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Effects of COVID-19 on business and research

The COVID-19 outbreak is a sharp reminder that pandemics, like other rarely occurring catastrophes, have happened in the past and will continue to happen in the future. Even if we cannot prevent dangerous viruses from emerging, we should prepare to dampen their effects on society. The current outbreak has had severe economic consequences across the globe, and it does not look like any country will be unaffected. This not only has consequences for the economy; all of society is affected, which has led to dramatic changes in how businesses act and consumers behave. This special issue is a global effort to address some of the pandemic-related issues affecting society. In total, there are 13 papers that cover different industry sectors (e.g., tourism, retail, higher education), changes in consumer behavior and businesses, ethical issues, and aspects related to employees and leadership.

1. Introduction

There has been a long history of fear of pandemic outbreaks. The discussion has not focused on whether there will be an outbreak, but when new outbreaks will happen ( Stöhr & Esveld, 2004 ). The events leading to influenza pandemics are recurring biological phenomena and cannot realistically be prevented. Pandemics seem to occur at 10–50-year intervals as a result of the emergence of new virus subtypes from virus re-assortment ( Potter, 2001 ). As the global population increases and we need to live closer to animals, it is likely that the transfer of new viruses to the human population will occur even more frequently. All our society can do is take preventive measures so that we are able to act quickly once we suspect an outbreak. We should also make an effort to learn from the consequences of pandemic outbreaks to prepare our societies for if—and, more likely, when—this happens again.

As we are in the middle of a pandemic outbreak, it is very difficult to estimate its long-term effects. Although society has been hit by several pandemics in the past, it is difficult to estimate the long-term economic, behavioral, or societal consequences as these aspects have not been studied to a great extent in the past. The limited studies that do exist indicate that the major historical pandemics of the last millennium have typically been associated with subsequent low returns on assets ( Jorda, Singh, & Taylor, 2020 ). For a period after a pandemic, we tend to become less interested in investing and more interested in saving our capital, resulting in reduced economic growth. Given the current situation, in which saving capital means negative returns, it is not at all certain that we will be as conservative as we have been in the past. Behavioral changes related to pandemic outbreaks seem to be connected with personal protection ( Funk, Gilad, Watkins, & Jansen, 2009 ), such as the use of face masks, rather than general behavior changes. Our lives, as humans in a modern society, seem to be more centered around convenience than around worrying about what might happen in the future.

On a societal level, we seem to be completely unprepared for large-scale of outbreaks. Our societies are more open than ever; we rely on the importing of important products, such as food, energy, and medical equipment, rather than sourcing them from close to where they are needed; and there are limited efforts to prepare for pandemic outbreaks. The guiding principle of our society seems to be efficiency and economic gain rather than safety. This may change after the current outbreak. It is also important to point out that the principles (eg. openness and global trade) on which society is based have lifted a large number of countries around the globe out of poverty and produced well-developed economies. It is not unlikely that our societies will back-off some of them leading to more poverty in the world.

The COVID-19 pandemic outbreak has forced many businesses to close, leading to an unprecedented disruption of commerce in most industry sectors. Retailers and brands face many short-term challenges, such as those related to health and safety, the supply chain, the workforce, cash flow, consumer demand, sales, and marketing. However, successfully navigating these challenges will not guarantee a promising future, or any future at all. This is because once we get through this pandemic, we will emerge in a very different world compared to the one before the outbreak. Many markets, especially in the fields of tourism and hospitality, no longer exist. All organizational functions are intended to prioritize and optimize spending or postpone tasks that will not bring value in the current environment. Companies, especially start-ups, have implemented an indefinite hiring freeze. At the same time, online communication, online entertainment, and online shopping are seeing unprecedented growth.

2. Interesting research themes

As research indicates that pandemics are reoccurring events, it is very likely that we will see another outbreak in our lifetime. It is apparent to anyone that the current pandemic has had enormous—but hopefully short-term—effects on all our lives. Countries have closed their borders, limited the movement of their citizens, and even confined citizens in quarantine within their homes for weeks. This is a rather unique occurrence, as we are used to freedom of movement, but in the midst of the pandemic outbreak, people have been fined just for being outside. Although our societies seem to be very accepting of these limitations and condemn people that do not follow the rules, but we need to ask ourselves how this will affect the views of our society (e.g., views regarding freedom, healthcare, government intervention). We should also be aware that infrastructure and routines to monitor citizens in order to limit the spread of the virus have been rolled out, and so we should ask ourselves how accepting we will be of monitoring in the future. We must realize that once these systems are in place, it is highly unlikely that they will be rolled back. Furthermore, in some countries, the ruling politicians have taken advantage of this situation and increased their control over the state, suppressing opposing opinions and thus jeopardizing democratic systems. Some of the worst examples are Turkmenistan, which has banned the use of the word “corona,” and Hungary, which is letting Viktor Orbán rule by decree indefinitely.

As previously mentioned, people have been confined to their homes. There has also been a constant stream of news on this invisible external threat from which we cannot protect ourselves. We have been occupied trying to figure out how best to protect ourselves and our loved ones. On top of that, many feel pressure due to losing their jobs or due to working in close proximity to potentially infected people, as society depends on them fulfilling their duty. The consequences of the pandemic outbreak have hit various sectors of society in different ways. People that are working in sectors connected to healthcare must endure endless tasks and very long working days. Additionally, people are losing their jobs at rates we have not seen since the Great Depression of the 1930s. The sectors that have seen the largest increases in unemployment are those that are hedonic in nature and require the physical presence of the customer (e.g., hospitality, tourism, and entertainment), as demand for these services has ceased to exist. The employees in these sectors tend to be younger and female. Past experience also indicates that once someone is outside the job market, it is very difficult to get back in as they will face more competition that may be more competent.

All countries that can are trying to stimulate their economies to keep as much as possible of their necessary infrastructure intact and to keep citizens productive or ready to become productive once the pandemic has been overcome. In order to keep society from deteriorating, people not only need jobs or a way to support themselves but also need access to what they view as necessary products and services. If this infrastructure does not exist, people start to behave in what is considered uncivil behavior (e.g., hording or looting). Countries around the globe have adopted very different approaches to handle the current stress on the job markets and infrastructure. Some countries have chosen to support businesses in order to help them keep the workforce intact, but others with less financial strength cannot do the same. Countries also have directly supported their citizens in various ways. There is an enormous body of rich information that researchers can collect to determine the best approaches for when when and if a major disaster happens in the future.

3. Consumer behavior during COVID-19

Around the globe, societies are in lockdown, and citizens are asked to respect social distance and stay at home. As we are social beings, isolation may be harmful for us ( Cacioppo & Hawkley, 2009 ). Feelings of loneliness have, among other things, been connected to poorer cognitive performance, negativity, depression, and sensitivity to social threats. There are indications that this is happening during the current pandemic, as there has been an increase in domestic violence, quarrels among neighbors, and an increase in the sales of firearms ( Campbell, 2020 ). However, we have also seen an increase in other, more positive types of behavior caused by social distancing that have not been researched. People have started to nest, develop new skills, and take better care of where they live. For instance, they may learn how to bake, try to get fit, do a puzzle, or read more. There has also been an increase in purchases of cleaning products, and more trash is being recycled. At the same time, we are eating more junk food and cleaning ourselves less. People are also stockpiling essentials, panic buying, and escaping to rural areas. This is an indication that what is happening to us and our behaviors is complex, and it would be interesting to study this phenomenon further.

Another consequence of the lockdowns is the extreme increase in the usage of Internet and social media. Previous research has indicated that humans who feel lonely tend to use social media more and, in some cases, even prefer social media over physical interaction ( Nowland, Necka, & Cacioppo, 2018 ). Social media also may bring out the worst in us through trolling or sharing of fake news. This is, to some degree, not as damaging as the “real life” is lived in the physical world and the Internet is an “add on” with, in most cases, limited impact on the physical world. By this, we are able to compartmentalize and distinguish what matters and what does not matter. However, the current situation has made social media the main mode of contacting or socializing with others. In many cases, the Internet is at present also the main way to get essential supplies and receive essential services, like seeing a doctor. The question, then, is what happens to us when the “real life” is lived online and becomes a way to escape the physical world?

As humans, we rely to a large degree on our senses; we are built to use them in all situations of life. Thus, we rely on them heavily when making decisions. However, the current isolation is depriving us of our senses, as we are not exposed to as many stimuli as normal situation. Thus, we are, in a sense, being deprived of stimulation. We are also being told by authorities not to use our senses; we should not touch anything, wear a mask, or get close to other humans. Thus, what happens once our societies open up? How long will this fear of using our senses linger, and will we be over-cautious for a while or may we try to compensate as we have to some degree been deprived of using them? These are just some aspects of consumer behavior; many more are covered by this special issue.

4. Markets during COVID-19

The COVID-19 outbreak is likely to cause bankruptcy for many well-known brands in many industries as consumers stay at home and economies are shut down ( Tucker, 2020 ). In the US, famous companies such as Sears, JCPenney, Neiman Marcus, Hertz, and J. Crew are under enormous financial pressure. The travel industry is deeply affected; 80% of hotel rooms are empty ( Asmelash & Cooper, 2020 ), airlines cut their workforce by 90%, and tourism destinations are likely to see no profits in 2020. Furthermore, expos, conferences, sporting events, and other large gatherings as well as cultural establishments such as galleries and museums have been abruptly called off. Consulting in general and personal services, like hairdressers, gyms, and taxis, have also come to a standstill due to lockdowns. Finally, important industries like the car, truck, and electronics industries have abruptly closed (although they started to open up two months after their closure). There are an endless number of questions we could ask ourselves in connection to this rather abrupt close-down. For instance, how do we take care of employees in such situations? Why are companies not better prepared to handle such situations (e.g., putting aside earnings or thinking of alternative sources of income)? How are the companies and even countries using the current situation to enhance their competitive situation? One of the countries that seem to be using the situation is China that is buying European based infrastructure and technology ( Rapoza, 2020 ).

While some businesses are struggling, some businesses are thriving. This is true for a number of Internet-based businesses, such as those related to online entertainment, food delivery, online shopping, online education, and solutions for remote work. People have also changed their consumption patterns, increasing the demand for takeout, snacks, and alcohol as well as cleaning products as we spend more time in our homes. Other industries that are doing well are those related to healthcare and medication as well as herbs and vitamins. Typically, when studying markets, it is assumed that they are static, a natural conclusion since they tend to change slowly. However, if there is one thing the COVID-19 outbreak has shown us, it is that markets are dynamic ( Jaworski, Kohli, & Sahay, 2000 ) and can move rapidly. Furthermore, a market is not just a firm; it is a network of actors (i.e., firms, customers, public organizations) acting in accordance with a set of norms. These systems are sometimes referred to as dynamic ecosystems that exist to generate value ( Vargo & Lusch, 2011 ). The COVID-19 outbreak poses a unique opportunity to study how markets are created and how they disappear within a very limited time span. It would also be interesting to explore whether the disappearance of one solution for a market may be replaced by another (e.g., combustion engines for electric or physical teaching for online teaching).

