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What You Need to Know About Coronavirus Variants, Including Omicron and BA.2

Editor’s Note: New details about these variants are emerging as researchers continue to learn more. While we aim to update this article as soon as new information becomes available, please check the CDC website for the latest details about variants in the United States.

November 2021 saw the emergence of a new variant, the Omicron variant, emerge in South Africa and quickly spread. The variant was first detected in the United States a month later, and became the dominant variant within a matter of weeks. The high degree of contagiousness brought on a surge that came on fast and subsided a few months later. Now talk of the BA.2 variant, a sub-variant of the Omicron strain, has folks wondering if the case lull that we’re currently experiencing is just another brief moment of relief.

Dr. Anthony Fauci, Chief White House Medical Adviser, said on March 20th that he expects to see an uptick in cases but is hopeful that we won’t see another surge . Still, on March 29th the CDC made a recommendation that individuals 50 years and older and certain immunocompromised individuals, who had received their booster shot more than four months ago, get a fourth mRNA booster shot.

What Are the Current Variants Affecting the United States?

BA.2, or Omicron sub-variant – on March 26th, the CDC released data showing that this variant had become the dominant variant in the United States, overtaking the initial Omicron sub-variant. It appears to be slightly more contagious than BA.1 and breakthrough cases are expected at a greater rate , as this variant appears to evade immunity better than its counterpart. A large study out of Denmark suggests that reinfection from BA.2 after a covid infection from BA.1 is rare . Instances of re-infection most often occurred in young, unvaccinated individuals who had had mild cases, so if you are vaccinated and recently recovered, you can rest a little easier. However, this variant doesn’t appear to cause more severe infection , so an increase in breakthrough cases isn’t expected to lead to an increase in hospitalizations and deaths in vaccinated and boosted individuals.

It’s important to note that this isn’t really a new variant. The BA.2 variant was identified at the same time as the original omicron variant— you can think of them like sisters— it just wasn’t causing the majority of cases until now. The label “Omicron” is an umbrella term that encompasses several sub-variants, including BA.2, BA.1.1, and B.1.1, both of which we just called Omicron until recently.

BA.1 and B.1.1.529, or Omicron – As mentioned above, these two variants have been grouped under the term Omicron since November 2021. These two variants currently account for 47% of cases in the United States. Experts discovered that booster shots are incredibly effective at reducing Omicron’s virulence. As such, health officials encourage everyone to receive a third shot of the Pfizer vaccine as soon as they are able to.

B.1.617.2, or Delta – As of early March, data from the CDC indicates that Delta is no longer contributing to case counts within the United States.

Our Current Vaccines Are Still Effective

With the Omicron variant, we saw a rise in breakthrough infections . It can be useful to understand that this term is a bit of a misnomer, as vaccines were always intended to protect against severe hospitalization and death, not necessarily illness, and by that metric vaccines have remained highly effective against multiple variants. Still, the potential impacts of illness— including the ability to spread the disease to more vulnerable loved ones and the unknown effects of long-covid— have many vaccinated individuals feeling nervous about potential exposure and breakthrough cases.

Studies suggest that BA.2 is as good at evading vaccine immunity as its counterpart variants are, but vaccines are still protective against illness, and the risk of getting sick is still significantly greater for unvaccinated individuals. Vaccines have also been demonstrated to reduce transmissibility of BA.2. In a study of Omicron-related covid cases in Danish households , researchers found that unvaccinated people were far more likely to spread BA.2 to their housemates than if they had BA.1. However, vaccinated individuals with BA.2 were less likely to get their housemates sick than vaccinated individuals with BA.1. This is all to say that vaccinations help to protect yourself and others, and in the case of BA.2 getting vaccinated for the people around you is an even more effective choice.

Masking, Testing, Vaccinating, and Common Sense Remain Important

Although the variants seem to be more transmissible, one thing health experts are confident about is that these mutated forms still spread in the same way that all coronaviruses transfer from person to person. When someone who has the virus coughs, sneezes, talks, or exhales they release respiratory droplets containing the virus into the air. These small droplets can land in the mouths, eyes, or noses of people nearby, who then contract the virus. In many places, mask mandates are being lifted. But masking is always a tool at your disposal that is highly effective at protecting you from infection, and many are choosing to keep wearing masks in certain settings.

In early 2020 cloth masks were recommended for the public, both because they helped alleviate shortages of approved masks for healthcare workers, and because they were effective at reducing spread. Supply of high quality masks and respirators is no longer a pressing issue, and research has indicated that cloth masks do not provide sufficient protection against Omicron. As such, masking recommendations have changed, and respirators such as N95s, KN95s, and KF94s are now recommended. The CDC has created a tool to help individuals identify locations near to them that offer free respirators . You can also use the CDC’s website to track covid case numbers by county and get masking recommendations based on local case count.

In addition to masking, don’t forget basic practices to prevent illness and spread, such as hand-washing, testing before and after high-risk events like family gatherings, and staying home when you feel sick.

Keeping Track of Emerging Variants 

The World Health Organization (WHO) is constantly tracking new variants. Variants of concern refer to variants that are currently impacting public health. These are any variant that is more transmissible, causes more severe illness, or reduces the efficacy of public health measures. Currently Omicron and Delta variants are listed as variants of concern. Additionally, the WHO also tracks variants of interest— variants with mutations likely to cause increased transmissibility or severity. At the time that this article was written, there were no variants of interest. Additionally, not all variants of interest become variants of concern, but if you’re someone who likes to stay on top of what might be developing, you can use the WHO’s covid tracking website to stay up to date.

Why Are These Variants Emerging?

COVID-19 continues to spread in the United States even as more people become vaccinated, and this unrestrained transmission is a primary contributing factor for the emergence of new variants. According to Dr. Ben Bimber , a research professor at Oregon Health and Science University, each time the virus has an opportunity to replicate — the process it undergoes when it enters a new host and begins infecting cells — it also has an opportunity to mutate.

This increased likelihood of mutations corresponding with the surge of cases across the U.S. highlights the importance of working to slow person-to-person COVID-19 transmission. “The only way to stop the emergence of new variants is to stop the spread of the virus,” Dr. Bimber told NBC News. “If there are more people infected, there’s simply more virus out there and it has more opportunities to mutate.”

But it can take several months to identify variants and determine if they’re causing surges. This time frame, coupled with the unknown and potentially harmful ways mutations could alter the virus, is worrisome. Fortunately, according to Dr. Dan Jones of Ohio State University’s Wexner Medical Center, there’s a clear pathway to preventing variants from spreading and keeping new variants from surfacing: getting vaccinated.

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Paragraph Writing on Covid 19 - Check Samples for Various Word Limits

The Covid-19 pandemic has been a deadly pandemic that has affected the whole world. It was a viral infection that affected almost everyone in some way or the other. However, the effects have been felt differently depending on various factors. As it is a virus, it will change with time, and different variants might keep coming. The virus has affected the lifestyle of human beings. The pandemic has affected the education system and the economy of the world as well. Many people have lost their lives, jobs, near and dear, etc.

