and equitable policies, practices, or programs?
• How might insights gained about work-life boundaries during the COVID-19 pandemic inform how institutions develop and implement supportive resources (e.g., reductions in workload, on-site childcare, flexible working options)?

Collaboration, Networking, and Professional Societies

• What were the short- and long-term effects of the COVID-19 pandemic-prompted switch from in-person conferences to virtual conferences on conference culture and climate, especially for women in STEMM?
• How will the increase in virtual conferences specifically affect women’s advancement and career trajectories? How will it affect women’s collaborations?
• How has the shift away from attending conferences and in-person networking changed longer-term mentoring and sponsoring relationships, particularly in terms of gender dynamics?
• How can institutions maximize the benefits of digitization and the increased use of technology observed during the COVID-19 pandemic to continue supporting women, especially marginalized women, by increasing accessibility, collaborations, mentorship, and learning?
• How can organizations that support, host, or facilitate online and virtual conferences and networking events (1) ensure open and fair access to participants who face different funding and time constraints; (2) foster virtual connections among peers, mentors, and sponsors; and (3) maintain an inclusive environment to scientists of all backgrounds?
• What policies, practices, or programs can be developed to help women in STEMM maintain a sense of support, structure, and stability during and after periods of disruption?

Academic Leadership and Decision-Making

• What specific interventions did colleges and universities initiate or prioritize to ensure that women were included in decision-making processes during responses to the COVID-19 pandemic?
• How effective were colleges and universities that prioritized equity-minded leadership, shared leadership, and crisis leadership styles at mitigating emerging and potential negative effects of the COVID-19 pandemic on women in their communities?
• What specific aspects of different leadership models translated to more effective strategies to advance women in STEMM, particularly during the COVID-19 pandemic?
• How can examples of intentional inclusion of women in decision-making processes during the COVID-19 pandemic be leveraged to develop the engagement of women as leaders at all levels of academic institutions?
• What are potential “top-down” structural changes in academia that can be implemented to mitigate the adverse effects of the COVID-19 pandemic or other disruptions?
• How can academic leadership, at all levels, more effectively support the mental health needs of women in STEMM?

Mental Health and Well-being

• What is the impact of the COVID-19 pandemic and institutional responses on the mental health and well-being of members of the academic STEMM workforce as a function of gender, race, and career stage?
• How are tools and diagnostic tests to measure aspects of wellbeing, including burnout and insomnia, used in academic settings? How does this change during times of increased stress, such as the COVID-19 pandemic?
• How might insights gained about mental health during the COVID-19 pandemic be used to inform preparedness for future disruptions?
• How can programs that focus on changes in biomarkers of stress and mood dysregulation, such as levels of sleep, activity, and texting patterns, be developed and implemented to better engage women in addressing their mental health?
• What are effective interventions to address the health of women academics in STEMM that specifically account for the effects of stress on women? What are effective interventions to mitigate the excessive levels of stress for Women of Color?

This page intentionally left blank.

The spring of 2020 marked a change in how almost everyone conducted their personal and professional lives, both within science, technology, engineering, mathematics, and medicine (STEMM) and beyond. The COVID-19 pandemic disrupted global scientific conferences and individual laboratories and required people to find space in their homes from which to work. It blurred the boundaries between work and non-work, infusing ambiguity into everyday activities. While adaptations that allowed people to connect became more common, the evidence available at the end of 2020 suggests that the disruptions caused by the COVID-19 pandemic endangered the engagement, experience, and retention of women in academic STEMM, and may roll back some of the achievement gains made by women in the academy to date.

The Impact of COVID-19 on the Careers of Women in Academic Sciences, Engineering, and Medicine identifies, names, and documents how the COVID-19 pandemic disrupted the careers of women in academic STEMM during the initial 9-month period since March 2020 and considers how these disruptions - both positive and negative - might shape future progress for women. This publication builds on the 2020 report Promising Practices for Addressing the Underrepresentation of Women in Science, Engineering, and Medicine to develop a comprehensive understanding of the nuanced ways these disruptions have manifested. The Impact of COVID-19 on the Careers of Women in Academic Sciences, Engineering, and Medicine will inform the academic community as it emerges from the pandemic to mitigate any long-term negative consequences for the continued advancement of women in the academic STEMM workforce and build on the adaptations and opportunities that have emerged.

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The dissertation journey during the COVID-19 pandemic: Crisis or opportunity?