5. Predicted lasting effects

Based on past experiences, we have become more conservative and protective after a pandemic outbreak. We save resources in order to be prepared if the unthinkable happens again. Countries are starting to stockpile things like food, equipment, and medicine or prepare to produce them locally. It is also essential for larger global firms to have reliable supply chains that do not break. Consequently, it is very likely that this pandemic will make these firms rethink their supply chains and, probably, move supply chains closer to where they are needed in order to avoid stopping production in the future. Furthermore, authorities have implied that other humans from other countries are dangerous as they may carry the virus. A closed border implies that the threat is from the outside. In addition, international flights are not likely to be an option for many in the coming years. Together, these circumstances mean that countries may become more nationalistic and less globalized. This may be a dangerous development, as long-term protection from the consequences of a pandemic outbreak is likely to require global effort and sharing of resources. Such cooperation is also key to tackle other global challenges that we may face in the future.

6. This special issue

In this special issue, we have invited scholars from different areas of business and management to write brief papers on various aspects of the effects of the COVID-19 pandemic. In total, there are 12 articles in the special issue, which are summarized below.

The first contribution, by Jagdish Sheth, is titled “Impact of COVID-19 on Consumer Behavior: Will the Old Habits Return or Die?” It explores how the current pandemic has affected several aspects of consumers’ lives, ranging from personal mobility to retail shopping, attendance at major life events like marriage ceremonies, having children, and relocation. The author investigates four contexts of construed consumer behavior, namely social context, technology, coworking spaces, and natural disasters. Additionally, the author foresees eight immediate effects of the pandemic on consumer behavior and consumption. Hoarding—the mad scramble observed at the start of the COVID-19 outbreak—applies not only to consumers but also to unauthorized middlemen who buy products in excess to sell at increased prices.

Consumers learn to adapt quickly and take an improvised approach to overcome constraints that have been imposed by governments. Pent-up demand may lead to a significant rebound in sales of durable products, like automobiles, houses, and large appliances, and some of the realities of COVID-19 will put consumers in a buying mood soon.

Embracement of digital technology, either through online services or information-sharing platforms like Zoom, has kept people connected around the world. Digital savviness will become a necessity, rather than an alternative, for schools, businesses, and healthcare providers. With the onset of lockdowns in many countries, online shopping, including grocery shopping, has become more prevalent.

The desire to do everything in-home has impacted consumers’ impulse buying habits. Slowly but surely, work–life boundaries will be blurred when both tasks are carried out from home. There should be efforts to compartmentalize the two tasks to make this a more efficient way of life.

Reunions with friends and family are now restricted to digital interactions, especially for people who work and live away from their families. We can expect a dramatic change in consumers’ behavior because of sophisticated technology. In addition, consumers may discover new talents as they spend less time on the road and more at home. They may experiment with cooking, learn new skills, and, soon, become producers with commercial possibilities. In the end, most consumer’s habits will return to normal, while some habits may die due to adaptation to the new norm.

The second contribution, “Interventions as Experiments: Connecting the Dots in Forecasting and Overcoming Pandemics, Global Warming, Corruption, Civil Rights Violations, Misogyny, Income Inequality, and Guns,” written by Arch G. Woodside, discusses whether there is an association between public health interventions, national and state/provincial governments interventions, and improved control of the COVID-19 outbreak in certain countries. The paper suggests “ultimate broadening of the concept of marketing” in order to design and implement interventions in public laws and policy, national and local regulations, and the everyday lives of individuals. It also lays out effective mitigating strategies by examining designs, implementations, and outcomes of COVID-19 interventions by examining deaths as a natural experiment.

While COVID-19 eradication intervention tests are being run for promising vaccines, these are considered true experiments, and analyzing the data from these interventions may involve examination of the success of each vaccine for different demographic subgroups in treatment and placebo groups in randomized control trials. Comparing the designs and impact of the current COVID-19 mitigation interventions across nations and states within the U.S. provides useful information for improving these interventions, even though they are not “true experiments.”

The third contribution, “Employee Adjustment and Well-Being in the Era of COVID-19: Implications for Human Resource Management” is written by Joel B. Carnevale and Isabella Hatak. They claim that COVID-19 is becoming the accelerator for one of the most drastic workplace transformations in recent years. How we work, socialize, shop, learn, communicate, and, of course, where we work will be changed forever. Person–environment (P-E) fit theories highlight that employee–environment value congruence is important because values influence outcomes through motivation. However, given the current environment, in which the fulfillment of needs and desires like greater satisfaction, higher engagement, and overall well-being is drastically altered, there is an increased likelihood of misfits working in organizations.

In response to this, organizations need to use virtual forms of recruitment, training, and socialization in lieu of face-to-face interactions. Increasing job autonomy will alleviate the family-related challenges that may arise within remote work environments by providing employees with the right resources to manage conflicting work and family demands. Human resource leaders within the organization must enhance relationship-oriented human resources systems in order to combat the risk of unforeseen and prolonged isolation among single, independent employees and to better prepare them for situations like the current crisis. The field of entrepreneurship can offer insights that can be adapted by organizations coping with the pandemic. Entrepreneurs’ struggles are largely caused by the lack of work-related social support in comparison to salaried employees. Nevertheless, some entrepreneurs are known to overcome these limitations by leveraging alternative, domain-specific sources of social support, such as positive feedback from customers, which ultimately enhances their well-being. Recycling such approaches to identify overlooked or untapped sources of social support is likely to be beneficial for employees given the current work environment dynamic.

The fourth contribution, written by Hongwei He and Lloyd C. Harris, is titled “The Impact of Covid-19 Pandemic on Corporate Social Responsibility and Marketing Philosophy.” The worldwide demand for hand sanitizers, gloves, and other hygiene products has risen because of the COVID-19 pandemic. And, in some countries, there has been a surge in complaints about profiteering and opportunism. As doctors combat the virus, prosecutors are pursuing the opportunistic profiteers who prey on the fearful. Many large corporations have a social purpose and set of values that indicate how much they appreciate their customers, employees, and stakeholders. This is the time for these corporations to make good on that commitment. Some organizations strive to set great examples. For example, Jack Ma, the co-founder of Alibaba, donated coronavirus test kits and other medical supplies to many countries around the world through the Jack Ma Foundation and Alibaba Foundation. Large corporations have often written off the costs of product failures, restructuring, or acquisitions. When writing off losses due to the coronavirus pandemic, it is understandable to pursue the bond established between the brand and consumer. This gesture can turn out to be more meaningful and lasting than when implemented during “normal” times.

On the bright side, the COVID-19 pandemic offers great opportunities for companies to actively engage with their corporate social responsibility (CSR) strategies and agenda. The post-COVID-19 marketplace is going to be irrecoverably different. Organizations will need to re-evaluate their visions, missions, and objectives to account for changes to their customers and competitors, amongst other shifts. A key facet of this is the exponential increase in digital communications and change.

Professors T. Y. Leung, Piyush Sharma, Pattarin Adithipyangkul, and Peter Hosie wrote “Gender Diversity and Public Health Outcomes: The COVID-19 Experience.” Public health is an interdisciplinary subject that involves the social sciences, public policy, public education, economics, and management. Failure to implement a proper public health policy may not only lead to a huge loss of human lives but also shatter the economy; expose the incompetence of public bodies, including governments and political leaders; and weaken the confidence of the general public. We are used to hearing that women are more other-directed and emotionally intelligent, but it has been proven that women are just as good, if not better, in terms of what we think of as male qualities, like being decisive and making tough calls, during a crisis. Prevalent issues like under-representation of women in leadership positions, mismanagement of public health systems, and inaccurate or inconsistent reporting of public health outcomes in the context of the recent pandemic need to be addressed by involving women at all stages of public health management, including planning, decision-making, and emergency response systems. This is important not only for a quick economic recovery in the aftermath of the COVID-19 crisis but also to prevent and manage such disasters in future.

The sixth paper in the special issue, “Managing Uncertainty during a Global Pandemic: An International Business Perspective,” was written by Piyush Sharma, T. Y. Leung, Russel P. J. Kingshott, Nebojsa S. Davcik, and Silvio Cardinali. Pandemics like that caused by COVID-19 are not just passing tragedies of sickness and death. The ubiquity of such a threat, and the uncertainty and fear that accompany it, lead to new consumer trends and norms. People become both more suspicious and less susceptible. The crisis also shines a light on the importance of international business research, which has been overlooked in the years leading up to this crisis. Social and informational uncertainty are likely to have economic repercussions.

As pointed out by the author, successful outcomes of social distancing and other restrictions are highly dependent upon societal acceptance and following through with restrictions. Social uncertainty and unrest among consumers due to being under lockdown for months could lead to a huge stifled demand for the products they missed. In this context, Samsung, a South Korean giant in consumer electronics and home appliances, may be a great case study during the ongoing COVID-19 crisis. Samsung established a huge manufacturing network over the years, with factories in multiple locations. This was done due to foresight of the risk of single sourcing, the need to fulfill large production demand, and the desire to reduce its dependence on China. This strategy has helped Samsung shift its production from one location to another during the ongoing COVID-19 crisis, thereby facing just a slowdown and not a complete shutdown of production. Similarly, to compensate for the closure of retail stores, Samsung has leveraged its contracts with mobile phone retailers and Benow (a payment and EMI technology firm) to create an e-commerce platform so that its retail business can continue to sell and deliver products directly to customers.

The seventh contribution, “Competing During a Pandemic? Retailers Ups and Downs During the COVID-19 Outbreak,” was written by Eleonora Pantano, Gabriele Pizzi, Daniele Scarpi, and Charles Dennis. The authors note that retailers who were not quick to adapt and factor COVID-19 into their operations are currently facing an existential crisis. The authors also highlight that retailers can minimize current and future business impacts by addressing four major emergencies.

First, retailers can identify and execute controllable activities. They must identify, optimize, and re-access existing technologies and business models. Specifically, they must understand how their stakeholders operate and interact to reduce response time and optimize communication channels. Second, all retailers, but especially grocery stores, are revisiting their business continuity plans to reassure customers that their needs will be met and manage the inevitable supply chain constraints and highs and lows caused by volatile demand. These retailers are prioritizing critical business activities and creating contingency plans for disruption. Third, retailers need to have an understanding of their financial needs as well as the essential role they play in their communities. For some regular customers, an open and well-stocked supermarket will reassure them that they are being cared for. Fourth, messages that retailers spread online during emergencies need to include information about products’ availability on the shelves and at digital outlets; control panic buying by restricting the quantity that customers can purchase; devise and implement protection plans for consumers and employees; contribute to overall public health; and use surveillance measures to limit the spread of the virus. To these ends, retailers need to improve their customer relationship management systems and promote safe interactions with customers (e.g., through online chats with employees) to provide real-time customer assistance.