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Paragraph writing on covid-19 in 100 words, paragraph writing on covid-19 in 150 words, paragraph writing on covid-19 in 200 words, paragraph writing on covid-19 in 250 words, frequently asked questions on covid-19.

Check the samples provided below before you write a paragraph on Covid-19.

Coronavirus is an infectious disease and is commonly called Covid-19. It affects the human respiratory system causing difficulty in breathing. It is a contagious disease and has been spreading across the world like wildfire. The virus was first identified in 2019 in Wuhan, China. In March, WHO declared Covid-19 as a pandemic that has been affecting the world. The virus was spreading from an infected person through coughing, sneezing, etc. Therefore, the affected people were isolated from everyone. The affected people were even isolated from their own family members and their dear ones. Other symptoms noticed in Covid – 19 patients include weariness, sore throat, muscle soreness, and loss of taste and smell.

Coronavirus, often known as Covid-19, is an infectious disease. It affects the human respiratory system, making breathing difficult. It’s a contagious disease that has been spreading like wildfire over the world. The virus was initially discovered in Wuhan, China, in 2019. Covid-19 was declared a global pandemic by the World Health Organization in March. The virus was transferred by coughing, sneezing, and other means from an infected person. As a result, the people who were affected were isolated from the rest of society. The folks who were afflicted were even separated from their own family members and loved ones. Weariness, sore throat, muscle stiffness, and loss of taste and smell are among the other complaints reported by Covid-19 individuals. Almost every individual has been affected by the virus. A lot of people have lost their lives due to the severity of the infections. The dropping of oxygen levels and the unavailability of oxygen cylinders were the primary concerns during the pandemic.

The Covid-19 pandemic was caused due to a man-made virus called coronavirus. It is an infectious disease that has affected millions of people’s lives. The pandemic has affected the entire world differently. It was initially diagnosed in 2019 in Wuhan, China but later, in March 2020, WHO declared that it was a pandemic that was affecting the whole world like wildfire. Covid-19 is a contagious disease. Since it is a viral disease, the virus spreads rapidly in various forms. The main symptoms of this disease were loss of smell and taste, loss of energy, pale skin, sneezing, coughing, reduction of oxygen level, etc. Therefore, all the affected people were asked to isolate themselves from the unaffected ones. The affected people were isolated from their family members in a separate room. The government has taken significant steps to ensure the safety of the people. The frontline workers were like superheroes who worked selflessly for the safety of the people. A lot of doctors had to stay away from their families and their babies for the safety of their patients and their close ones. The government has taken significant steps, and various protocols were imposed for the safety of the people. The government imposed a lockdown and shut down throughout the country.

The coronavirus was responsible for the Covid-19 pandemic. It is an infectious disease that has affected millions of people’s lives. The pandemic has impacted people all across the world in diverse ways. It was first discovered in Wuhan, China, in 2019. However, the World Health Organization (WHO) proclaimed it a pandemic in March 2020, claiming that it has spread throughout the globe like wildfire. The pandemic has claimed the lives of millions of people. The virus had negative consequences for those who were infected, including the development of a variety of chronic disorders. The main symptoms of this disease were loss of smell and taste, fatigue, pale skin, sneezing, coughing, oxygen deficiency, etc. Because Covid-19 was an infectious disease, all those who were infected were instructed to segregate themselves from those who were not. The folks who were affected were separated from their families and locked in a room. The government has prioritised people’s safety. The frontline personnel were like superheroes, working tirelessly to ensure the public’s safety. For the sake of their patients’ and close relatives’ safety, many doctors had to stay away from their families and babies. The government had also taken significant steps and implemented different protocols for the protection of people.

What is meant by the Covid-19 pandemic?

The Covid-19 pandemic was a deadly pandemic that affected the lives of millions of people. A lot of people lost their lives, and some people lost their jobs and lost their entire families due to the pandemic. Many covid warriors, like doctors, nurses, frontline workers, etc., lost their lives due to the pandemic.

From where did the Covid-19 pandemic start?

The Covid-19 pandemic was initially found in Wuhan, China and later in the whole world.

What are the symptoms of Covid-19?

The symptoms of Covid-19 have been identified as sore throat, loss of smell and taste, cough, sneezing, reduction of oxygen level, etc.

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Mini review article, covid-19: emergence, spread, possible treatments, and global burden.

• 1 Department of Pharmacology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, India
• 2 Department of Health Sciences, School of Education and Health, Cape Breton University, Sydney, NS, Canada

The Coronavirus (CoV) is a large family of viruses known to cause illnesses ranging from the common cold to acute respiratory tract infection. The severity of the infection may be visible as pneumonia, acute respiratory syndrome, and even death. Until the outbreak of SARS, this group of viruses was greatly overlooked. However, since the SARS and MERS outbreaks, these viruses have been studied in greater detail, propelling the vaccine research. On December 31, 2019, mysterious cases of pneumonia were detected in the city of Wuhan in China's Hubei Province. On January 7, 2020, the causative agent was identified as a new coronavirus (2019-nCoV), and the disease was later named as COVID-19 by the WHO. The virus spread extensively in the Wuhan region of China and has gained entry to over 210 countries and territories. Though experts suspected that the virus is transmitted from animals to humans, there are mixed reports on the origin of the virus. There are no treatment options available for the virus as such, limited to the use of anti-HIV drugs and/or other antivirals such as Remdesivir and Galidesivir. For the containment of the virus, it is recommended to quarantine the infected and to follow good hygiene practices. The virus has had a significant socio-economic impact globally. Economically, China is likely to experience a greater setback than other countries from the pandemic due to added trade war pressure, which have been discussed in this paper.

Introduction

Coronaviridae is a family of viruses with a positive-sense RNA that possess an outer viral coat. When looked at with the help of an electron microscope, there appears to be a unique corona around it. This family of viruses mainly cause respiratory diseases in humans, in the forms of common cold or pneumonia as well as respiratory infections. These viruses can infect animals as well ( 1 , 2 ). Up until the year 2003, coronavirus (CoV) had attracted limited interest from researchers. However, after the SARS (severe acute respiratory syndrome) outbreak caused by the SARS-CoV, the coronavirus was looked at with renewed interest ( 3 , 4 ). This also happened to be the first epidemic of the 21st century originating in the Guangdong province of China. Almost 10 years later, there was a MERS (Middle East respiratory syndrome) outbreak in 2012, which was caused by the MERS-CoV ( 5 , 6 ). Both SARS and MERS have a zoonotic origin and originated from bats. A unique feature of these viruses is the ability to mutate rapidly and adapt to a new host. The zoonotic origin of these viruses allows them to jump from host to host. Coronaviruses are known to use the angiotensin-converting enzyme-2 (ACE-2) receptor or the dipeptidyl peptidase IV (DPP-4) protein to gain entry into cells for replication ( 7 – 10 ).

In December 2019, almost seven years after the MERS 2012 outbreak, a novel Coronavirus (2019-nCoV) surfaced in Wuhan in the Hubei region of China. The outbreak rapidly grew and spread to neighboring countries. However, rapid communication of information and the increasing scale of events led to quick quarantine and screening of travelers, thus containing the spread of the infection. The major part of the infection was restricted to China, and a second cluster was found on a cruise ship called the Diamond Princess docked in Japan ( 11 , 12 ).