Despite dissertation's significance in enhancing the quality of scholarly outputs in tourism and hospitality fields, insufficient research investigates the challenges and disruptions students experience amidst a public health crisis. This study aims to fill the research gaps and integrate attribution and self-efficacy theories to understand how the COVID-19 pandemic influences students' decision-making and behaviours during the dissertation writing process. Qualitative exploration with 15 graduate students was conducted. The results indicate that adjustment of data collection approaches was the most shared external challenge, while students' religious background and desire for publishing COVID related topics were primary internal motivations.

1. Introduction

Dissertation writing is an essential part of academic life for graduate students ( Yusuf, 2018 ). By writing the dissertation, students can build research skills to analyse new data and generate innovative concepts to inform future scientific studies ( Fadhly et al., 2018 ; Keshavarz & Shekari, 2020 ). Therefore, scholars in higher education are dedicated to guiding students to complete impactful dissertations. Duffy et al. (2018) note that thesis advisors can empower students to explore novel ideas and identify new products or services for the tourism and hospitality industry beyond the traditional contribution of extending the existing research literature. Namely, the intriguing ideas proposed in students’ dissertations will eventually enrich and diversify the literature in the tourism and hospitality academia. Furthermore, the process of identifying impactful ideas will prepare students for a successful career either as a researcher or practitioner.

However, dissertation writing can be a challenging experience for both native and non-native writers. Students are sometimes confused about the characteristics of the dissertation or the expectations from the academics and practitioners ( Bitchener et al., 2010 ). A graduate student has to make numerous decisions during the dissertation writing journey. To successfully guide the students through this complicated writing journey, thesis advisors need to understand the factors influencing students' writing motivation and decision-making process. Previous studies have suggested these influential factors can be broadly classified into external sources (e.g., advisor/supervisor's influence, trends in the field, or publishability of the topic) and internal sources (e.g., researcher's background or researcher interest; Fadhly et al., 2018 ; I'Anson & Smith, 2004 ; Keshavarz & Shekari, 2020 ). Despite this classification, the discussions related to the impacts of macro-environments, such as socio-cultural trends, economic conditions, or ecology and physical environments, on students' dissertation writing are extremely lacking. Since the time background and the world situation when writing a dissertation are also critical factors influencing students' writing goals, more research should be done to broaden students' dissertation writing experiences.

The COVID-19 pandemic has immensely impacted global education, students' learning, and research activities. According to Dwivedi et al. (2020) , the COVID-19 pandemic has affected international higher education leading to the closure of schools to control the spread of the virus. Meanwhile, Alvarado et al. (2021) found that the global health crises have seriously disrupted doctoral students' Dissertations in Practice (DiP). Specifically, students must learn new methodologies and adjust the research settings and sampling techniques because of virtual-only approaches. Some have to find new topics and research questions since the original one cannot be investigated during the quarantine period. However, students may turn this current crisis into an opportunity as they build a shared community and support each other's private and academic lives. Apparently, the crisis can result in a stronger bond of friendship, and this may generate more collaborative research projects in the future.

As mentioned earlier, some studies have tried to identify factors influencing students' dissertation writing journey, albeit lack considerations related to the effects of macro-environments. Given the severe impacts of COVID-19 on the macro-environments of global higher education and the tourism industry, this study aims to fill the research gap and explore how a public health crisis may influence graduate students' dissertation writing, especially in the field of tourism and hospitality. Specifically, this study utilizes attribution and self-efficacy theory as the research framework to examine the internal and external factors that influenced graduate students' dissertation journey amidst the COVID-19 pandemic (see Fig. 1 ). The use of attribution and self-efficacy theory is appropriate in the current study because both explain how people make sense of society, influences of others, their decision-making process and behaviours. Although some may argue these theories are outdated, many scholars have used them to explain students' behaviours and experiences during the COVID-19 pandemic. For example, Xu et al. (2021) found that social capital and learning support positively influence students' self-efficacy, employability and well-being amidst the crisis. Meanwhile, Lassoued et al. (2020) used attribution theory to explore the university professors and their students' learning experience during the COVID-19 pandemic. They found that both groups attributed the problems to reaching high quality in distance learning to students' weak motivation to understand abstract concepts in the absence of in-person interaction.

The theoretical framework.

Understanding the lived experience of students would enable stakeholders in tourism and hospitality education to deeply comprehend the plight and predicaments of students face and the innovate ways to mitigate those challenges amidst the COVID-19 pandemic. Thus, this study utilizes a qualitative approach to explore the impacts of internal and extremal factors on the dissertation writing process. The study was set in the context of an international graduate hospitality and tourism program in Taiwan known for its diverse student body. The research question that guides such qualitative exploration is: How have external and internal factors influenced graduate students’ dissertation writing journey during the COVID-19 pandemic?