In Fabian Eggers’ contribution, “Masters of Disasters? Challenges and Opportunities for SMEs in Times of Crisis,” he identifies small- to medium-sized businesses with low or unstable cashflow as particularly vulnerable during crises, as they are currently struggling for profitability. Studies reveal the interconnectedness between finance and strategy, particularly entrepreneurial orientation and market orientation in strategies. The paper highlights that a combination of entrepreneurial orientation and market orientation can lead to lean and flexible marketing efforts, which are particularly valuable in times of crisis. In addition, entrepreneurial orientation and market orientation can be combined into an entrepreneurial marketing post-disaster business recovery framework that highlights that seeking opportunities, organizing resources, creating customer value, and accepting risk are markedly different in a post-disaster context.

Sandeep Krishnamurthy contributed with “The Future of Business Education: A Commentary in the Shadow of the Covid-19 Pandemic.” The paper highlights that social distancing is prompting educational institutions to rethink how they are connecting with their student bodies. Spatial interaction is becoming the new norm, and the blurring of physical and virtual communication is likely to continue until the pandemic is overcome. Globally, the higher education system will undergo a decade of radical technology-led transformation, according to the author. The author identified five trends that will revolutionize how we educate after COVID-19:

  • 1. The Algorithm as Professor – Rather than taking a traditional route and learning from a human professor in classrooms, students will learn remotely from an algorithm. The AI-enabled algorithm will provide customized personal learning experiences. Students will be able to quickly master rudimentary and routinized tasks. Then, the algorithm will prepare them for an in-person experience, where a “warm body” will engage them in Socratic dialogue.
  • 2. The University as a Service – Traditionally, we have followed a linear formulation of society. Students go through K-12 education, some get an undergraduate degree, and some go on to further studies. However, the current and future environment is too volatile to sustain this educational structure. Students will need to learn what they need when they need it. Personalized, continuing education will become the norm.
  • 3. The University as Assessment Powerhouse – In a world characterized by AI and automation, learning can come from many sources. Students will learn from each other, algorithmic systems, and public information. However, universities will continue to have a powerful place as assessors of learning. Students will come to universities to gain objective credentials based on powerful assessments of learning.
  • 4. Learning Personalization to Support Diversity – Students of the future will have access to multiple pathways to learn the same content. For example, a course may be available through algorithmic engagement, animation/video/augmented reality, face-to-face instruction, or any mixture thereof. Using assessment data, the university of the future will be able to pinpoint the learning needs of each student and provide a personalized experience.
  • 5. Problem Solving Through Ethical Inquiry - As the influence of artificial intelligence and automation grow exponentially in our lives, there will be a great need for students to become problem solvers through ethical inquiry. Clearly, the future will not simply be about what the answers are; it will be about which problems we wish to solve, given what we know. Students will need to become more comfortable with the need to evaluate AI algorithms based on their efficacy and their ethical foundation.

Contribution number ten, “Consumer Reacting, Coping and Adapting Behaviors in the COVID-19 Pandemic,” is written by Colleen P. Kirk and Laura S. Rifkin. In it, the authors explore numerous consumer insights during a major pandemic outbreak. Mainly, they examine consumer behaviors across three phases: reacting (e.g., hoarding and rejecting), coping (e.g., maintaining social connectedness, do-it-yourself behaviors, and changing views of brands), and longer-term adapting (e.g., potentially transformative changes in consumption and individual and social identity). The authors also identify a number of negative aspects of the pandemic that will likely impact consumer behavior. As they state, given the mandatory close quarters people must keep due to stay-at-home requirements, domestic abuse may be on the rise. In addition, throughout history, pandemics provide an excuse for increased racial and anti-immigrant biases.

In “How Firms in China Innovate in COVID-19 Crisis? An Exploratory Study of Marketing Innovation Strategies,” written by Yonggui Wang, Aoran Hong, Xia Li, and Jia Gao, the authors explore how firms in China worked to make their marketing strategies a success. They do so by identifying the typology of firms’ marketing innovations based on two dimensions: the motivation for innovations and the level of collaboration in innovations.

The authors outline four innovative strategies to combat crises for businesses. The responsive strategy works predominantly for firms that involve physical contact, but it can easily be transferred from offline marketing channels to online channels. A collective strategy can be implemented by firms that are highly affected by the crisis, which need to develop new business by collaborating with other firms during the crisis. A proactive strategy is for firms that are less affected by the COVID-19 crisis (mostly online businesses) to develop new businesses to meet the special demands of existing customers during the COVID-19 crisis. Firms that are less affected during the COVID-19 crisis can take an alternative approach: a partnership strategy. Firms should usually develop new offerings through collaboration with other firms.

Professors Amalesh Sharma, Anirban Adhikary, and Sourav Bikash Borah contributed with “Covid-19 Impact on Supply Chain Decisions: Strategic Insights for NASDAQ 100 Firms using Twitter Data.” During black swan events like the COVID-19 pandemic, which may have severe long-term consequences, a deep understanding of business risks can help organizations establish the right plan. In this article, the authors identified supply chain challenges faced by companies using their Twitter data. To develop insights from the findings, the authors constructed unigrams, bigrams, and trigrams that revealed the supply-chain-related aspects that gain attention on Twitter.

A topic analysis was performed to identify keywords used in discussions about COVID-19. The obtained insights show that the greatest challenge for the organizations was accessing realistic customer demands. A pandemic may increase or decrease demand for specific products, making estimation of realistic final customer demand more difficult and more urgent to address. Some user accounts suggested that organizations are still lacking in terms of technological readiness and that companies are looking to gain visibility across value chains. There are growing discussions about building supply chain resilience by identifying risks. Many organizations are not only focusing on social sustainability but also turning their attention toward environmental sustainability. To deal with the challenges brought on by unprecedented times, the leaders of organizations must reimagine and redesign the supply chain; rely on technology such as artificial intelligence, the Internet of Things, and blockchain in their supply chain designs; and focus on sustainable supply chain.

Finally, Marianna Sigala wrote “Tourism and COVID-19: Impacts and Implications for Advancing and Resetting Industry and Research.” Tourism is experiencing a rapid and steep drop in demand during the COVID-19 pandemic. Despite the tourism industry’s proven resilience in other unprecedented times, the impact of the current pandemic will likely last longer for international tourism than for other affected industries. However, the tourism industry should not only recover but also reimagine and reform the next normal economic order. Currently, there is a lack of research on how crises can alter the industry, how the industry adapts to changes with innovative techniques, and how research that can establish the next norms can be conducted. To study the needs and gaps in research work, the author reviews past and emerging literature to capture its impacts and impart some ideas from different research fields that will allow tourism to grow and evolve.


Naveen Donthu is a Distinguished University Professor at Georgia State University. He holds the title of Vanchel Pennebaker Eminent Scholar Chair and is the Kenneth Bernhardt Distinguished Department Chair of the Marketing Department. His research has appeared in journals such as Marketing Science , Management Science , Journal of Marketing , Journal of Marketing Research , and Journal of Consumer Research. He is the current editor-in-chief for the Journal of Business Research .

Anders Gustafsson is a Professor of Marketing at the Norwegian Business School. Dr Gustafsson is also a Distinguished Professorial Fellow at the University of Manchester’s Alliance Manchester Business School, and he is part of Center for Services Leadership Global Faculty at the W. P. Carey School of Business, Arizona State University. Dr. Gustafsson has published articles in journals such as the Journal of Marketing , Journal of Marketing Research , Journal of Consumer Research , Journal of Service Research , and Journal of Product Innovation Management . He is the current editor-in-chief for the Journal of Business Research and an area editor for the Journal of Service Research . Recently, he received the Christopher Lovelock Career Contributions to the Services Discipline Award. He is the current president of AMA’s Academic Council (2019/2020).

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Paper The impact of COVID-19 on small business outcomes and expectations

To explore the impact of coronavirus disease 2019 (COVID-19) on small businesses, we conducted a survey of more than 5,800 small businesses between March 28 and April 4, 2020. Several themes emerged. First, mass layoffs and closures had already occurred - just a few weeks into the crisis. Second, the risk of closure was negatively associated with the expected length of the crisis. Moreover, businesses had widely varying beliefs about the likely duration of COVID-related disruptions. Third, many small businesses are financially fragile: The median business with more than $10,000 in monthly expenses had only about 2 weeks of cash on hand at the time of the survey. Fourth, the majority of businesses planned to seek funding through the Coronavirus Aid, Relief, and Economic Security (CARES) Act. However, many anticipated problems with accessing the program, such as bureaucratic hassles and difficulties establishing eligibility. Using experimental variation, we also assess take-up rates and business resilience effects for loans relative to grants-based programs. 

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  • Authored by Alexander W. Bartik Marianne Bertrand Zoe Cullen Edward L. Glaeser Michael Luca Christopher Stanton
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Us small businesses have little cushion against prolonged disruptions.

New research underscores the need for fast and easy-to-access government interventions when small businesses are interrupted.

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research paper on covid 19 impact on business

COVID-19: Implications for business

Covid-19: briefing note #100, april 13, 2022, as covid-19 becomes endemic in much of the world, we turn our focus to sustainable and inclusive growth..

On March 2, 2020, just over a week before a global pandemic was declared, we published COVID-19: Briefing note #1. Our plan was to publish an update on the virus’s implications for business for as many weeks as the news felt urgent. We did not expect to continue for more than two years, nor to ever publish briefing note #100, as we have today.

It’s painful to reflect on these 100 editions, on the millions of lives lost, the suffering and grief, and the myriad disruptions to lives and livelihoods. But in what is perhaps a hopeful sign, we now feel the time is right to stop. COVID-19 news seems less urgent than at any time in the past two years. All of McKinsey’s published work now intrinsically accounts for the pandemic, even if it is not directly mentioned. COVID-19 has gone from being a fresh emergency to a fact of life.

In a few weeks, we will relaunch this weekly report with links to the latest McKinsey publications. Our new theme will be sustainable and inclusive growth. After more than two years of reporting on a destructive force, we look forward to sharing our research and thoughts on how people and organizations can build a better world.

McKinsey is already exploring how to achieve sustainable and inclusive growth, the topic of the inaugural episode of the new Future of America podcast . McKinsey Global Institute director and senior partner Kweilin Ellingrud and senior partner Greg Kelly discuss how leading companies can use the pandemic recovery as an opportunity to accelerate prosperity  for more Americans. Customers and consumers want to be associated with companies that are making a positive difference. Companies can accelerate inclusivity and sustainability by having real awareness, committing to change, rewarding the change, and providing coaching and development to make the change happen.

After more than two years of reporting on a destructive force, we look forward to sharing our research and thoughts on how people and organizations can build a better world.

Much near-term growth will arise from a once-in-a-lifetime wave of capital spending on physical assets  between now and 2027. This surge of roughly $130 trillion in investment will flood into projects to decarbonize and renew critical infrastructure. But few organizations are prepared to deliver on this capital influx with the speed and efficiency it demands. Companies should consider implementing a portfolio-synergistic strategy in which planning is top down, a major business challenge requiring savvy stakeholder management, capital markets expertise, and an understanding of complex approval processes.