The new virus was identified to be a novel Coronavirus and was thus initially named 2019-nCoV; later, it was renamed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ( 13 ), and the disease it causes is now referred to as Coronavirus Disease-2019 (COVID-19) by the WHO. The virus was suspected to have begun its spread in the Huanan seafood wholesale market in the Wuhan region. It is possible that an animal that was carrying the virus was brought into or sold in the market, causing the spread of the virus in the crowded marketplace. One of the first claims made was in an article published in the Journal of Medical Virology ( 14 ), which identified snakes as the possible host. A second possibility was that pangolins could be the wild host of SARS-CoV-2 ( 15 ), though the most likely possibility is that the virus originated from bats ( 13 , 16 – 19 ). Increasing evidence and experts are now collectively concluding the virus had a natural origin in bats, as with previous such respiratory viruses ( 2 , 20 – 24 ).

Similarly, SARS and MERS were also suspected to originate from bats. In the case of MERS, the dromedary camel is an intermediate host ( 5 , 10 ). Bats have been known to harbor coronaviruses for quite some time now. Just as in the case of avian flu, SARS, MERS, and possibly even HIV, with increasing selection and ecological pressure due to human activities, the virus made the jump from animal to man. Humans have been encroaching increasingly into forests, and this is true over much of China, as in Africa. Combined with additional ecological pressure due to climate change, such zoonotic spillovers are now more common than ever. It is likely that the next disease X will also have such an origin ( 25 ). We have learned the importance of identification of the source organism due to the Ebola virus pandemic. Viruses are unstable organisms genetically, constantly mutating by genetic shift or drift. It is not possible to predict when a cross-species jump may occur and when a seemingly harmless variant form of the virus may turn into a deadly strain. Such an incident occurred in Reston, USA, with the Reston virus ( 26 ), an alarming reminder of this possibility. The identification of the original host helps us to contain future spreads as well as to learn about the mechanism of transmission of viruses. Until the virus is isolated from a wild animal host, in this case, mostly bats, the zoonotic origin will remain hypothetical, though likely. It should further be noted that the virus has acquired several mutations, as noted by a group in China, indicating that there are more than two strains of the virus, which may have had an impact on its pathogenicity. However, this claim remains unproven, and many experts have argued otherwise; data proving this are not yet available ( 27 ). A similar finding was reported from Italy and India independently, where they found two strains ( 28 , 29 ). These findings need to be further cross-verified by similar analyses globally. If true, this finding could effectively explain why some nations are more affected than others.

Transmission

When the spread of COVID-19 began ( Figure 1 ), the virus appeared to be contained within China and the cruise ship “Diamond Princess,” which formed the major clusters of the virus. However, as of April 2020, over 210 countries and territories are affected by the virus, with Europe, the USA, and Iran forming the new cluster of the virus. The USA ( Figure 2 ) has the highest number of confirmed COVID-19 cases, whereas India and China, despite being among the most population-dense countries in the world, have managed to constrain the infection rate by the implementation of a complete lockdown with arrangements in place to manage the confirmed cases. Similarly, the UK has also managed to maintain a low curve of the graph by implementing similar measures, though it was not strictly enforced. Reports have indicated that the presence of different strains or strands of the virus may have had an effect on the management of the infection rate of the virus ( 27 – 29 ). The disease is spread by droplet transmission. As of April 2020, the total number of infected individuals stands at around 3 million, with ~200,000 deaths and more than 1 million recoveries globally ( 30 , 34 ). The virus thus has a fatality rate of around 2% and an R 0 of 3 based on current data. However, a more recent report from the CDC, Atlanta, USA, claims that the R 0 could be as high as 5.7 ( 35 ). It has also been observed from data available from China and India that individuals likely to be infected by the virus from both these countries belong to the age groups of 20–50 years ( 36 , 37 ). In both of these countries, the working class mostly belongs to this age group, making exposure more likely. Germany and Singapore are great examples of countries with a high number of cases but low fatalities as compared to their immediate neighbors. Singapore is one of the few countries that had developed a detailed plan of action after the previous SARS outbreak to deal with a similar situation in the future, and this worked in their favor during this outbreak. Both countries took swift action after the outbreak began, with Singapore banning Chinese travelers and implementing screening and quarantine measures at a time when the WHO recommended none. They ordered the elderly and the vulnerable to strictly stay at home, and they ensured that lifesaving equipment and large-scale testing facilities were available immediately ( 38 , 39 ). Germany took similar measures by ramping up testing capacity quite early and by ensuring that all individuals had equal opportunity to get tested. This meant that young, old, and at-risk people all got tested, thus ensuring positive results early during disease progression and that most cases were mild like in Singapore, thus maintaining a lower death percentage ( 40 ). It allowed infected individuals to be identified and quarantined before they even had symptoms. Testing was carried out at multiple labs, reducing the load and providing massive scale, something which countries such as the USA did quite late and India restricted to select government and private labs. The German government also banned large gatherings and advocated social distancing to further reduce the spread, though unlike India and the USA, this was done quite late. South Korea is another example of how a nation has managed to contain the spread and transmission of the infection. South Korea and the USA both reported their first COVID-19 cases on the same day; however, the US administration downplayed the risks of the disease, unlike South Korean officials, who constantly informed their citizens about the developments of the disease using the media and a centralized messaging system. They also employed the Trace, Test, and Treat protocol to identify and isolate patients fast, whereas the USA restricted this to patients with severe infection and only later broadened this criterion, like many European countries as well as India. Unlike the USA, South Korea also has universal healthcare, ensuring free diagnostic testing.

Figure 1 . Timeline of COVID-19 progression ( 30 – 32 ).

Figure 2 . Total confirmed COVID 19 cases as of May 2020 ( 33 ).

The main mode of transmission of 2019-nCoV is human to human. As of now, animal-to-human transfer has not yet been confirmed. Asymptomatic carriers of the virus are at major risk of being superinfectors with this disease, as all those infected may not develop the disease ( 41 ). This is a concern that has been raised by nations globally, with the Indian government raising concerns on how to identify and contain asymptomatic carriers, who could account for 80% of those infected ( 42 ). Since current resources are directed towards understanding the hospitalized individuals showing symptoms, there is still a vast amount of information about asymptomatic individuals that has yet to be studied. For example, some questions that need to be answered include: Do asymptomatic individuals develop the disease at any point in time at all? Do they eventually develop antibodies? How long do they shed the virus for? Can any tissue of these individuals store the virus in a dormant state? Asymptomatic transmission is a gray area that encompasses major unknowns in COVID-19.

The main route of human-to-human transmission is by droplets, which are generated during coughing, talking, or sneezing and are then inhaled by a healthy individual. They can also be indirectly transmitted to a person when they land on surfaces that are touched by a healthy individual who may then touch their nose, mouth, or eyes, allowing the virus entry into the body. Fomites are also a common issue in such diseases ( 43 ).