This study is timely and critical considering the uncertainties that characterize pandemics which aggravates the already perplexities that associate dissertation writing. It throws light on factors that are susceptible to pandemic tendencies and factors that are resilient to crisis. The findings of this study would provide insights into how crises affect academia and suggest effective ways for higher educational institutions, academicians, and other key stakeholders to forge proactive solutions for future occurrences. Especially, higher education institutions would be well-positioned and informed on areas to train students and faculty members to ameliorate the impacts associated with pandemics.

2. Literature review

2.1. covid-19 and its impacts on educational activities.

Public health crises have ramifications for educational behaviour and choices; this is especially true of the COVID-19 pandemic. Most countries and institutions of higher education are still battling with the consequences suffered from the COVID-19 pandemic. Not surprisingly, there has been a tsunami of studies on the implications of the COVID-19 pandemic (e.g., Dwivedi et al., 2020 ; Manzano-Leon et al., 2021 ; Alam & Parvin, 2021 ). Assessing these studies, we found that although there are substantial extant studies on the negative implications of the COVID-19 pandemic, limited studies have also emphasised the positive side of the pandemic on education. For example, Dwivedi et al. (2020) concluded that the COVID-19 had revealed the necessity of online teaching in higher educational institutions. For they observed that at Loughborough, though face-to-face teaching is practised, one cannot relegate online teaching as some students will be unable to return to campus due to border closures. Thus, faculty members have to convert existing material to the online format. Furthermore, Manzano-Leon et al. (2021) also pointed out that the COVID-19 has allowed students to interact with their peers beyond traditional education. They pinpointed that playful learning strategies such as escape rooms enable students to interact well. Alam and Parvin (2021) also underscored students who studied during the COVID-19 pandemic performed better academically than those before. This finding suggests that online education is supposedly more active than face-to-face mode.

Apart from these positive implications aforementioned, most studies have emphasised the negative impacts of COVID-19 on education. Dwivedi et al. (2020) reviewed how the global higher education sector has been affected by the COVID-19 pandemic. It caused the closure of schools, national lockdowns and social distancing, and a proliferation of online teaching. COVID-19 forced both teachers and students to work and study remotely from home. According to Dhawan (2020) , the rapid deployment of online learning to protect students, faculty, communities, societies, and nations affected academic life. Online learning seemed like a panacea in the face of COVID-19's severe symptoms; however, the switch to online also brought several challenges for teachers and students. Lall and Singh (2020) noted that disadvantages of online learning include the absence of co-curricular activities and students' lack of association with friends at school. Many studies have also confirmed the pandemic's adverse effects on students' mental health, emotional wellbeing, and academic performance ( Bao, 2020 ; de Oliveira Araújo et al., 2020 ).

Despite the pandemic has caused numerous difficulties for many educational institutions, scholars and educators have risen to the challenges and tried to plan effective strategies to mitigate such stressing circumstances. For example, to respond the needs of a better understanding of students' social-emotional competencies for coping the COVID-19 outbreak, Hadar et al. (2020) utilized the VUCA (volatile, uncertain, complex, ambiguous) framework to analyse teachers and students' struggles. Each element of VUCA is defined as follows:

• ● Volatility: the speed and magnitude of the crisis;
• ● Uncertainty: the unpredictability of events during the crisis;
• ● Complexity: the confounding events during the crisis;
• ● Ambiguity: the confusing and mixed meanings during the crisis.

This analysis and conceptualization of crises help to explain some of the students’ concerns on mental health, emotional wellbeing, and academic performance ( Bao, 2020 ; de Oliveira Araújo et al., 2020 ).

The pandemic also exacerbated existing challenges facing students and universities across the globe. According to Rose-Redwood et al. (2020) , the COVID-19 endangered the career prospects of both students and scholars. University partnerships with the arts sector, community service, and non-governmental organizations also suffered. The tourism and hospitality (academic) field faced unique challenges in light of COVID-19 without exception. Forms of tourism such as over-tourism and cruise tourism were temporarily unobservable, and most pre-crisis studies and forecast data were no longer relevant ( Bausch et al., 2021 ). Consequently, many empirical and longitudinal studies were halted due to the incomparability of data. Even though many studies have been conducted to explore the impacts of the COVID pandemic on educational activities, none of these studies has addressed how this public health crisis has affected graduate students’ dissertation journey. Therefore, the present research is needed to fill the gaps in the mainstream literature.