Sustainable, inclusive growth will require changing the workplace to maximize the contributions of all people. In the COVID-19 era, women across all sectors have shouldered more household responsibilities, and more women report feelings of burnout. These problems can be more acute for women in healthcare, who have fewer opportunities to work remotely and report feeling greater pressure to prioritize work over family. In spite of these challenges, healthcare continues to outperform other sectors in the representation of women , who make up more than two-thirds of entry-level employees and 53 percent of employees in roles at the senior-manager level or above, which is 18 percentage points higher than the average across all sectors.

Each sector, industry, and function will have to reinvent itself to achieve maximum growth and sustainability. Procurement leaders, for example, are facing one of the toughest market environments of their careers. Procurement organizations need to take a leading role in protecting enterprise margin and growth , invest in proven technology and process automation, and build deep expertise in supply market dynamics, among other fundamental changes. A pair of articles featuring McKinsey and outside experts explore how the CFO’s role is also rapidly evolving —expanding in scope, requiring new capabilities, and demanding greater collaboration with C-suite peers. Among the most significant changes to the role is the demand for CFOs to help promote capability building and talent development  within their organizations.

Here are other key findings from our research this week:

  • Lithium is needed to produce virtually all batteries currently used in electric vehicles (EVs) as well as consumer electronics. We believe the world will secure enough lithium for the EV revolution , as long as new mining technologies and potential mining sites receive funding and end users communicate upcoming needs so that lithium miners have enough time to react.
  • Our interactive explores how fashion is finding ways to participate in the metaverse .
  • McKinsey’s methodology can be used to prioritize investments in innovations based on the economic impact of the health improvements they deliver to society .

Our latest edition of McKinsey for Kids   explores how programmers use games to teach computers how to think, ultimately developing AI. Kids can read, take quizzes, and watch animations to learn about how the human brain and computers are both alike and different and about a cornerstone of AI programming called “reinforcement learning.”

In our latest edition of Author Talks , neuroscience expert and Cognitas Group cofounder Dr. Laura Watkins discusses her new book (coauthored with Vanessa Dietzel), The Performance Curve: Maximize Your Potential at Work while Strengthening Your Well-being   (Bloomsbury Publishing, November 2021). Using insights from neuroscience, adult development psychology, yoga, and behavioral therapy, the book proposes practical ways to improve work performance without sacrificing mental or physical health.

This briefing note was edited by Katy McLaughlin, a senior editor in McKinsey’s Southern California office.

COVID-19: Briefing note #99, April 6, 2022

Some pandemic effects will take a long time to cure..

COVID-19 appears to be moving to endemicity in some parts of the world. But even in these places, some of the pandemic’s damaging consequences are only now being assessed and understood. This week, McKinsey studied the degrees of learning loss suffered by students around the world. We also looked at the pandemic’s lingering effects on the airline industry and on labor markets and examined how long it might take for some things to go back to how they used to be and why others never will.

On average, students globally are eight months behind  where they would have been absent the COVID-19-pandemic, but the impact varies widely (exhibit). Within countries, the pandemic also widened gaps between historically vulnerable students and more privileged peers. We estimate by 2040, unfinished learning related to COVID-19 could translate to annual losses of $1.6 trillion to the global economy. Educational systems could consider a tiered approach to support reengagement, with more support (including social and emotional) for the highest-risk students.

The COVID-19 pandemic caused airline revenues to drop by 60 percent in 2020, and air travel and tourism are not expected to return to 2019 levels before 2024. Challenges vary across the global aviation landscape. In particular, airlines need to bolster their resilience  by increasing their cash reserves, which would reduce the need for bailouts every time a crisis hits, and by improving their ability to reduce supply quickly and cost-effectively when demand abruptly falls. McKinsey’s latest survey of more than 5,500 air travelers globally  revealed a potential long-term challenge: the share of respondents who say they plan to fly less to minimize their environmental impact rose five percentage points since 2019 to 36 percent, and more than half of respondents said that aviation should become carbon neutral in the future. “Flygskam,” or shame about flying, plays a role. Leading airlines that build a brand promise on sustainability will likely attract a growing share of business.

In a current episode of McKinsey Talks Talent , McKinsey talent experts Bryan Hancock and Bill Schaninger discuss the power workers have gained as an indirect effect of the pandemic . Although there has been some high-profile organizing activity, the real source of worker power comes from the current high demand for labor and because remote workers have a wider-than-ever range of job choices.

  • On the latest episode of The McKinsey Podcast , Sven Smit, senior partner and chair of the McKinsey Global Institute, discussed some potential effects of the ongoing war in Ukraine . Refugee numbers may climb from the current few million to ten or even 15 million. The potential doubling or even tripling of food and energy prices could cause hardship for less well-off populations around the world.
  • Distributors can learn from Amazon Business and other large digital players that are building best-in-class distribution networks  and offering products they used to avoid due to technical or supply chain challenges.
  • Paper and forest product CEOs should consider future-proofing companies with strategies such as “precision forestry”; by leading on environmental, social, and governance (ESG); and by harnessing digital and analytics capabilities to strengthen competitiveness.
  • The semiconductor industry’s aggregate annual growth could average from 6 to 8 percent a year up to 2030, resulting in a $1 trillion industry. Amid the growth of remote working, AI, and demand for electric vehicles, manufacturers and designers should now take stock and ensure they are best placed to reap the rewards.
  • General and administrative functions can optimize for speed and flexibility by eliminating the silos that traditionally occur between different departments. This will drive better cross-department coordination and allow leaders to realign staff more efficiently.
  • Health provider systems could prioritize efforts to meet patients’ unmet needs  by creating partnerships with schools, community organizations, payers, private businesses, and government agencies.
  • In 2020, Californians bought and wore more than 500,000 tons of clothing, almost all of which will eventually enter landfills covering an area about 3.5 times the size of the City of Los Angeles. The key to reducing fashion waste is circularity —building a closed loop for recycling materials back into the manufacturing process.

In our latest edition of Author Talks , Todd Rose, a former Harvard University professor and the cofounder of the think tank Populace, discusses his latest book, Collective Illusions: Conformity, Complicity, and the Science of Why We Make Bad Decisions   (Hachette Book Group, February 2022). The book explores why people are likely to buy into fundamental misunderstandings of what most people think.

Also in Author Talks , we spoke with Amy Zegart, a senior fellow at the Hoover Institution and the Freeman Spogli Institute at Stanford University, where she is also a professor of political science. Zegart discussed her new book , Spies, Lies, and Algorithms: The History and Future of American Intelligence   (Princeton University Press, February 2022). The book explores the current state of intelligence, why the government is behind on adopting new technologies, and what the public misunderstands about the spy business.

COVID-19: Briefing note #98, March 30, 2022

One of covid-19’s health effects is the transformation of healthcare..

The COVID-19 pandemic devastated the world’s health but may leave a lasting legacy of improving how the world addresses healthcare. The effort to develop and distribute vaccines demonstrated how much can be achieved with global collaboration, lessons that can be applied to ambitious improvements in well-being. This week, McKinsey explored how the pandemic changed healthcare approaches, including expectations, delivery, viral-vector gene therapy, investment, and consumer attitudes.

Humanity mobilized against COVID-19 at a speed and scale previously unseen. While far from perfect, the undertaking’s successes should inspire the world to challenge the view of what is possible. Over the past century, life expectancy has dramatically increased in most parts of the world, but the portion of life that human beings spend in moderate and poor health hasn’t changed (exhibit). The McKinsey Health Institute believes humanity could add roughly six years per person on average of higher-quality life  by making six major shifts in how the world approaches health.

Even when COVID-19 becomes endemic, healthcare delivery in the United States will continue to transform rapidly . McKinsey’s 14th annual healthcare conference explored the next wave of industry evolution and how healthcare organizations must innovate to thrive. The future of care delivery is evolving to become patient-centric, virtual, ambulatory, in the home, value based, and risk bearing. It will be driven by data and analytics, enabled by new medical technologies, and funded by private investors.

COVID-19 accelerated viral-vector gene therapies . Some of the earliest viral-vector-based therapies targeting rare diseases required companies to produce only about 1,000 doses across development, access programs, and two years of commercialization. In comparison, the unprecedented demand and funding for COVID-19 vaccines enabled a ten- to 100-fold increase in production when adjusted by dose amount, with over two billion doses of the AstraZeneca viral-vector-based vaccine already produced. Keeping pace with increasing demand requires the consideration of challenges, the potential for standardization, and strategizing for accelerating patient access.

In light of growing opportunities, private investors are pouring into healthcare. That becomes clear throughout McKinsey’s annual Global Private Markets Review , which delves into the data and details of a wide range of private markets asset classes, including private equity, debt, real estate, and infrastructure investing. Healthcare is a recurring theme in this year’s report: in 2021, the healthcare sector had the fastest deal-volume growth globally since 2016. Of the largest ten private equity deals in 2021, three were in healthcare, and the largest deal involved a manufacturer and distributor of healthcare supplies. Many of the top 20 private equity firms have dedicated teams for healthcare, which speaks to its growing importance within the asset class.

The number of vaccinated US respondents in McKinsey’s Consumer Health Insights Survey  has remained about the same since November of 2021, when 77 percent reported that they were vaccinated. Approximately 75 percent of respondents to the February survey reported that they’d been vaccinated; in addition, 63 percent of vaccinated respondents plan to stay current on COVID-19 vaccinations as recommended by healthcare leaders. Consumers are increasingly comfortable testing for COVID-19 at home; in fact, it now ranks as the most preferred testing location. Additionally, more than half of respondents indicated that they would prefer a health plan with virtual-health benefits.

  • In the next decade, expect giant leaps in outer space. In the latest edition of McKinsey’s multimedia The Next Normal series, “ The future of space: It’s getting crowded out there ,” McKinsey experts and industry executives envision the space industry’s near future.
  • Inflation could challenge the buying power of the Department of Defense (DOD) for the $773 million budget approved for fiscal year 2023. To address these risks, the DOD and industry leaders should increase affordability, improve inventory management, and develop better contracts that will help both buyers and sellers if costs rise.
  • The US construction sector faces a labor mismatch . In October 2021, 402,000 construction positions in the United States remained unfilled at the end of the month. That’s a headwind for a sector that our modeling suggests could create 3.2 million new jobs across the nonresidential-construction value chain over the next decade.
  • More than one-fifth of global greenhouse-gas emissions come from agriculture, making the development and consumer adoption of alternative proteins a meaningful opportunity  to reduce negative climate impacts. Top executives from alternative meat companies spoke to McKinsey about opportunities and challenges facing the industry.
  • On the latest episode of The McKinsey Podcast , McKinsey partner Mekala Krishnan talks about how companies can get started on the path to net-zero emissions .
  • On the McKinsey on Consumer and Retail Podcast , McKinsey retail experts Tiffany Burns and Tyler Harris discuss five things retailers need to improve in omnichannel sales , including making the experience more seamless for customers and getting products to customers faster.