Aerosol-based transmission of the virus has not yet been confirmed ( 43 ). Stool-based transmission via the fecal-oral route may also be possible since the SARS-CoV-2 has been found in patient feces ( 44 , 45 ). Some patients with COVID-19 tend to develop diarrhea, which can become a major route of transmission if proper sanitation and personal hygiene needs are not met. There is no evidence currently available to suggest intrauterine vertical transmission of the disease in pregnant women ( 46 ).

More investigation is necessary of whether climate has played any role in the containment of the infection in countries such as India, Singapore, China, and Israel, as these are significantly warmer countries as compared with the UK, the USA, and Canada ( Figure 2 ). Ideally, a warm climate should prevent the virus from surviving for longer periods of time on surfaces, reducing transmissibility.

Pathophysiology

On gaining entry via any of the mucus membranes, the single-stranded RNA-based virus enters the host cell using type 2 transmembrane serine protease (TMPRSS2) and ACE2 receptor protein, leading to fusion and endocytosis with the host cell ( 47 – 49 ). The uncoated RNA is then translated, and viral proteins are synthesized. With the help of RNA-dependant RNA polymerase, new RNA is produced for the new virions. The cell then undergoes lysis, releasing a load of new virions into the patients' body. The resultant infection causes a massive release of pro-inflammatory cytokines that causes a cytokine storm.

Clinical Presentation

The clinical presentation of the disease resembles beta coronavirus infections. The virus has an incubation time of 2–14 days, which is the reason why most patients suspected to have the illness or contact with an individual having the illness remain in quarantine for the said amount of time. Infection with SARS-CoV-2 causes severe pneumonia, intermittent fever, and cough ( 50 , 51 ). Symptoms of rhinorrhoea, pharyngitis, and sneezing have been less commonly seen. Patients often develop acute respiratory distress syndrome within 2 days of hospital admission, requiring ventilatory support. It has been observed that during this phase, the mortality tends to be high. Chest CT will show indicators of pneumonia and ground-glass opacity, a feature that has helped to improve the preliminary diagnosis ( 51 ). The primary method of diagnosis for SARS-CoV-2 is with the help of PCR. For the PCR testing, the US CDC recommends testing for the N gene, whereas the Chinese CDC recommends the use of ORF lab and N gene of the viral genome for testing. Some also rely on the radiological findings for preliminary screening ( 52 ). Additionally, immunodiagnostic tests based on the presence of antibodies can also play a role in testing. While the WHO recommends the use of these tests for research use, many countries have pre-emptively deployed the use of these tests in the hope of ramping up the rate and speed of testing ( 52 – 54 ). Later, they noticed variations among the results, causing them to stop the use of such kits; there was also debate among the experts about the sensitivity and specificity of the tests. For immunological tests, it is beneficial to test for antibodies against the virus produced by the body rather than to test for the presence of the viral proteins, since the antibodies can be present in larger titers for a longer span of time. However, the cross-reactivity of these tests with other coronavirus antibodies is something that needs verification. Biochemical parameters such as D-dimer, C-reactive protein, and variations in neutrophil and lymphocyte counts are some other parameters that can be used to make a preliminary diagnosis; however, these parameters vary in a number of diseases and thus cannot be relied upon conclusively ( 51 ). Patients with pre-existing diseases such as asthma or similar lung disorder are at higher risk, requiring life support, as are those with other diseases such as diabetes, hypertension, or obesity. Those above the age of 60 have displayed the highest mortality rate in China, a finding that is mirrored in other nations as well ( Figure 3 ) ( 55 ). If we cross-verify these findings with the population share that is above the age of 70, we find that Italy, the United Kingdom, Canada, and the USA have one of the highest elderly populations as compared to countries such as India and China ( Figure 4 ), and this also reflects the case fatality rates accordingly ( Figure 5 ) ( 33 ). This is a clear indicator that aside from comorbidities, age is also an independent risk factor for death in those infected by COVID-19. Also, in the US, it was seen that the rates of African American deaths were higher. This is probably due to the fact that the prevalence of hypertension and obesity in this community is higher than in Caucasians ( 56 , 57 ). In late April 2020, there are also claims in the US media that young patients in the US with COVID-19 may be at increased risk of stroke; however, this is yet to be proven. We know that coagulopathy is a feature of COVID-19, and thus stroke is likely in this condition ( 58 , 59 ). The main cause of death in COVID-19 patients was acute respiratory distress due to the inflammation in the linings of the lungs caused by the cytokine storm, which is seen in all non-survival cases and in respiratory failure. The resultant inflammation in the lungs, served as an entry point of further infection, associated with coagulopathy end-organ failure, septic shock, and secondary infections leading to death ( 60 – 63 ).

Figure 3 . Case fatality rate by age in selected countries as of April 2020 ( 33 ).

Figure 4 . Case fatality rate in selected countries ( 33 ).

Figure 5 . Population share above 70 years of age ( 33 ).

For COVID-19, there is no specific treatment available. The WHO announced the organization of a trial dubbed the “Solidarity” clinical trial for COVID-19 treatments ( 64 ). This is an international collaborative study that investigates the use of a few prime candidate drugs for use against COVID-19, which are discussed below. The study is designed to reduce the time taken for an RCT by over 80%. There are over 1087 studies ( Supplementary Data 1 ) for COVID-19 registered at clinicaltrials.gov , of which 657 are interventional studies ( Supplementary Data 2 ) ( 65 ). The primary focus of the interventional studies for COVID-19 has been on antimalarial drugs and antiviral agents ( Table 1 ), while over 200 studies deal with the use of different forms of oxygen therapy. Most trials focus on improvement of clinical status, reduction of viral load, time to improvement, and reduction of mortality rates. These studies cover both severe and mild cases.

Table 1 . List of therapeutic drugs under study for COVID-19 as per clinical trials registered under clinicaltrials.gov .

Use of Antimalarial Drugs Against SARS-CoV-2

The use of chloroquine for the treatment of corona virus-based infection has shown some benefit in the prevention of viral replication in the cases of SARS and MERS. However, it was not validated on a large scale in the form of a randomized control trial ( 50 , 66 – 68 ). The drugs of choice among antimalarials are Chloroquine (CQ) and Hydroxychloroquine (HCQ). The use of CQ for COVID-19 was brought to light by the Chinese, especially by the publication of a letter to the editor of Bioscience Trends by Gao et al. ( 69 ). The letter claimed that several studies found CQ to be effective against COVID-19; however, the letter did not provide many details. Immediately, over a short span of time, interest in these two agents grew globally. Early in vitro data have revealed that chloroquine can inhibit the viral replication ( 70 , 71 ).