2.2. Attribution theory and self-efficacy

The current study employs attribution theory and self-efficacy to understand graduate students' dissertation writing journeys. Attribution theory explains how individuals interpret behavioural outcomes ( Weiner, 2006 ) and has been used in education and crisis management ( Abraham et al., 2020 ; Sanders et al., 2020 ). For example, Chen and Wu (2021) used attribution theory to understand the effects of attributing students' academic achievements to giftedness. They found that attributing students' academic success to giftedness had a positive indirect relationship with their academic achievement through self-regulated learning and negative learning emotions. However, attribution theory has been criticised for its inability to explain a person's behaviour comprehensively. This is well enunciated by Bandura (1986) that attribution theory does not necessarily describe all influential factors related to a person's behaviour. Instead, it provides in-depth accounts of one's self-efficacy. Hence, scholars have advocated the need for integrating self-efficacy into attribution theory ( Hattie et al., 2020 ).

Self-efficacy is closely related to attribution theory. Extant studies have investigated the essence of self-efficacy in education and its role on students' achievements ( Bartimote-Aufflick et al., 2016 ; Hendricks, 2016 ). For instance, in their educational research and implications for music, Hendricks (2016) found that teachers can empower students' ability and achievement through positive self-efficacy beliefs. This is achieved through Bandura's (1986) theoretical four sources of self-efficacy: vicarious experience, verbal/social persuasion, enactive mastery experience, and physiological and affective states. The current study integrates attribution theory and self-efficacy as the research framework to provide intellectual rigour and reasons underlined students' decision-making during their dissertation journey.

2.3. Internal and external factors that influence dissertation writing processes

This study considered both internal and external factors affecting graduate students' dissertation journeys in line with attribution theory. Internal factors are actions or behaviours within an individual's control ( LaBelle & Martin, 2014 ; Weiner, 2006 ). Many studies have evolved and attributed dissertation topic selection to internal considerations. For instance, I'Anson and Smith's (2004) study found that personal interest and student ability were essential for undergraduate students' thesis topic selection. Keshavarz and Shekari (2020) also found that personal interest is the primary motivation for choosing a specific thesis topic. In another study focused on undergraduate students at the English department, Husin and Nurbayani (2017) revealed that students' language proficiency was a dominant internal factor for their dissertation choice decisions.

On the other hand, external factors are forces beyond an individual's control ( LaBelle & Martin, 2014 ). Similar to internal factors, there is an avalanche of studies that have evolved and uncovered external factors that characterize students' dissertation decisions in the pre-COVID period (e.g., de Kleijn et al., 2012 ; Huin; Nurbayani, 2017 ; Keshavarz & Shekari, 2020 ; Pemberton, 2012 ; Shu et al., 2016; Sverdlik et al., 2018 ). For instance, de Kleijn et al. (2012) found that supervisor influence is critical in the student dissertation writing process. They further revealed that an acceptable relationship between supervisor and student leads to a higher and quality outcome; however, a high level of influence could lead to low satisfaction. Meanwhile, Pemberton (2012) delved into the extent teachers influence students in their dissertation process and especially topic selection. This study further underlined that most supervisors assist students to select topics that will sustain their interest and competence level. Unlike previous research, Keshavarz and Shekari (2020) found that research operability or feasibility was a critical external factor that informed students' dissertation decisions. In other words, practicality and usefulness are essential in determining the dissertation choices.

These studies above show how internal and external factors may determine students' dissertation decisions. Despite those studies providing valuable knowledge to broaden our understanding of which factors may play significant role in students' dissertation journeys, most of their focus was on undergraduate students and was conducted before COVID-19. Given that the learning experiences among graduate and undergraduate students as well as before and during the pandemic may differ significantly, there is a need to investigate what specific external and internal factors underline graduate students’ dissertation decisions during the COVID-19. Are those factors different from or similar to previous findings?

3. Methodology

Previous studies have disproportionately employed quantitative approaches to examine students' dissertation topic choice (e.g., Keshavarz & Shekari, 2020 ). Although the quantitative method can aid the researcher to investigate focal phenomena among larger samples and generalize the results, it has also been criticized for the lack of in-depth analysis or does not allow respondents to share their lived experiences. Given the rapid evolution and uncertainty linked with the COVID-19 pandemic, the contextual and social factors may drive individuals to respond to such challenges differently. Therefore, efforts toward analyzing individual experiences during the public health crisis are necessary to tailor individual needs and local educational policy implementation ( Tremblay et al., 2021 ). Accordingly, the current study adopts a qualitative approach grounded in the interpretivism paradigm to explore the factors affecting graduate students’ dissertation research activities and understand the in-depth meaning of writing a dissertation.