In our latest edition of Author Talks , Tessa West, an NYU associate professor of psychology, talks about her new book, Jerks at Work: Toxic Coworkers and What to Do about Them   (Portfolio, January 2022). If anyone in the C-suite embraces jerk behaviors, it’s going to trickle down through the company because jerkish behavior is contagious at work, she says.

Also in Author Talks , science journalist Catherine Price discusses her new book, The Power of Fun: How to Feel Alive Again (The Dial Press, December 2021). People can improve their mental and physical health by getting in touch with what is really fun for them and making it a priority—rather than just vegging out in front of a screen, she says.

COVID-19: Briefing note #97, March 23, 2022

Uncertainty returns—but this time, the cause is not covid-19..

The COVID-19 pandemic created short-term disruptions and provoked long-term changes in how the world lives and does business. Russia’s invasion of Ukraine is now doing the same. This week, McKinsey published on what we know about the war and some of its possible global consequences. Among them are likely impacts to supply chains and how companies think about preparing for crises, two of our other topics this week. Another article provides a hopeful look at the investment pouring into decarbonization and renewal of infrastructure.

We, like many others, are shocked by the unfolding humanitarian tragedy resulting from the Russian invasion of Ukraine  (exhibit).

As a result of the war in Ukraine, the era of not looking too closely at supply chains, trusting suppliers, and optimizing for cost is probably over. Those behaviors, already made suspect by new tariff regimes and the COVID-19 pandemic, are now likely to be consigned to history. Our latest research finds that despite progress over the past several years, companies are still struggling to build the capabilities that their emerging digital supply chains  need. The most effective capability-building programs invest in foundational, end-to-end supply chain knowledge building, coupled with advanced functional, technical, and leadership training.

As in any conflict, uncertainty is high, although it is already certain that global consequences will include disruptions to energy and food markets, testing many companies’ resilience. McKinsey’s annual global board survey of approximately 1,500 corporate directors found that a mere 7 percent of respondents gave their boards the highest rating for risk management, and only 40 percent say their organizations are prepared for the next large crisis. On the Inside the Strategy Room podcast, McKinsey senior adviser Nora Aufreiter; senior partner Celia Huber, who leads McKinsey’s board services work in North America; and associate partner Ophelia Usher discussed how boards can improve how they handle big crises .

The world will see a once-in-a-lifetime wave of capital spending on physical assets  between now and 2027. Roughly $130 trillion will flood into projects to decarbonize and renew critical infrastructure. But it won’t be easy: constructing and justifying the cost of a physical asset such as a manufacturing plant is much more difficult than it was decades ago, given inflation, rigorous sustainability requirements, and rapid changes in technology and regulations.

  • The COVID-19 pandemic accelerated online purchases and package deliveries at an unprecedented rate. Even conservative estimates project that cross-border e-commerce in goods will expand to about $1 trillion  in merchandise value by 2030, from its current value of approximately $300 billion. Regulations and tariffs are also likely to increase, as are customer expectations for speed, decentralized supply chains, and specialist segments.
  • The increasing frequency and magnitude of economic volatility have put more pressure on traditional financial planning and analysis (FP&A) processes and teams. Next-level FP&A teams  have figured out how to build more speed and flexibility into their processes, which can trigger more efficient and effective operations throughout the company.
  • Health equity is an opportunity and a challenge for pharmaceutical and life sciences players. By following the data and by working together, organizations can meet needs and create a cycle of trust in underserved communities.
  • Debra Facktor, head of U.S. Space Systems for Airbus U.S. Space & Defense , spoke to McKinsey about her job responsibilities, the future of the aerospace sector, and her experience as a woman in a male-dominated industry.
  • On the McKinsey Talks Operations podcast, Bruce Lawler, managing director for the Massachusetts Institute of Technology’s Machine Intelligence for Manufacturing and Operations program, and Vijay D’Silva, senior partner emeritus at McKinsey, discussed why some companies are pulling ahead of others with machine learning .
  • On the Inside the Strategy Room podcast, Robert Uhlaner, who co-led McKinsey’s Strategy & Corporate Finance Practice until his retirement this summer, and Liz Wol, the global leader of McKinsey’s work on M&A capability building, discussed programmatic M&A . This approach to mergers and acquisitions has proven to be the most successful at delivering results—provided you execute it right.

Our latest edition of Author Talks features Reshma Saujani, founder of Girls Who Code and an activist for women’s economic empowerment, discussing her new book, Pay Up: The Future of Women and Work (and Why It’s Different Than You Think) (Atria/One Signal Publishers, March 2022). Working mothers are overburdened and exhausted, so companies that want them to come back to the workforce need to help with childcare, paid leave, and mental-health support.

Also in Author Talks , retired Navy SEAL commander Rich Diviney talks about his book, The Attributes: 25 Hidden Drivers of Optimum Performance (Random House, January 2021). Diviney dives into how we can—and should—assess and develop our own attributes, equipping ourselves for optimum performance within our lives and throughout our careers.

COVID-19: Briefing note #96, March 16, 2022

On the second anniversary of the covid-19-pandemic, we reflect on what we’ve learned..

Just over two years ago, the World Health Organization declared a pandemic. Since then, one in every 1,300 people alive in 2019 has died from infection with SARS-CoV-2. Two years on, it is easy to forget how remarkable the development of COVID-19 vaccines was: moving in just 326 days from a genomic sequence to the authorization of a vaccine shattered all previous records.

For this anniversary, we reflected on ten core lessons of the pandemic  (see sidebar), some of which exposed fault lines in our society and others that demonstrated amazing capabilities. A separate initiative compiled two years’ worth of research on pandemic impacts, while a third article examined how the pandemic set input prices rising and what to do about it.

Ten core lessons of the pandemic

  • Infectious diseases are a whole-of-society issue.
  • The vaccine-development paradigm has been transformed for emergencies and, potentially, for more.
  • Conversely, weaknesses in vaccine manufacturing and equitable distribution will require systemic change.
  • Trust is one of the most delicate but critical requirements for an effective pandemic response.
  • Agility and speed will be the new basis for differentiation.
  • Government policy matters—but individual behavior sometimes matters more.
  • Schools are the true fulcrum for the functioning of society.
  • Work will never be the same.
  • Economic stimulus works, but only in concert with strong public-health measures.
  • Whether we experience these problems again will depend on the investments and institutions we establish now.

As part of our examination of where the pandemic took us and what’s next, we’ve gathered interviews and articles about COVID-19 from the past two years . Interviews with General James Mattis; Steven M. Jones, co-inventor of the first Ebola vaccine; and McKinsey senior partner Shubham Singhal addressed the crisis as it occurred. Packages of articles examining the pandemic’s effects on areas including healthcare, operations, and sustainable and inclusive growth show how industries have been shaped by the experience and how leaders are looking toward the future.

The aftershocks of the COVID-19 pandemic continue to rock the global economy. Following the shutdowns of 2020 and the supply chain challenges of 2021, another wave of disruptions is now breaking over businesses around the world: rising input prices . Accurate cost models and advanced digital operations help organizations respond to rising costs and equip them with the tools and capabilities they need to thrive when prices fall.

  • Cybersecurity threats are growing and threaten companies of all sizes, municipalities, and state and federal governments. The solution is to reinforce defenses by anticipating emerging cyberthreats and understanding the new defensive capabilities that companies can use today and others they can plan to use tomorrow.
  • On the McKinsey on Healthcare podcast, Errol Pierre, senior vice president of state programs at Healthfirst, discusses what New York’s largest not-for-profit insurer learns from working with diverse communities .
  • By 2020, 40 years after the development of the first commercial machines, the additive-manufacturing sector  had become a €13.4 billion industry. As technical barriers fall, the onus is on manufacturers to build skills, processes, and business models.
  • McKinsey’s second annual review of the progress of digitization in German healthcare  shows solid uptakes of telemedicine and consumer health apps, but lagging use of e-prescriptions, health-data exchange, and use of electronic health records.
  • McKinsey and Club 21e Siècle created the French Corporate Diversity Barometer to measure the diversity of national origins and socioeconomic backgrounds of the executives of large companies in France .
  • Prioritizing privacy, sustainability, and inclusion will soon be essential to successful tech development . Companies must provide the tools, training, and resources for product managers to make responsible innovation ubiquitous.
  • Internal-combustion-engine suppliers must manage uncertainty during these challenging times for the industry. To succeed, they will need a new operating model that includes formulating dynamic responses to continuing disruptions and focusing on building value through higher return on invested capital.
  • Sustainability and digital (particularly e-commerce) will create significant challenges for packaging industry leaders , as well as once-in-a-lifetime transformational opportunities.

This week, McKinsey senior partners Carolyn Dewar, Scott Keller, and Vik Malhotra launch their new book, CEO Excellence: The Six Mindsets That Distinguish the Best Leaders from the Rest (Scribner, March 2022). The authors spoke about their interviews with 67 CEOs as part of our Author Talks series and how they identified the traits that separate the best leaders from the pack.

COVID-19: Briefing note #95, March 9, 2022

Another global crisis is now overshadowing covid-19..

For the first time in two years, concerns about another global crisis overshadowed the COVID-19 pandemic: the Russian government’s invasion of Ukraine and the humanitarian tragedy it is causing. Implications for the world economy will become more visible in the coming weeks and months; this week, McKinsey identified some immediate global economic impacts. Coincidentally, our other major publishing initiative this week is a deep dive into insurance—an industry that exists, in essence, in case things go wrong.

The Russian government’s invasion of Ukraine is causing a humanitarian crisis and economic risks. Our Global Economics Intelligence executive summary  for February discusses how the invasion of Ukraine has mostly set energy prices surging. The oil price (Brent) was near $60 per barrel on December 1 but climbed steadily thereafter, touching $100 in late February. The price of natural gas and coal has similarly climbed during this period (exhibit). Prior to the invasion, the US dollar was depreciating slightly against most major currencies; it is now rising in value. Other immediate economic effects were spikes in the prices of gold, crude oil, and natural gas, as well as stock market losses.

As part of our celebration of International Women’s Day 2022, 20 female McKinsey partners offer insights in a series of interviews on the insurance industry . Topics include operations, growth, claims management, underwriting, product innovation, digital business building, and motor insurance. Further interviews examine women’s representation in the insurance industry and look at the broader issue of diversity in insurance.

New customer expectations, low interest rates, and new sources of competition (such as leading tech companies, insurtechs, and third-party capital) are putting pressure on insurance carriers to be more innovative . It’s not easy: successfully profiting from innovation is a complex, company-wide endeavor, and most insurers have not yet consistently cracked this code. Steps for building innovation into the way an organization works include shifting resources from core business tasks to breakthrough innovation initiatives and developing distinct product-development pathways and processes.

Insurers should consider programmatic M&A : systematically acquiring small to midsize businesses, services, and capabilities and integrating them as new businesses or capabilities. Insurers can use this approach to tackle issues including sustaining growth in core life and annuity businesses and enhancing property and casualty presence in growth markets.