HCQ and CQ work by raising the pH of the lysosome, the cellular organelle that is responsible for phagocytic degradation. Its function is to combine with cell contents that have been phagocytosed and break them down eventually, in some immune cells, as a downstream process to display some of the broken proteins as antigens, thus further enhancing the immune recruitment against an antigen/pathogen. The drug was to be administered alone or with azithromycin. The use of azithromycin may be advocated by the fact that it has been seen previously to have some immunomodulatory role in airway-related disease. It appears to reduce the release of pro-inflammatory cytokines in respiratory illnesses ( 72 ). However, HCQ and azithromycin are known to have a major drug interaction when co-administered, which increases the risk of QT interval prolongation ( 73 ). Quinine-based drugs are known to have adverse effects such as QT prolongation, retinal damage, hypoglycemia, and hemolysis of blood in patients with G-6-PD deficiency ( 66 ). Several preprints, including, a metanalysis now indicate that HCQ may have no benefit for severe or critically ill patients who have COVID-19 where the outcome is need for ventilation or death ( 74 , 75 ). As of April 21, 2020, after having pre-emptively recommended their use for SARS-CoV-2 infection, the US now advocates against the use of these two drugs based on the new data that has become available.

Use of Antiviral Drugs Against SARS-CoV-2

The antiviral agents are mainly those used in the case of HIV/AIDS, these being Lopinavir and Ritonavir. Other agents such as nucleoside analogs like Favipiravir, Ribavirin, Remdesivir, and Galidesivir have been tested for possible activity in the prevention of viral RNA synthesis ( 76 ). Among these drugs, Lopinavir, Ritonavir, and Remdesivir are listed in the Solidarity trial by the WHO.

Remdesivir is a nucleotide analog for adenosine that gets incorporated into the viral RNA, hindering its replication and causing chain termination. This agent was originally developed for Ebola Virus Disease ( 77 ). A study was conducted with rhesus macaques infected with SARS-CoV-2 ( 78 ). In that study, after 12 h of infection, the monkeys were treated with either Remdesivir or vehicle. The drug showed good distribution in the lungs, and the animals treated with the drug showed a better clinical score than the vehicle group. The radiological findings of the study also indicated that the animals treated with Remdesivir have less lung damage. There was a reduction in viral replication but not in virus shedding. Furthermore, there were no mutations found in the RNA polymerase sequences. A randomized clinical control study that became available in late April 2020 ( 79 ), having 158 on the Remdesivir arm and 79 on the placebo arm, found that Remdesivir reduced the time to recovery in the Remdesivir-treated arm to 11 days, while the placebo-arm recovery time was 15 days. Though this was not found to be statistically significant, the agent provided a basis for further studies. The 28-days mortality was found to be similar for both groups. This has now provided us with a basis on which to develop future molecules. The study has been supported by the National Institute of Health, USA. The authors of the study advocated for more clinical trials with Remdesivir with a larger population. Such larger studies are already in progress, and their results are awaited. Remdesivir is currently one of the drugs that hold most promise against COVID-19.

An early trial in China with Lopinavir and Ritonavir showed no benefit compared with standard clinical care ( 80 ). More studies with this drug are currently underway, including one in India ( 81 , 82 ).

Use of Convalescent Patient Plasma

Another possible option would be the use of serum from convalescent individuals, as this is known to contain antibodies that can neutralize the virus and aid in its elimination. This has been tried previously for other coronavirus infections ( 83 ). Early emerging case reports in this aspect look promising compared to other therapies that have been tried ( 84 – 87 ). A report from China indicates that five patients treated with plasma recovered and were eventually weaned off ventilators ( 84 ). They exhibited reductions in fever and viral load and improved oxygenation. The virus was not detected in the patients after 12 days of plasma transfusion. The US FDA has provided detailed recommendations for investigational COVID-19 Convalescent Plasma use ( 88 ). One of the benefits of this approach is that it can also be used for post-exposure prophylaxis. This approach is now beginning to be increasingly adopted in other countries, with over 95 trials registered on clinicaltrials.gov alone, of which at least 75 are interventional ( 89 ). The use of convalescent patient plasma, though mostly for research purposes, appears to be the best and, so far, the only successful option for treatment available.

From a future perspective, the use of monoclonal antibodies for the inhibition of the attachment of the virus to the ACE-2 receptor may be the best bet. Aside from this, ACE-2-like molecules could also be utilized to attach and inactivate the viral proteins, since inhibition of the ACE-2 receptor would not be advisable due to its negative repercussions physiologically. In the absence of drug regimens and a vaccine, the treatment is symptomatic and involves the use of non-invasive ventilation or intubation where necessary for respiratory failure patients. Patients that may go into septic shock should be managed as per existing guidelines with hemodynamic support as well as antibiotics where necessary.

The WHO has recommended that simple personal hygiene practices can be sufficient for the prevention of spread and containment of the disease ( 90 ). Practices such as frequent washing of soiled hands or the use of sanitizer for unsoiled hands help reduce transmission. Covering of mouth while sneezing and coughing, and disinfection of surfaces that are frequently touched, such as tabletops, doorknobs, and switches with 70% isopropyl alcohol or other disinfectants are broadly recommended. It is recommended that all individuals afflicted by the disease, as well as those caring for the infected, wear a mask to avoid transmission. Healthcare works are advised to wear a complete set of personal protective equipment as per WHO-provided guidelines. Fumigation of dormitories, quarantine rooms, and washing of clothes and other fomites with detergent and warm water can help get rid of the virus. Parcels and goods are not known to transmit the virus, as per information provided by the WHO, since the virus is not able to survive sufficiently in an open, exposed environment. Quarantine of infected individuals and those who have come into contact with an infected individual is necessary to further prevent transmission of the virus ( 91 ). Quarantine is an age-old archaic practice that continues to hold relevance even today for disease containment. With the quarantine being implemented on such a large scale in some countries, taking the form of a national lockdown, the question arises of its impact on the mental health of all individuals. This topic needs to be addressed, especially in countries such as India and China, where it is still a matter of partial taboo to talk about it openly within the society.

In India, the Ministry of Ayurveda, Yoga, and Naturopathy, Unani, Siddha and Homeopathy (AYUSH), which deals with the alternative forms of medicine, issued a press release that the homeopathic, drug Arsenicum album 30, can be taken on an empty stomach for 3 days to provide protection against the infection ( 92 ). It also provided a list of herbal drugs in the same press release as per Ayurvedic and Unani systems of medicine that can boost the immune system to deal with the virus. However, there is currently no evidence to support the use of these systems of medicine against COVID-19, and they need to be tested.

The prevention of the disease with the use of a vaccine would provide a more viable solution. There are no vaccines available for any of the coronaviruses, which includes SARS and MERS. The development of a vaccine, however, is in progress at a rapid pace, though it could take about a year or two. As of April 2020, no vaccine has completed the development and testing process. A popular approach has been with the use of mRNA-based vaccine ( 93 – 96 ). mRNA vaccines have the advantage over conventional vaccines in terms of production, since they can be manufactured easily and do not have to be cultured, as a virus would need to be. Alternative conventional approaches to making a vaccine against SARS-CoV-2 would include the use of live attenuated virus as well as using the isolated spike proteins of the virus. Both of these approaches are in progress for vaccine development ( 97 ). Governments across the world have poured in resources and made changes in their legislation to ensure rapid development, testing, and deployment of a vaccine.

Barriers to Treatment

Lack of transparency and poor media relations.