3.1. Data collection

Since statistical representation is not the aim of qualitative research, the purposive sampling instead of probability sampling technique was used for this study ( Holloway & Wheeler, 2002 ). Graduate students who were composing their dissertation and could demonstrate a clear understanding on the issues under study are selected as the target research subjects. To gain a rich data, the sample selection in the current study considers background, dissertation writing status, and nationality to ensure a diversified data set ( Ritchie et al., 2014 ). Data was collected from graduate students in Taiwan who were currently writing their dissertations. Taiwan was chosen as the research site because the pandemic initially had a minor impact on Taiwan than on other economically developed countries ( Wang et al., 2020 ). In the first year (2019–2020) of their study, the graduate students could conduct their research projects without any restrictions. Therefore, traditional data collections and research processes, such as face-to-face interview techniques or onsite questionnaire distributions were generally taught and implemented in Taiwanese universities at that time. However, in their second year of the graduate program (2021), the COVID-19 cases surged, and the government identified some domestic infection clusters in Taiwan. Thus, the ministry of education ordered universities to suspend in-person instruction and move to online classes from home as part of a national level 3 COVID-19 alert. Many graduate students have to modify their data collection plan and learn different software to overcome the challenges of new and stricter rules. As they have experienced the sudden and unexpected change caused by the COVID-19 in their dissertation writing journey, Taiwanese graduate students are deemed as suitable research participants in this research.

Following Keshavarz and Shekari (2020) , interview questions were extracted from the literature review and developed into a semi-structured guide. Semi-structured interview was employed allowing for probing and clarifying explanations. This also allowed both the interviewer and the interviewee to become co-researchers (Ritchie et al., 2005). The questions asked about internal, and external factors influencing dissertation writing (including topic selection and methodology) during COVID-19. Specifically, students were asked how they chose their dissertation topic, how they felt COVID-19 had impacted their dissertation, and what significant events influenced their academic choices during the pandemic. Before each interview, the purpose of the study was explained and respondents provided informed consent. All the interviews were audio-recorded and later transcribed.

Interviews, lasting about 50–60 min, were conducted with 15 graduate students as data saturation was achieved after analysing 15 interviews. The saturation was confirmed by the repetition of statements like, “personal interest motivated me”, “my supervisor guided me to select a topic”, and “I changed my data collection procedure to online”.

3.2. Data analysis and trustworthiness

Before the formal interview, two educational experts who are familiar with qualitative research were solicited to validate the wording, semantics, and meanings of the interview questions. Then, a pilot test was conducted with three graduate students to check the clarity of the expression for every interview question and revise potentially confusing phrasing. Validity and trustworthiness were also achieved through the use of asking follow-up questions. The transcripts of formal interviews were analysed using Atlas.ti 9. Qualitative themes were developed following open, selective, and axial coding procedures ( Corbin & Strauss, 1990 ). Finally, the relationships among themes and codes were identified, facilitating the research findings and discussions.

In order to prevent biases from affecting the findings of the study, series of procedures were undertaken following previous qualitative research. First, multiple quotations from respondents underlined the research findings which meant the respondents' true perspectives and expressions were represented. Moreover, the analyses were done independently and there was peer checking among the authors. There was also member checking where themes found were redirected to respondents for verification. In addition, external validation of the themes was done by asking other graduate students who share similar characteristics for comparability assessment to make the findings transferable.

4. Results and discussion

4.1. profile of respondents.

Respondents were purposively drawn from diverse backgrounds (including nationality, gender, and programs) to enrich the research findings. The sample includes graduate students who began dissertation writing in Taiwan during the COVID-19 pandemic period. The majority of the respondents are female and from South East Asia. Table 1 provides background information of these interviewees.

Background information of study respondents.

4.2. Internal factors

As Table 2 depicts, the themes ascertained from the data analysis were categorised according to internal and external factors which underpin the attribution theory ( Weiner, 2006 ). In consonance with previous studies, graduate students’ dissertation writing during the pandemic was influenced by internal factors (i.e., personal interest and religious background) and external considerations (i.e., career aspirations, society improvement, language issues, supervisor influence, COVID-19 publishable topics, data collection challenges). The analyses of each factor are presented below.

Major themes and codes emerging from the data.

The most salient internal factors affecting dissertation topic selection were (1) personal interest and (2) religious background. For personal interest, respondent 1 expressed:

The first thing is that [it] comes from my interest. I'm currently working on solo female traveller [s], which is the market I want to study. So, the priority comes from my personal preference and to learn about this market no matter the external situation. I also think that this is due to how I was brought up. My parent nurtured me that way, and I love to do things independently, especially when travelling.