  • On The McKinsey Podcast , McKinsey partners Michael Chui and Mark Collins share their thoughts on the findings of McKinsey’s latest Internet of Things (IoT) report . Fast-growing areas include consumer applications (especially in the connected home); hospital, acute-care, and residential-care settings; and factories, cities, and work sites. Integrating IoT is often easier in greenfield settings but harder to integrate into legacy environments.
  • Of 346 large M&A deals announced between 2013 and 2020, 47 were canceled for antitrust or regulatory reasons . While executing remedy separations, it is vital to adhere to the perimeter set by regulators, move fast in identifying potential buyers, and ensure a close integration between the remedy separation process and the overall transaction and integration process.

In this edition of Author Talks , Deepa Purushothaman talks about her new book, The First, the Few, the Only: How Women of Color Can Redefine Power in Corporate America (Harper Collins, March 2022). Drawing on more than 500 original interviews, Purushothaman examines work life for women of color and what needs to change to improve their experiences.

COVID-19: Briefing note #94, March 3, 2022

The covid-19 pandemic may finally be ending..

A new variant may yet trigger another chapter in the COVID-19 pandemic, and societies must be prepared to respond if and when that happens. But for now, the pandemic phase looks to be ending. With a possible conclusion in sight, this week McKinsey focused on how postpandemic workforces can be supported with expanded opportunity, digital tools, more equitable promotions, and better office design.

In the latest edition of our “ When will the COVID-19 pandemic end ?” series, McKinsey examined scenarios that would lead to either reigniting a pandemic-level crisis or further steps toward endemicity. As long as Omicron remains the dominant variant, there is reason for relative optimism; in the United States, for example, hospitalizations would remain low (exhibit). By and large, the six-month outlook in many countries is brighter than at any time in the past two years. The main risk to the transition to endemicity is a significantly different and more severe new variant that replaces Omicron as the dominant strain.

The latest episode of the McKinsey Global Institute’s Forward Thinking podcast features David Autor, the Ford Professor of Economics at the Massachusetts Institute of Technology . Autor identifies pandemic paradoxes, which include that many thought US poverty and joblessness would skyrocket, but the opposite occurred when poverty rates plummeted to unprecedented lows and the United States ended up with a labor shortage. Leaders should think about ways to expand opportunities, including by being honest with themselves and the labor market about which jobs truly require a college degree.

On McKinsey Talks Talent , HR expert David Green speaks with McKinsey talent experts Bryan Hancock and Bill Schaninger. HR leaders can use people analytics  to identify big-picture attrition patterns, illuminate how office space is being used, and automate parts of the recruiting process, including finding diverse candidates.

In technical roles, only 52 women are promoted to manager for every 100 men, according to McKinsey’s Women in the Workplace 2021  report, coauthored with LeanIn.Org. Companies can improve women’s promotion rates  by providing equitable access to skill building, implementing a structured promotion process that seeks to remove bias, and building a strong culture of support for women via mentors and sponsors.

Diane Hoskins, co-CEO of Gensler, a global design and architecture firm , has been thinking about effective workplaces for decades and is now helping her clients navigate the next normal. In a conversation with McKinsey Real Estate Practice leader Aditya Sanghvi, Hoskins discusses how COVID-19 made it even more essential to design offices around organizational strategies, leadership models, operational frameworks, and potential outcomes of a company.

  • The Consumer Price Index rose faster in January than at any time in the prior 40 years. Businesses facing inflation are caught  between the need to reprice and sustain margins and the damage this can do to customer relationships and sales. McKinsey’s suggested approach can help companies establish sales-led pricing for inflation while maintaining long-term value for the business and its customers.
  • Banks can learn to manage nonfinancial risks by observing the effective approaches corporates have developed. These include embedding risk into strategy and improving overall resilience.
  • Our analysis suggests that in 2030, demand for green steel in Europe could be twice as great as the available supply, and there may be global shortages of recycled aluminum and recycled plastic. By planning green-materials sourcing strategies , companies can achieve immediate emissions reductions and sustain progress toward longer-term goals.
  • COVID-19 accelerated the sophistication of China’s logistics industry , a crucial node in the global supply chain. Greater consolidation and integration are likely in some subsectors—such as third-party logistics and express-delivery carriers—and expect growth in other areas, such as warehouse automation and air cargo.
  • On the McKinsey on Government podcast, McKinsey senior partner Scott Blackburn and partner Brooke Weddle discuss how the US government’s leaders can implement an effective transformation.

In this edition of Author Talks , Whitney Johnson, the CEO of tech-enabled talent agency Disruption Advisors, talks about her new book, Smart Growth: How to Grow Your People to Grow Your Company  (Harvard Business Review Press, January 2022). Mastering new skills follows an S-curve, where there’s a difficult introductory phase, a “sweet spot” where you’re enjoying applying new knowledge, and an end part of the curve where boredom can set in. Leaders need to understand where their teams are to create the right supports for each phase, Johnson says.

COVID-19: Briefing note #93, February 23, 2022

The covid-19-pandemic accelerated our need for a new kind of growth..

The COVID-19 pandemic served as an accelerant in multiple ways. This week, McKinsey looked at how the pandemic spurred the adoption of telehealth and e-commerce, exacerbated pressure on nurses, and made company operations more complex. In the big picture, it increased the urgency for a new vision of global growth, one that benefits more people and leaves our planet healthy.

Crises such as COVID-19 can become watersheds of policy and strategy. In an editorial published in Fortune , Klaus Schwab, the founder and executive director of the World Economic Forum, and Bob Sternfels, McKinsey’s global managing partner, propose pursuing a sustainable, inclusive growth agenda  that supports the health of the natural environment while improving the livelihoods of wider population segments. Leaders can shape a resilience agenda by addressing the interrelationships between climate, healthcare, labor needs, supply chains, digitization, finance, and inequality and economic development.

To build a better future, the emphasis must now shift from defensive measures and short-term goals to a sustainable, inclusive growth agenda.

The pandemic ignited telehealth: as of mid-2021, utilization was 38 times higher  than before the pandemic. However, McKinsey’s most recent Physician Survey showed that most doctors don’t love telehealth as much as patients do . Most expect to return to a primarily in-person delivery model over the next year, and 62 percent said they recommend in-person over virtual care to patients.

The pandemic essentially forced consumers to try e-commerce and to increasingly rely on product ratings and reviews to give them the confidence to make purchases. The total number of global reviews roughly doubled in the year after COVID-19 started. On The McKinsey Podcast , McKinsey partner Dave Fedewa and McKinsey senior expert Chauncey Holder discuss how companies need to adapt to the new world in which reviews matter more than ever .

Healthcare workers and their organizations continue to face unparalleled demands stemming from the COVID-19 pandemic. Thirty-two percent of registered nurses surveyed in the United States in November said they may leave  their current direct-patient-care role, according to McKinsey’s latest research. Healthcare organizations can consider a number of medium- and longer-term strategies to support their workforces.

As companies look at areas to automate, they need a clear, complete picture of service processes . The complexity of services, which often involve coordinating multiple functions in nonlinear ways, makes bad handoffs a perpetual problem. Add to these factors the burgeoning number of customer touchpoints and the accelerated move to remote working since the start of the COVID-19 pandemic, and the challenge looms even larger. An approach we call process insights—which marries technology tools and analytics in a disciplined, three-stage process—shows promise.

While our theme this week is the pandemic’s accelerating effects, we also looked at the opposite: how COVID-19 can spur lightning-fast pullbacks. Although consumer confidence is growing, desire for travel has shown a faltering recovery due to sporadic COVID-19 outbreaks. Our examination of China’s tourism industry  showed that a predictable pattern is emerging where desire for travel recovers roughly two months after a decline. Furthermore, travelers’ preferences are shifting, with implications for travel companies.

  • Signed in November, the US Infrastructure Investment and Jobs Act will provide more than $1 trillion in public investment. One core component of the legislation is addressing the country’s aging water system . The act provides funding to replace lead pipes, address emerging contaminants in small and disadvantaged communities, and support rural water projects.
  • A relative lack of top software companies threatens Europe’s economic competitiveness. But Europe could take a lead in software  and build large players by playing to the continent’s strengths: vertical B2B software, software platforms for digitizing small and medium-size enterprises, and horizontal platforms built on European R&D excellence.
  • Software sourcing , now a major driver of overall product cost, requires critical investments in capabilities and technologies, as well as significant financial resources. Those players that can procure software and related services at minimum cost and risk have a distinct competitive advantage.
  • Asian acquirers are key players in the Asian M&A landscape , and many are setting their sights worldwide. Our research finds that the most effective dealmakers practice programmatic M&A  tied directly to a stated strategy.
  • On the McKinsey on Consumer and Retail podcast, McKinsey partner David Feber and Amcor CEO and managing director Ron Delia talk about exciting innovations that could transform the packaging industry .

This week in Author Talks , Ruchika Tulshyan, an award-winning inclusion strategist and speaker, discusses her new book, Inclusion on Purpose: An Intersectional Approach to Creating a Culture of Belonging at Work (MIT Press, March 2022). She explores the bias behind terms such as “lean in” and “culture fit” and proposes that inclusion efforts target the needs of women of color.

This briefing note was edited by Katy McLaughlin, a senior editor in the Southern California office.

COVID-19: Briefing note #92, February 16, 2022

As omicron reminded us, health is everything..

McKinsey focused on health this week, starting with a discussion of how Omicron has played out so far and what is likely next in the pandemic’s trajectory. An article on women’s health explores the remarkable tradition of viewing it as a healthcare niche, rather than a core concern of half the world’s population. Technology is increasingly merging with healthcare, so we extrapolated this theme further to examine how to keep companies’ technology healthy.

In this episode of The McKinsey Podcast , Shubham Singhal, senior partner and global leader of McKinsey’s Healthcare and Public & Social Sector Practices, reflects on where Omicron has taken us so far and where we go from here . Omicron spread so fast because it evades prior immunity and is more transmissible, allowing it to out-compete the previously dominant strain. Society will begin viewing COVID-19 as endemic when we’re comfortable getting on with life even though the risk of disease is not zero (and for the unvaccinated, it remains high).

Half of the world’s population is women, and women account for 80 percent of consumer-purchasing decisions in the healthcare industry. Yet women’s health has been considered a niche market  and a mere subset of healthcare. A particularly illuminating statistic: only 1 percent of healthcare research and innovation is invested in female-specific conditions beyond oncology. Changing how the industry thinks about women’s health is an important step toward identifying value-creating opportunities for meeting women’s healthcare needs.

It is not a light switch event to get to an endemic phase, because it is as much about the behavior and psychology that we all exhibit as it is about the epidemiology of the virus itself.