The lack of government transparency and poor reporting by the media have hampered the measures that could have been taken by healthcare systems globally to deal with the COVID-19 threat. The CDC, as well as the US administration, downplayed the threat and thus failed to stock up on essential supplies, ventilators, and test kits. An early warning system, if implemented, would have caused borders to be shut and early lockdowns. The WHO also delayed its response in sounding the alarm regarding the severity of the outbreak to allow nations globally to prepare for a pandemic. Singapore is a prime example where, despite the WHO not raising concerns and banning travel to and from China, a country banned travelers and took early measures, thus managing the outbreak quite well. South Korea is another example of how things may have played out had those measures by agencies been taken with transparency. Increased transparency would have allowed the healthcare sector to better prepare and reduced the load of patients they had to deal with, helping flatten the curve. The increased patient load and confusion among citizens arising from not following these practices has proved to be a barrier to providing effective treatments to patients with the disease elsewhere in the world.

Lack of Preparedness and Protocols

Despite the previous SARS outbreak teaching us important lessons and providing us with data on a potential outbreak, many nations did not take the important measures needed for a future outbreak. There was no allocation of sufficient funds for such an event. Many countries experienced severe lack of PPE, and the lockdown precautions hampered the logistics of supply and manufacturing of such essential equipment. Singapore and South Korea had protocols in place and were able to implement them at a moment's notice. The spurt of cases that Korea experienced was managed well, providing evidence to this effect. The lack of preparedness and lack of protocol in other nations has resulted in confusion as to how the treatment may be administered safely to the large volume of patients while dealing with diagnostics. Both of these factors have limited the accessibility to healthcare services due to sheer volume.

Socio-Economic Impact

During the SARS epidemic, China faced an economic setback, and experts were unsure if any recovery would be made. However, the global and domestic situation was then in China's favor, as it had a lower debt, allowing it to make a speedy recovery. This is not the case now. Global experts have a pessimistic outlook on the outcome of this outbreak ( 98 ). The fear of COVID-19 disease, lack of proper understanding of the dangers of the virus, and the misinformation spread on the social media ( 99 ) have caused a breakdown of the economic flow globally ( 100 ). An example of this is Indonesia, where a great amount of fear was expressed in responses to a survey when the nation was still free of COVID-19 ( 101 ). The pandemic has resulted in over 2.6 billion people being put under lockdown. This lockdown and the cancellation of the lunar year celebration has affected business at the local level. Hundreds of flights have been canceled, and tourism globally has been affected. Japan and Indonesia are estimated to lose over 2.44 billion dollars due to this ( 102 , 103 ). Workers are not able to work in factories, transportation in all forms is restricted, and goods are not produced or moved. The transport of finished products and raw materials out of China is low. The Economist has published US stock market details indicating that companies in the US that have Chinese roots fell, on average, 5 points on the stock market as compared to the S&P 500 index ( 104 ). Companies such as Starbucks have had to close over 4,000 outlets due to the outbreak as a precaution. Tech and pharma companies are at higher risk since they rely on China for the supply of raw materials and active pharmaceutical ingredients. Paracetamol, for one, has reported a price increase of over 40% in India ( 104 – 106 ). Mass hysteria in the market has caused selling of shares of these companies, causing a tumble in the Indian stock market. Though long-term investors will not be significantly affected, short-term traders will find themselves in soup. Politically, however, this has further bolstered support for world leaders in countries such as India, Germany, and the UK, who are achieving good approval ratings, with citizens being satisfied with the government's approach. In contrast, the ratings of US President Donald Trump have dropped due to the manner in which the COVID-19 pandemic was handled. These minor impacts may be of temporary significance, and the worst and direct impact will be on China itself ( 107 – 109 ), as the looming trade war with the USA had a negative impact on the Chinese and Asian markets. The longer production of goods continues to remain suspended, the more adversely it will affect the Chinese economy and the global markets dependent on it ( 110 ). If this disease is not contained, more and more lockdowns by multiple nations will severely affect the economy and lead to many social complications.

The appearance of the 2019 Novel Coronavirus has added and will continue to add to our understanding of viruses. The pandemic has once again tested the world's preparedness for dealing with such outbreaks. It has provided an outlook on how a massive-scale biological event can cause a socio-economic disturbance through misinformation and social media. In the coming months and years, we can expect to gain further insights into SARS-CoV-2 and COVID-19.

Author Contributions

KN: conceptualization. RK, AA, JM, and KN: investigation. RK and AA: writing—original draft preparation. KN, PN, and JM: writing—review and editing. KN: supervision.

Conflict of Interest

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

Acknowledgments

The authors would like to acknowledge the contributions made by Dr. Piya Paul Mudgal, Assistant Professor, Manipal Institute of Virology, Manipal Academy of Higher Education towards inputs provided by her during the drafting of the manuscript.

Supplementary Material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpubh.2020.00216/full#supplementary-material

Supplementary Data 1, 2. List of all studies registered for COVID-19 on clinicaltrials.gov .

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Keywords: 2019-nCoV, COVID-19, SARS-CoV-2, coronavirus, pandemic, SARS

Citation: Keni R, Alexander A, Nayak PG, Mudgal J and Nandakumar K (2020) COVID-19: Emergence, Spread, Possible Treatments, and Global Burden. Front. Public Health 8:216. doi: 10.3389/fpubh.2020.00216

Received: 21 February 2020; Accepted: 11 May 2020; Published: 28 May 2020.

Reviewed by:

Copyright © 2020 Keni, Alexander, Nayak, Mudgal and Nandakumar. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Krishnadas Nandakumar, mailnandakumar77@gmail.com

This article is part of the Research Topic

Coronavirus Disease (COVID-19): Pathophysiology, Epidemiology, Clinical Management and Public Health Response

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COVID-19 and its impact on education, social life and mental health of students: A survey

The outbreak of COVID-19 affected the lives of all sections of society as people were asked to self-quarantine in their homes to prevent the spread of the virus. The lockdown had serious implications on mental health, resulting in psychological problems including frustration, stress, and depression. In order to explore the impacts of this pandemic on the lives of students, we conducted a survey of a total of 1182 individuals of different age groups from various educational institutes in Delhi - National Capital Region (NCR), India. The article identified the following as the impact of COVID-19 on the students of different age groups: time spent on online classes and self-study, medium used for learning, sleeping habits, daily fitness routine, and the subsequent effects on weight, social life, and mental health. Moreover, our research found that in order to deal with stress and anxiety, participants adopted different coping mechanisms and also sought help from their near ones. Further, the research examined the student’s engagement on social media platforms among different age categories. This study suggests that public authorities should take all the necessary measures to enhance the learning experience by mitigating the negative impacts caused due to the COVID-19 outbreak.