This finding is in line with previous studies such as Keshavarz and Shekari (2020) ; I’Anson and Smith (2004) , who emphasised the relevance of personal interest in students' dissertation decision-making. Informed by the self-efficacy and attribution theories, we found that students who attribute their decision-making on dissertation writing to internal factors (i.e., personal interest) have relatively high self-efficacy levels. As argued by Bandura (1977) , efficacy expectation is “the conviction that one can successfully execute the behaviour required to produce the outcomes” (p. 193). Namely, self-efficacy is determined by an individual's capability and ability to execute decisions independently, devoid of any external considerations. Despite the uncertainties and challenging circumstances amidst COVID-19, students who believe their ability and research skills usually adhere to their original dissertation topics and directions.

Religious consideration is another conspicuous factor informing graduate students' dissertation journey during the COVID-19 pandemic. As respondent 7 mentioned:

Islam has become my way of life. I am a Muslim. It is my daily life, so I like to research this. I was born into this faith, and I am inclined to explore Halal food. I feel committed to contributing my research to my faith no matter outside circumstances. Maybe if I combine it with academic (research), it will be easier to understand and easier to do.

Although not much has been seen regarding religious considerations in students' dissertation topic selection in previous studies, this research reveals religious background as a significant internal factor. From a sociology perspective, religious orientation and affiliation could affect individual behaviour ( Costen et al., 2013 ; Lee & Robbins, 1998 ), and academic decision-making is not an exception. Religious backgrounds are inherent in the socialisation process and could affect how a person behaves or how they make a particular decision. This premise is further accentuated by Costen et al. (2013) , who argued that social connectedness affects college students' ability to adjust to new environments and situations. Social connectedness guides feelings, thoughts, and behaviour in many human endeavours ( Lee & Robbins, 1998 ). Social connectedness and upbringing underpin peoples' personality traits and behavioural patterns. Therefore, this study has extended existing literature on factors that affect graduate students' decision-making on dissertation writing from a religious perspective, which is traceable to an individual's socialisation process. In other words, during crises, most students are inclined to make decisions on their dissertation writing which are informed by their social upbringing (socialisation).

4.3. External factors

As Table 2 indicates, abundant external factors inform graduate students’ decision-making on their dissertation writing process. Except for career aspirations, language concerns, and supervisor influences that previous studies have recognized ( Chu, 2015 ; Jensen, 2013 ; Keshavarz & Shekari, 2020 ; Lee & Deale, 2016 ; Tuomaala et al., 2014 ), some novel factors were identified from the data, such as “COVID-19 publishable topic” and “online data collection restrictions”.

Unlike extant studies that have bemoaned the negative impacts of the COVID on education ( Qiu et al., 2020 ; Sato et al., 2021 ), the current study revealed that graduate students were eager to research on topics that were related to COVID-19 to reflect the changes of the tourism industry and trends.

Initially, overtourism [was] a problem in my country, and I want to write a dissertation about it. However, there is no tourism at my research site because of the COVID-19 pandemic. So, I had to change my topic to resilience because resilience is about overcoming a crisis. I had to discuss with my supervisor, and she suggested the way forward that I revise my topic to make it relevant and publishable due to the COVID-19 pandemic (respondent 8).

This response shows the unavoidable impacts of the COVID-19 on the research community. As Bausch et al. (2021) pointed out, tourism and hospitality scholars have to change their research directions because some forms of tourism such as overtourism and cruise tourism were temporarily unobservable amidst the pandemic. Thus, many pre-pandemic studies and forecast data were no longer relevant. However, the COVID-19 pandemic can bring some positive changes. Nowadays, the industry and academics shift their focus from pro-tourism to responsible tourism and conduct more research related to resilience. As Ting et al. (2021) suggested, “moving forward from the pandemic crisis, one of the leading roles of tourism scholars henceforth is to facilitate high-quality education and training to prepare future leaders and responsible tourism practitioners to contribute to responsible travel and tourism experiences.” (p. 6).

Furthermore, the COVID-19 pandemic has significant ramifications upon the research methods in hospitality and tourism. As respondent 1 denoted,

Because of [the] COVID-19 pandemic, there were certain limitations like I cannot analyse interviewee's body language due to social distancing … some interruptions when we conduct online interviews due to unstable internet connectivity, which would ultimately affect the flow of the conversation.

The adjustments of research methods also bring frustrations and anxiety to students. For instance, respondent 3 expressed: “I became anxious that I won't be able to collect data because of social distancing, which was implemented in Taiwan.” The volatile, uncertain, complex, and ambiguous (VUCA) feelings caused by the COVID-19 pandemic significantly influences students' mood, thinking and behaviour ( Hadar et al., 2020 ).