FemTech is an emerging category consisting of tech-enabled, consumer-centric solutions addressing women’s health. Depending on scope, estimates for FemTech’s current market size range from $500 million to $1 billion, and forecasts suggest opportunities for double-digit revenue growth. Our analysis of 763 companies indicates that the dynamics underlying FemTech are accelerating and that public awareness, company formation, and funding are surging.

When employees feel understood and supported by their employers, they tend to be happier, more effective, and more likely to stick around. Companies can use the power of AI and machine learning to coach employees . An AI-driven system can be designed to identify key moments when employees would benefit from a “nudge” that guides them toward positive actions, including improving their health, accessing training, and trying a different performance approach.

To protect the health of our work environments from ransomware , everyone from the board and C-suite to down the line must work to ingrain security into an organization’s DNA. Ransomware costs are expected to reach $265 billion by 2031. Supply chain attacks rose by 42 percent in the first quarter of 2021 in the United States, affecting up to seven million people, while security threats against industrial control systems and operational technology more than tripled in 2020.

  • McKinsey’s Global Insurance Report 2022 explores long-term challenges facing the industry as well as a raft of trends unleashed by COVID-19. Insurers face fundamental strategic questions of how to create more value for shareholders and how to reframe the role of insurance in society. The report proposes nine imperatives that will help carriers navigate the current environment and focus on the businesses of which they are the best natural owners.
  • With a target of a 78 percent reduction in economy-wide greenhouse-gas emissions by 2035 now enshrined in law, there is a strong impetus to transition the United Kingdom’s energy system to net zero . Looking at electricity demand, technology, and the grid, McKinsey examines options available to investors, regulators, policy makers, and energy companies.
  • Companies used to outsource business processes primarily as a cost-saving strategy. Today, companies outsource to capitalize on sophisticated provider offerings , including customized industry solutions and advances in digital technology, such as AI, analytics, and machine learning.

In this edition of Author Talks Amy Webb, a leading futurist and business adviser, talks about her recent book, The Genesis Machine: Our Quest to Rewrite Life in the Age of Synthetic Biology (Hachette Book Group, February 2022), coauthored by microbiologist Andrew Hessel. The book explores a new field of science that combines engineering, design, and computers with biology, enabling the engineering of living cells. Webb says that synthetic biology—the ability to reprogram the fundamental units of life—is going to change industries such as healthcare, agriculture, and industrial materials.

COVID-19: Briefing note #91, February 9, 2022

The ceo job description just got a bit longer..

CEOs have always carried a heavy workload, but the issues they confront today add several fresh layers. Climate change requires a new way of looking at asset value that models the potential impact of various types of risk. COVID-19 and its aftermath means leaders must engage empathetically in topics relating to their employees’ well-being. This week, McKinsey examined how the pandemic and other world events have added to leaders’ list of most important tasks.

Climate change and the risks it imposes upon assets and markets is one of the biggest challenges confronting CEOs and other leaders today. The real-estate industry is already facing the need to build new capabilities that allow it to assess how climate-change risks alter values and what subsequent actions to take. Part of capability building involves understanding both physical risks and transition risks stemming from regulatory, social, and market reactions to climate change (exhibit). Once real estate and other leaders understand value impact, they can proceed to decarbonizing and finding new sources of value throughout the climate transition.

COVID-19 brought on a new set of employee pressures , including trying to take care of work and children at a time when school doors close suddenly, and managing the 24/7 nature of working from home. These burdens also imply a new set of pressures for CEOs and other leaders as they attempt to support overburdened workforces. On the McKinsey Talks Talent podcast, McKinsey talent experts Bryan Hancock and Bill Schaninger discuss how leaders must engage in employees’ lives and well-being in ways they seldom did in the past.

We’re in one of the most bewildering labor markets  in a generation, said Asutosh Padhi, McKinsey’s managing partner for North America, in a CNN Business Perspectives commentary. CEOs can respond by expanding recruitment efforts to people who have work experience but don’t have degrees; supporting more “gateway jobs,” or stepping-stone positions that provide an income boost; and by challenging their organizations to embrace a more inclusive, skills-based approach to hiring and talent management.

Across industries, product-development functions are encountering a perfect storm of supply chain issues  arising from the pandemic, the current labor mismatch , and evergreen themes of managing cost, quality, and time. Rather than becoming part of the much-bemoaned war for talent, companies can develop the capabilities of their existing workforce  to fill skills gaps.

As the economy continues to reel from the effects of COVID-19, consumer-packaged-goods companies are under more pressure  than ever. Prices for food and packaging commodities have increased by more than 22 percent. Manufacturing wages and labor costs rose in 2020 from 5 to 20 percent of total costs. To respond to these rapid, sweeping changes, companies need to transform their operating models to the new reality.

Given that economies are expected to shift away from stimulus spending and other policy supports, forecasters and economists generally project a slower pace for global growth in 2022—but one that is still faster than prepandemic levels. January’s Global Economics Intelligence executive summary  focuses on how inflation is playing out around the world, efforts to control it, and its impact on growth and employment.

  • To better understand recent developments in sustainable packaging , we mapped regulations in 30 countries and found four common patterns. To ensure they comply with evolving requirements, packaging companies should track regulatory changes in their focus markets and implement processes to address future requirements proactively.
  • Responding to a McKinsey survey, two out of three Americans told us their social values now shape their shopping choices, and 45 percent believe retailers should actively support Black-owned businesses and brands. Most retailers will need to make changes to meet the needs of these “inclusive consumers” by sourcing products that dovetail with consumer values and by communicating the changes to the public.
  • Up to four-fifths of a product’s lifetime emissions  are determined by decisions made at the design stage. By building on proven cost-optimization techniques, companies can get those choices right.
  • Myths often hold back heavy industries from activating agile working practices . However, agility in heavy-industry organizations can be used to make operational improvements, to enhance run activities, to augment all-important safety standards, and ultimately to become an enduring source of competitive advantage.

In this edition of Author Talks , Neil Hoyne, Google’s chief measurement strategist, discusses his new book Converted: The Data-Driven Way to Win Customers’ Hearts (Penguin Random House, February 2022). Data alone is not the answer for companies trying to grow, Hoyne says. Instead, companies can find growth by creating the right data strategy, leadership, and processes.

COVID-19: Briefing note #90, February 2, 2022

The postpandemic world calls for fresh leadership ideas..

Organizations increasingly recognize that modern leadership means knowing how to make the most of digitization and technology, diverse talent, and the opinions of a range of stakeholders. This week, McKinsey dug for the details. Articles and an interactive explore how companies can take advantage of advanced-intelligence technology and become truly data driven. A new interview series illuminates how three Black leaders developed their leadership styles, while further articles explore casting the idea net wider.

Leading industrial and manufacturing companies are using machine-intelligence technologies to move the needle on a broad set of performance indicators, achieving three or four times the impact of average players. The full scale of the opportunity is set to continue as more use cases evolve from simple dashboards to greater levels of autonomy.

What exactly does it mean to be a data-driven enterprise , and what would such an organization look like by 2025? Our interactive helps executives envision success by defining seven characteristics of a data-driven organization, how each would differ from what we typically see today, and how to achieve each step. Companies able to make the most progress fastest stand to capture the highest value from data-supported capabilities.

McKinsey created the Connected Leaders Academy to equip Black, Hispanic, Latino, and Asian leaders with the network and capabilities to achieve their professional aspirations. In our new interview series , My Leadership Journey, participants from the private sector, academia, the arts, and other walks of life reflect on their formative experiences and leadership styles. Jason Wright, president of Washington’s football team, the Commanders , told McKinsey about getting cut nine times from the NFL and talking his way back to opportunity by honing a narrative about what he could contribute. Stephanie Hill, executive vice president of Lockheed Martin’s Rotary and Mission Systems , discussed the importance of accepting uncomfortable challenges to build a career. Barry Lawson Williams, founder and former managing general partner of Williams Pacific Ventures , who has also served on 16 major public-company boards, spoke about how he built a network that helped position him for lucky breaks.

What does an army veteran who has returned from deployment five times have to teach a McKinsey organizational expert? Plenty, as a letter and conversations between Adria Horn, executive vice president of workforce at Tilson, a national telecom provider, and senior partner Aaron De Smet revealed. Horn reached out to McKinsey after reading about how companies can reengage employees postpandemic . She shared her view of parallels between soldiers returning from war zones and employees coming back  to the office after living through the COVID-19 pandemic. The resulting conversation explores the alienation of return and how employers can work from a place of empathy.

Brainstorming is supposed to result in conversations like the one between Horn and De Smet. But too often, the value of casting the net wide for opinions is undercut by participants feeling pressured to conform. A structured approach that guides a group through anonymous brainstorming  and silent voting removes some of the risks that can thwart honest discussion.

  • Based on a survey of physicians who serve predominantly Medicare fee-for-service and Medicare Advantage patients, we estimate that up to $265 billion worth of care services could shift from traditional facilities to the home by 2025  without a reduction in quality or access. Care at Home could create value for payers, healthcare facilities and physician groups, providers, technology companies, investors, and, above all, patients.
  • Korean companies would benefit from portfolio restructuring by making governance more transparent and by advancing women’s equality at work. In a wide-ranging conversation, André Andonian, managing partner of McKinsey Korea, discusses McKinsey’s near- and long-term goals in the country and how Korea is preparing for the post-COVID-19 economy .
  • Investors are directing more funds to projects involving lunar and beyond orbital regimes , which have traditionally attracted less attention than regimes at lower altitudes. All signs point to continued growth.

Even the most seasoned professional was a neophyte at some point, a fact celebrated in our My Rookie Moment video series, in which McKinsey colleagues discuss the first time they had to deal with a particular challenge. The latest edition features stories about “leaps of faith,” in which partners had to do something for which they felt unprepared. Yarns include a tale of on-command public speaking and the recollection of facing a client who demanded different conclusions.

COVID-19: Briefing note #89, January 26, 2022

Tackling the other big global crisis..

Since March of 2020, we have focused this weekly update on sharing research into the health emergency facing the world. This week, we took a break from the COVID-19 pandemic to zero in on the other crisis that poses threats to lives and livelihoods: climate change, and the need to transition to a net-zero world. Additional articles looked at pressing issues including why the loss of US manufacturing has increased inequality, and how the Great Attrition is playing out in nursing.

A new report from the McKinsey Global Institute  looks at what an economic transformation to net-zero emissions would entail . The transformation would affect all countries and all sectors of the economy, either directly or indirectly. In six sections of the report, we assess economic shifts for 69 countries and changes in sectors that produce about 85 percent of overall emissions, as well as provide estimates for what it will all cost (exhibit).

The report includes an examination of effective decarbonization actions , which include shifting the energy mix, increasing energy efficiency, and enhancing sinks of both long- and short-lived greenhouse gases. Another section illustrates the economic and societal adjustments that would enable a successful transition  to net-zero emissions by 2050, focusing on demand, capital allocation, costs, and jobs. We examine which sectors of the economy are more exposed to a net-zero transition , and how the transition could play out in various countries and regions . A section about actions for stakeholders  explores what companies, financial institutions, and governments and multilateral institutions can do.