1. Introduction

The emergence of Corona Virus disease (COVID-19) has led the world to an unprecedented public health crisis. Emergency protocols were implemented in India to control the spread of the virus which resulted in restrictions on all non-essential public movements ( Saha et al. 2020 ). With the closure of educational institutions, the need for a rapid transition from physical learning to the digital sphere of learning emerged ( Kapasia et al. 2020 ). Online learning has been observed as a possible alternative to conventional learning ( Adnan and Anwar 2020 ). However, according to a meta-analysis on e-learning ( Cook 2009 ), it is reported that online learning is better than nothing and similar to conventional learning. To improve the e-learning experience, the education institutions are required to comply with the guidelines and recommendations by government agencies, while keeping students encouraged to continue learning remotely in this tough environment ( Aucejo et al. 2020 ). Bao (2020 ) addresses five high-impact guidelines for the efficient conduct of online education.

This rapid evolution at such a large scale has influenced the students of all age groups ( Hasan and Bao 2020 ). It is expected that the continued spread of the disease, travel restrictions and the closure of educational institutions across the country would have a significant effect on the education, social life, and mental health of students ( Odriozola-gonzález et al. 2020 ). The students from the less privileged backgrounds have experienced larger negative impacts due to the Covid-19 outbreak ( Aucejo et al. 2020 ). Reduction in family income, limited access to digital resources, and the high cost of internet connectivity have disrupted the academic life of the students. Moreover, 1.5 billion students across the world are now deprived of basic education ( Lee 2020 ) leading to a serious psychological impact on their health. Moreover, changes in daily routine including lack of outdoor activity, disturbed sleeping patterns, social distancing have affected the mental well-being of the students. ( Cao et al. 2020 ) uses 7-item Generalized Anxiety Disorder Scale (GAD-7) as a diagnostic tool for the assessment of anxiety disorders, panic disorders, and social phobia. Further, ( Ye et al. 2020 ) analyses mediating roles of resilience, coping, and social support to deal with psychological symptoms.

In this paper, we investigated and analyzed the potential consequences of the COVID-19 pandemic on the life of students. Our research shows that there is a wide gap between the government's policy aspirations and the implementation of these online education policies at the grassroots level. Moreover, our study attempts to assess the mental situation of students of different age groups using different parameters including sleeping habits, daily fitness routine, and social support. Further, we analyse different coping mechanisms used by students to deal with the current situation.

2. Objective and methods

A 19-set questionnaire was developed, which included a variety of multiple-choice questions, Likert scale and for a few questions, the respondents were allowed to enter free texts. The survey was administered using the Google Forms platform, which requires subjects to be logged in to an e-mail account to participate in the survey, it restricted multiple entries from an individual account. The distribution of the questionnaire was conducted through the outreach of social media platforms, e-mail, and standard messaging services. Clear instructions with the google form were provided to ensure the respondent must be a student.

2.1. Study design

A web-based survey was conducted to students through the medium of Google online platforms from July 13 to July 17, 2020. The online survey questionnaire contained four subgroups:

• (a) Participants were asked to describe their general demographics, such as age, the region of residence.
• (b) Information about the daily online learning routine following the transition from offline learning in educational institutions in India: average time spent for online study (hours) /day; medium for online study; average time spent for self-study (hours)/day.
• (c) Assessment of the experience of online learning to evaluate the levels of satisfaction among students.
• (d) Assessment of health due to the change in lifestyle: average time spent on sleep (hours)/day; change in weight; average time spent on fitness (hours)/day; the number of meals/days; also, we considered further questions about the medium of stress busters during the pandemic, cohesion with family members, etc.

The aim of this survey study is to investigate the impact of the COVID-19 pandemic on the education, health, and lifestyle of students from different age-groups.

2.2. Statistical analysis

In this study, we conducted a cross-sectional survey with a sample size of 1182 students from different educational institutions. A summary of demographic details in the form of numbers and percentages is provided. Mean at 95% Confidence Interval limit was calculated for learning hours for online classes and self-study, duration of sleep, time spent on fitness and sleep. Kruskal Wallis test, a non-parametric test was used to assess the significant difference in the time spent on the aforementioned activities among different age distributions. Fisher’s exact test was performed to assess the differences between respondent’s health with the variables of interest. In order to analyse the association between age categories and different variables such as change in weight, health issues faced, stress busters, etc, the Pearson Chi Square test was used. JMP Version 15.2.1 from SAS was used for analysis. A statistically significant value of P < 0.05 was considered.

2.3. Ethical consideration

The following survey was done in a properly informed set up and consent from the individuals was taken for the participation. No individual was forced against their will and no identifying information was collected.

3.1. Participants characteristics

A total of 1182 subjects from different educational institutions including schools, colleges, and universities in the Delhi-National Capital Region (NCR) participated in the online questionnaire. The demographic detail of the participants is shown in Table 1 . The mean age is 20.16 years (95% confidence interval (CI), 19.8–20.4) (range, 7–59). The age of the participants was normally distributed (‘7–17’ year old, 303; ‘18–22’ year old, 694; ‘23–59’ year old, 185). 728 (61.62%) of the respondents lived in Delhi-NCR and the rest were living outside of Delhi-NCR during the period of the pandemic.

Demographic data of the respondents to the online survey questionnaire.

3.2. Assessment of online learning

According to Table 2 , the Kruskal Wallis test was used to assess the difference in the time spent by different age categories for daily routine activities. The average time spent on online classes for students was 3.20 h/day (95% confidence interval (CI), 3.08–3.32). However, the average time spent on online classes was significantly higher for students with age group ‘7–17’ years (3.69 h/day), and lower for students with age groups, ‘18–22’ years (2.98 h/day) and ‘23–59’ years (2.66 h/day) (P < 0.0001*). Further, respondents were asked about the time they allot per day for self-study, however, there was no significant difference among different age group categories (P = 0.106). Overall, 2.91 h/day (95% CI, 2.78–3.03) was the average time spent on self-study. According to the assessment of satisfaction level among students (see Fig. 1 .a), 38.3% of students had negative response towards online classes (2.6% poor and 35.7% very poor), 33.4% considered it average while 28.4% (19.9% good and 8.5% excellent) gave a positive review. Surprisingly, the in-depth analysis showed the satisfaction levels varied significantly with different age groups. There were 51.6% (48.6% very poor and 3% poor) negative online class reviews from subjects in the ‘18–22’ age group, compared to 31.5% (29.1% very poor and 2.4% poor) negative reviews from subjects in the ‘7–17’ age group who spent more time on online classes.

Table showing how different variables (time spent on online class, self-study, fitness, sleep, and social media) changes with different age distributions.

Kruskal Wallis test was used to produce a P-value that analyzes significant difference between different age distributions. *Statistically significant (P < 0.05).

Visualizations demonstrate a) Likert analysis of Online classes for the sample and for different age categories b) Medium for the online classes b) Learning medium used by different age categories.

The respondents were further asked about the medium of their online learning (see Fig. 1 .b), 57.3% in the age group ‘7–17’ used smartphones while the majority of students from age group ‘18–22’ (56.4%) and age group ‘23–59’ (57.8%) used laptop/desktop for study. However, only a small portion of the total students (3.1%, n = 37) used tablet. With regard to the time spent in online classes, there was a statistically significant difference between the various mediums used (P = 0.0002). As shown in Table 3 , 4.29 h/day (95% CI, 3.63–4.96) was the average time spent on online classes using tablets, 3.43 h/day (95% CI, 3.25–3.61) when using laptop/desktop, and 3.06 h/day (95% CI, 2.90–3.23) when using smartphones.