Apparently, during crises, graduate students' decision-making on their dissertation writing was precipitated by external considerations beyond their control. Based on self-efficacy and attribution theory, the fear that characterises crises affects students' self-efficacy level and eagerness to resort to external entities (e.g., supervisor influences or difficulties in collecting data) to assuage their predicament. In other words, some students may have a low self-efficacy level during the COVID-19 pandemic, which was triggered by the negative impacts of the crisis. Furthermore, scholars may need to notice that COVID-19 is likely to affect conclusions drawn on studies undertaken during this period due to over-reliance on online data collection.

5. Conclusions and implications

Although numerous studies have been conducted to understand the influences of the COVID-19 crisis on educational activities, none of them focuses on the graduate student's dissertation writing journey. Given the significant contributions dissertations may make to advancing tourism and hospitality knowledge, this study aims to fill the gap and uses attribution and self-efficacy theories to explore how internal and external factors influenced graduate students' decision-making for dissertations amidst the crisis. Drawing on qualitative approaches with graduate students who began writing their dissertation during the COVID-19 period, the study provides insights into students' learning experiences and informs stakeholders in hospitality and tourism education to make better policies.

There are several findings worthy of discussion. Firstly, graduate students' sociological background (i.e., personal interest and religious background), which is inherent in an individual's socialisation processes, inform their decision-making in the dissertation processes during the COVID-19 pandemic. This is in line with the self-efficacy theory, which argues that an individual has the conviction that they have the necessary innate abilities to execute an outcome ( Bandura, 1977 ). Namely, respondents with high self-efficacy levels attributed their decisions to internal factors. Unlike previous studies' findings that personal interest was a factor that underpinned graduate students' decision-making ( I'Anson & Smith, 2004 ; Keshavarz & Shekari, 2020 ), it is observed that religious background is an additional factor that was evident and conspicuous during the COVID-19 pandemic.

Secondly, the complexity and uncertainty that characterised the COVID-19 pandemic made emotion a dominant factor that affected graduate students’ dissertation journey and indirectly triggered other external factors that provoked behavioural adjustments among students. The trepidation and anxiety that COVID-19 has caused significantly affects the self-efficacy level of students and predisposes them to external considerations, such as the will of the supervisor or the difficulties in data collection, in their dissertation journey. This study paralleled previous research and revealed that respondents with low self-efficacy were influenced by external considerations more than individuals with high self-efficacy ( Bandura, 1977 ). However, this study highlights how a public health crisis accelerates students who have low self-efficacy to attribute their unsatisfactory academic life to the external environment, leading to depression and negative impacts on ideology ( Abood et al., 2020 ).

Lastly, the COVID-19 pandemic has dramatically influenced the direction of research and body of knowledge in tourism and hospitality. This is seen in the light of the influx of COVID-19 related research topics adapted by graduate students. Furthermore, over-reliance on online data collection approaches were observed in this research. Although online surveys and interviews have many advantages, such as low cost and no geographic restrictions, the results drawn from this approach frequently suffer from biased data and issues with reliability and validity. For example, Moss (2020) revealed that survey respondents from Amazon MTurk are mostly financially disadvantaged, significantly younger than the U.S. population, and predominantly female. As more and more students collect data from online survey platforms such as Amazon MTurk, dissertation advisors may need to question the representativeness of the study respondents in their students’ dissertation and the conclusions they make based on this population.

5.1. Theoretical implications and future study suggestions

This paper has extended the attribution and self-efficacy theories by revealing that a public health crisis moderates attributive factors that underpinned the decision-making of individuals. The integration of self-efficacy theory and attributive theory has proven to better unravel the behaviour of graduate students during the COVID-19 pandemic than solely utilizing one of them. The application and extension of the self-efficacy and attribution theories are rarely observed in the context of hospitality and tourism education, and thus, this study creates the foundation for future scholars to understand students’ attitudes and behaviour in our field.

The findings highlight some factors triggered by the COVID-19 pandemic and have not been identified previously. For example, the religious background was a significant driver to selecting a particular research topic. This research also shows a shift in research direction to hot and publishable issues related to COVID-19. The utility of the dissertation becomes a significant consideration among graduate students. Additionally, emotion is recognized as another critical factor affecting the dissertation writing journey. The current study informs academia and the research community on the extent to which the COVID-19 would influence idea generation and the direction of research in the foreseeable future, as extant studies have overlooked this vital connection. Future studies should consider those factors when investigating relevant behaviours and experiences.