Time spent on online classes using different learning medium.

3.3. Assessment of health in educational institutions

Among the respondents from different age groups (see Fig. 2 ), 13.6% (n = 160) faced health-related issues during the period of nationwide travel restrictions. Further respondents were asked about the change in body weight within this period, 37.1% reported an increase in weight, 17.7% reported a decrease in weight, and 45.3% reported no change in weight. When asked whether they are satisfied with their utilization of time, the majority of respondents (51.4%, n = 608) answered in ‘NO’, and the rest (n = 575) answered with ‘YES’. Also, 70.3% of the respondents stated that they were socially connected with their family members.

Visualizations demonstrate a) Pie Chart for Likert questions: whether the respondent faced health issues; whether the respondent utilized the time efficiently; whether the respondent is socially well connected. b) Stacked bar chart to analyze the change in weight during the period of lockdown.

According to Table 4 , fisher’s exact test indicated that the respondents who were not socially well connected and believed that they did not utilize their time in lockdown, had a significant impact on their state of health. Also, in Table 5 , the Pearson Chi Square test for Likert analysis on ‘time utilized’ (P < 0.0001*), ‘health issue faced’ (P < 0.0001*), and ‘socially well connected’ (P = 0.0002*) rejected the null hypothesis that there is no association between these variables with the different distribution of age groups. To maintain a state of health and well-being, it is necessary to perform a certain amount of exercise daily. The findings of Table 2 showed that the time spent on fitness was statistically different for different age groups (P = 0.039*, Kruskal Wallis test). And, the average time spent on sleep was 7.87 h/day (95% Confidence Interval, 7.77–7.96). The differences between the age groups in terms of duration of sleep were statistically significant.

Fisher’s exact test to analyse the effect of multiple factors on health.

*Statistically significant (P < 0.05).

Pearson Chi Square test for the association between different variables and age distribution.

Further, respondents were questioned about the measures adopted to cope with the rising stress levels during the pandemic. According to the Pearson Chi Square test in Table 4 , there was a significant difference in the measures used by the different age categories. Fig. 3 shows the detailed distribution of different stress reliever activities used among different age categories.

Visualization demonstrate the distribution of stress relieving activities among different age categories.

3.4. Social media

According to Fig. 3 , a significant number of individuals from different age categories used social media as a medium for stress reliever. Further in Fig. 4 . a, the findings provide the distribution of the sample for the use of different platforms. While the majority of respondents used social media, 1.44% did not have an account on any platform. Fig. 4 . b gives the detailed distribution of platforms for age-wise groups. YouTube (39%) was the preferred platform for the age group '7–17,' followed by Whatsapp (35%) and Instagram (17%). Most of the social networking sites in India restricts individuals below 13 years of age to have an account on their platforms. However, some individuals under 13 years of age used Instagram (n = 2), Whatsapp (n = 16), and Snapchat (n = 1). For the age group ‘18-22’, Instagram (39%) was the most preferred networking site, and the respondents in the age-group ‘23-59’ preferred WhatsApp (38%).

Visualization demonstrate the distribution of preferred social media platform for a) the sample and b) among different age categories.

As shown in Table 2 , the average time spent on social media for the age group ‘7-17’ was 1.68 h/day (95% Confidence Interval, 1.52–1.85), 2.64 h/day (95% Confidence Interval, 2.50–2.78) for the age group ‘18-22’, and for the age group ‘23-59’, it was 2.37 h/day (95% Confidence Interval, 2.14–2.61). The difference between the groups was statistically different (P < 0.0001*).

4. Discussion

The outbreak of Covid-19 has upended the lives of all parts of the society. One of the most immediate changes introduced was the closure of educational institutions to slow the transmission of the virus. In order to prevent further interruption of studies, new teaching methods for the online delivery of education were introduced ( Johnson et al., 2020 , Di Pietro et al., 2020 ). However, these measures can have long-term consequences on the lives of students ( Cohen et al. 2020 ). Therefore, there is a strong need to record and study the effects of the changes being made. In this study, our aim is to analyze the impact of the COVID-19 pandemic on the education, health, social life of the students, and demonstrate results about its subsequent effect on their daily routine amid travel restrictions. The findings indicate that the time spent by students on online classes did not comply with the guidelines issued by the Ministry of Human Resources Development (MHRD) ( Department of School Education & Literacy Ministry of Human Resource Development 2020 ). Limited class interaction and inefficient time table significantly affected the satisfaction levels among students. The peer-to-peer impact in the school environment motivates individuals to work hard and learn social skills, which may not be possible in an online setting. Moreover, the biggest challenge for online learning is the requirement of efficient digital infrastructure and digital skillset for both students and teachers.

Further, this study analyses the impact of different factors to measure stress levels among students. Alarmingly, 51.4% of respondents reported that they did not utilize their time during the period of lockdown. Furthermore, sleeping habits, daily fitness routines, and social interaction significantly affected their health conditions. The government agencies imposed measures such as social distancing and restrictions on travel but they did not take into account the health implications. Although, these measures are necessary to regulate safe conditions, there is no strategy to safeguard the psychological impact due to the Covid-19 pandemic. Our research also explores the different coping mechanisms used by students of different age groups. Moreover, we analyzed various digital social media tools used by students as a self-management strategy for mental health. Our statistical analysis addresses key concerns related to online education and health due to the Covid-19 pandemic.

5. Opinions and recommendations

Once the COVID-19 pandemic ends and educational institutions re-open, the concerned authorities should continue to invest in online education to enhance learning experience. They should carefully analyze the issues experienced during sudden transition to online learning and prepare for any future situations. Proper training of educators for the digital skills and improved student-teacher interaction must be conducted. For disadvantaged students, availability of digital infrastructure with proper internet availability and access to gadgets must be ensured to avoid any disruption to their study.

Due to the situation in Covid-19, many students are likely to suffer from stress, anxiety, and depression, so it is necessary to provide emotional support to students. Future work in this direction could be to analyze the association of different stress busters on the mental health of the students. Moreover, guidelines should be created to anticipate the needs of the vulnerable student population. Improved healthcare management would ensure the delivery of mental health support.

6. Limitations

There are some limitations to our study that should be noted. The first limitation is the sampling technique used. It relies on digital infrastructure and voluntary participation that increases selection bias. The imposed travel restrictions limited the outreach to students who do not have access to online learning. Second, the study is obtained from one specific area, given the lockdown orders and the online medium of classes, we expect these results to be fairly generalizable for schools and universities nationwide. Another limitation of this study is the cross-sectional design of the survey, there was no follow-up period for the participants.

7. Conclusion

In this study, our findings indicated that the Covid-19 outbreak has made a significant impact on the mental health, education, and daily routine of students. The Covid-19 related interruptions highlight key challenges and provide an opportunity to further evaluate alternate measures in the education sector. The new policies and guidelines in this direction would help mitigate some of the negative effects and prepare educators and students for the future health crisis.

Declaration of Competing Interest

There is no conflict of interest.

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