The time that the current study was done is likely to affect the findings. Therefore, it is recommended that future research explore graduate students’ dissertation journey in the post-COVID-19 era to ascertain whether there will be similarities or differences. This would help to give a comprehensive picture of the impacts of the COVID-19 on education. Moreover, the findings of this study cannot be generalised as it was undertaken at a particular Taiwanese institution. We recommend that quantitative research with larger samples could be conducted to facilitate the generalisation of the findings. Finally, it is suggested that a meta-analysis or systematic literature review on articles written on the COVID-19 pandemic and education could be done to further identify more influential factors related to the public health crisis and educational activities.

5.2. Practical implications for hospitality and tourism education

The findings revealed that negative emotion might trigger students' attribution to external factors that affected the dissertation journey. Thus, relevant stakeholders should develop strategies and innovate ways to ease the fears and anxieties of the COVID-19 pandemic. This study calls for immediate actions to prevent spillover effects on upcoming students. Faculty members, staff, and teachers should be trained on soft skills such as empathy, flexibility, and conflict solutions required by the hospitality and tourism industry.

Moreover, the thesis supervisors should notice students' over-reliance on online data collection due to the COVID-19 pandemic. As it may possibly affect the quality and findings of their students' dissertations, there should be sound and logical justification for this decision. Collecting data online should be backed by the appropriateness of the method and the research problem under study instead of the convenience of obtaining such data. There is an urgent need for students to be guided for innovative data collection methods. The school can turn the COVID-19 crisis into an opportunity to improve the online teaching materials and equipment. The research programs may consider including more teaching hours on online research design or data collection procedures to bring positive discussions on the strengths of such approaches.

Credit author statement

Emmanuel Kwame Opoku: Conceptualization, Methodology, Formal analysis, Writing - Original Draft, Writing - Review & Editing, Project administration. Li-Hsin Chen: Conceptualization, Supervision, Review, Editing, Response to reviewers. Sam Yuan Permadi: Investigation, Visualization, Project administration.

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New COVID-19 vaccine for fall should target JN.1 lineage, not variant, FDA panel

A panel of health experts convened this week to decide which vaccine the U.S. should use against COVID-19 this fall.

The federal advisory group decided on Wednesday the new vaccine should focus on the JN.1 lineage that has dominated virus strains in recommendations.

The Vaccines and Related Biological Products Advisory Committee – composed of leading U.S. health experts – gathered virtually to recommend a new vaccine to supplement protection against COVID-19 which weakens over time. Current vaccines built to fight XBB.1.5 also don’t provide as much protection against JN.1 and several sub-variants driving cases for months, officials and vaccine makers said during the hourslong meeting.

The 16-member panel, which gathered four previous times since 2022, unanimously voted for a shot that would target the JN.1 lineage. The U.S. Food and Drug Administration is expected to use the committee’s recommendations to develop vaccines for the next year. The recommendations follow a recent assessment by the World Health Organization that vaccines should use a “monovalent JN.1 lineage” for vaccines.

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The panelists considered several JN.1 sub-variants. The sub-variants KP.2 and KP.3, which are very similar to JN.1, have been driving new cases, according to federal tracking estimates . Officials noted that COVID-19 is rapidly evolving. The goal of the group was to capture the virus’ changes ahead of expected upticks in cases later this year.

Vaccine manufacturers Pfizer, Moderna and Novavax each told the panel they were prepared to make JN.1-targeted vaccines available in August pending FDA approval.

Late in 2023, JN.1 overtook the XBB lineage that formed last year’s vaccines . Officials said JN.1 infections were no more severe than XBB cases. This was distinct from the severity when cases jumped from delta to omicron variants that drove cases, hospitalizations and deaths globally in 2021.

Last year’s vaccine offered increased protection against COVID-19 to people who got the vaccine, officials said. It terms of protection by lineage, last year’s vaccine for XBB.1.5 gave protection against the JN.1 lineage, however, it likely wasn’t as effective compared to other XBB lineage sub-variants.

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Updated vaccines are set to be released in the fall , ahead of expected winter upticks in COVID-19 cases. The vote comes as the U.S., like the rest of the world, is seeing a decline in the vaccination rate against COVID-19.

The CDC has recommended that adults 65 and older and people who are immunocompromised get a booster of the updated COVID-19 vaccine as soon as its available. On Wednesday, the panel didn’t say whether older people would need boosters. The recommendations also coincide with the CDC's free vaccine program, launched less than a year ago, anticipated end in August – right around the time manufacturers said they can make the new shots available.