Also this week: revitalizing US manufacturing could be fundamental to resolving inequities  while driving sustainable, inclusive growth. Today, the manufacturing sector represents just 10 percent of US GDP and jobs but drives 20 percent of the nation’s capital investment, 35 percent of productivity growth, 60 percent of exports, and 70 percent of business R&D expenditure. Strengthening the sector could also address the pervasive supply chain issues wreaking havoc all over the world, easing short-term disruption caused by the pandemic while improving global competitiveness in the midterm to long term.

During a time of unprecedented need, what can employers do to prevent losing nurses , the backbone of the healthcare workforce, to the Great Attrition ? The McKinsey Podcast speaks with senior partner Gretchen Berlin, a registered nurse, about the need to pay nurses adequately and to ensure that there’s sufficient staffing, respite, and gratitude.

  • In October 2020, coking coal accounted for more than half of the cost of the raw materials needed to produce a metric ton of steel via a blast furnace—a rare occurrence by historical standards. Though prices have fallen since then, steelmakers should consider the effect of longer-term coal price increases  as part of their planning and adjust their plans as the implications evolve.
  • The new normal for sporting goods  includes increased health awareness, acceptance of athleisure, thriving e-commerce, and sustainability as a core concern. McKinsey’s summary of the state of the industry suggests strategies for navigating the trends.
  • New and better digital tools can help companies analyze voice conversation  and unlock the full potential of digital investments to improve customer service.

In the latest edition of our Author Talks series, John Koenig, author of The Dictionary of Obscure Sorrows (Simon & Schuster, November 2021), discusses how and why he invents new words for emotions and sensations. From “kenopsia” (the eeriness of places left behind) to “suerza” (a feeling of quiet amazement that you exist at all), Koenig’s made-up words pinpoint universal experiences and demonstrate how creative human language can be.

COVID-19: Briefing note #88, January 19, 2022

Fallout from the pandemic demands targeted action..

For much of the COVID-19 pandemic, leaders have tried to prepare for what might unfold. Today, some of those possibilities have arrived as undeniable challenges that demand new ways of operating. This week, McKinsey looked at fallout, including inflation, young peoples’ mental-health struggles, a pattern of “jolting” growth, and the demand for government agencies to improve customer service.

Not since the 1970s has inflation been such a central issue for companies, so finding creative ways to mitigate price increases  is a dormant skill in many organizations. McKinsey experts offer a series of steps supply-chain leaders can use to determine whether a price increase is fair, starting by identifying the main cost inputs that have the highest level of change, estimating the percentage of the total cost these inputs make up, and calculating an acceptable price-increase range (exhibit). Response strategies include using a strong fact base for win–win negotiating and exploring new suppliers.

A series of McKinsey consumer surveys and interviews indicated unprecedented behavioral-health challenges facing Generation Z  and stark differences among generations. Gen Z respondents were more likely than other generations to report having been diagnosed with a mental-health or substance-use issue, as well as more likely to have sought no treatment for the problem. Gen Z respondents were also two to three times more likely than other generations to report thinking about, planning, or attempting suicide in the 12 months spanning late 2019 to late 2020.

There could be a postpandemic boom on the horizon, but it will likely depend on business leaders’ ability to respond to productivity and growth “jolts”  caused by the pandemic. The onset of COVID-19 brought a set of discontinuities that drove the first jolt to growth and productivity. Now, near-term uncertainties pose risks to growth; however, responding effectively could translate to a second jolt. The potential third and final jolt may be the largest as companies reshape their long-term strategies to reflect—and define—the next normal.

On the McKinsey on Government podcast, McKinsey partner Tony D’Emidio and associate partner Marcy Jacobs discuss how the pandemic forced many government agencies to modernize the customer experience  (CX) amid high demand for unemployment and healthcare assistance. Transparency has improved, but there is more work to do so that when citizens fill out applications or forms, they get status updates instead of just wondering what happened. Another insight: better CX brings costs down because satisfied customers call with fewer questions.

  • Road freight accounts for 53 percent of CO 2 emissions within global trade-related transport, a share expected to rise to 56 percent by 2050 if current trends continue. Road Freight Zero: Pathways to faster adoption of zero-emission trucks is a joint publication by the World Economic Forum and McKinsey that describes how countries can reach their emissions goals for road freight.
  • With a market of more than $2.8 trillion worldwide, fragmented retail is poised to be transformed by “eB2B” players : portals and applications that replace the in-person sales model for small retailers and restaurants. By understanding the market structure and properly setting the scale and speed of change, companies can design an eB2B solution capable of disruption.
  • Reaching net zero in the cement and construction value chain by 2050 will require the buildings and construction industry to decarbonize three times faster over the next 30 years versus the previous 30. At the COP26 Climate Change Conference in Glasgow, Scotland, McKinsey brought together global property owners, contractors, materials suppliers, investors, equipment manufacturers, and disruptors to define the path forward. Among the takeaways: the industry can boost innovation by developing common standards and shared R&D resources.

What makes a CEO great? In this edition of Author Talks , McKinsey senior partners Carolyn Dewar, Scott Keller, and Vik Malhotra discuss their new book, CEO Excellence: The Six Mindsets That Distinguish the Best Leaders from the Rest (Scribner, March 2022). The authors interviewed 67 CEOs worldwide who met their criteria for excellence and diversity of both background and approach and identified keys to excellence that can provide lessons for any type of leader.

COVID-19: Briefing note #87, January 12, 2022

People are the fuel that will power the next industrial revolution..

Amid the Omicron surge, it’s perhaps poignant to note that all the advanced technology in the world means nothing without a population capable of adopting it and creating with it. COVID-19 vaccines are a good example of a technology that depends on people’s acceptance. This week, McKinsey explored how people in various industries and sectors relate to technology and the power of these interactions.

The McKinsey Talks Operations podcast brings together the CEOs of Flex, Protolabs, and Western Digital to discuss why the Fourth Industrial Revolution will be people powered . Digital manufacturing and production will change how the world makes goods but only if there is training and development to teach workers the skills to use these technologies. With the current labor mismatch in many countries, now is the time to further engage workers for a digitally enabled future.

With Fourth Industrial Revolution technologies in the hands of a workforce empowered with the skills needed to use them, an organization’s digital-transformation journey can move from aspiration to reality.

A pivot to telemedicine, remote work, and other technologies helped a leader in pediatric medicine manage the onslaught of COVID-19. Boston Children’s Hospital president and CEO Dr. Kevin Churchwell  calls for more innovation to cope with a sharp rise in children and young adults with behavioral- and mental-health issues. This generation of kids is being reared under physical distancing, lockdowns, and school closures. Churchwell believes that those presenting with mental-health issues would benefit from a tech-enabled continuum of care that encompasses the family, the primary-care pediatrician, the school system, the hospital, and the state.

Sarah Bond, Microsoft’s corporate vice president for game creator experience and ecosystem at Xbox , describes how recognizing that game playing is a fundamental human trait helped Microsoft create its “ubiquitous global gaming ecosystem.” Investments in cloud gaming, the Game Pass subscription service, and cross-platform play allow gamers to participate anywhere, anytime, on any device.

Tulsa Remote, a program that enabled Tulsa, Oklahoma, to attract 1,300 remote workers to the area, also prioritizes the human need for connection. In addition to giving relocators $10,000, the program provides membership to a local coworking space and assists in finding housing. Events, both virtual and in-person, are intended to mitigate the potential isolation of remote work. The initiative has attracted 50,000 applicants and is making a meaningful impression on the local economy.

In a typical organization, only a specific department and designated functions are accountable for quality in design, development, operations, and even postmarket activities. But in a smart-quality organization, everyone owns quality . Pharmaceutical and medtech companies can create value by redesigning key quality processes along these principles.

  • As the move toward cleaner technologies progresses, the metals and mining sector will provide the raw materials required for the energy transition . The required pace of transition means that the availability of certain raw materials will need to scale up quickly—and, in certain cases, at volumes ten times or more than the current market size. We expect materials shortages, price fly-ups, and the need for technological innovation and substitutions.
  • Stakeholder capitalism asks leaders to prioritize long-termism over short-term gain. In the latest episode of the Inside the Strategy Room podcast, senior partner Dame Vivian Hunt and senior adviser to McKinsey Bruce Simpson, CEO of the Stephen A. Schwarzman Foundation, discuss research and experience that strongly link stakeholder capitalism to traditional sources of value.

What makes a CEO great? In a recent edition of Author Talks , McKinsey senior partners Carolyn Dewar, Scott Keller, and Vik Malhotra discuss their new book, CEO Excellence: The Six Mindsets That Distinguish the Best Leaders from the Rest (Scribner, March 2022). The authors interviewed 67 CEOs worldwide who met their criteria for excellence and diversity of both background and approach and identified keys to excellence that can provide lessons for any type of leader.

Also in Author Talks , Tareq Azim, founder of Empower Gym, trainer of NFL greats, and creator of the Afghan Women’s Boxing Federation, talks about his new book, Empower: Conquering the Disease of Fear (Simon & Schuster, January 2022), which was coauthored with Seth Davis. Azim discusses how he created a place for women to practice the most male-dominated activity in the most male-dominated society of all time and how anyone can find inner strength.

COVID-19: Briefing note #86, January 5, 2022

Omicron demands renewed focus on familiar pandemic themes..

A new year is here, but COVID-19’s latest surge feels so very last year—not to mention the year before that. To kick off 2022, McKinsey looked at issues that many people thought would have started to resolve as the virus died down, but which instead require renewed engagement. Topping our list this week are employee burnout and hits to tourism. But there is positive news as well: reports on the state of mobility and pharmaceuticals reflect that pandemic-inspired changes are leading some industries in new directions.

Compared with nonparents, employed parents are more likely to miss days of work because they are experiencing symptoms of burnout  (exhibit). Companies need to understand what the compound pressures of employment and parenting during a pandemic are doing to these workers and consider a list of interventions to counteract their experience of burning the candle at both ends.

Women also are reporting higher-than-average rates of burnout. In a new episode of The McKinsey Podcast , senior partners Alexis Krivkovich and Lareina Yee discuss results from the recently released Women in the Workplace 2021  report. Forty-two percent of women report being burned out , a percentage that is higher than it was last year and higher than it is for men. Reasons include the fact that one in three women, and 60 percent of mothers with young children, spend five or more hours a day on housework and caregiving.

Early January is when many of us go on a diet and re-up at the gym. Here’s another tune-up option: take our “Can you turn attrition into attraction?” quiz  to test how good you are at combatting burnout, rewarding employees in meaningful ways, and strengthening bonds with your teams.

Our “ year in review ” recap of 2021 highlights themes that many were hoping to leave behind, including the pandemic and the Great Resignation, as well as aspirations, such as inclusive growth and digital transformation, that will only grow in importance. The “ year in images ” collection showcases the most evocative art we published last year, while the “ year in charts ” collection tells visual stories about virus cases and vaccination rates, diversity targets and employee experiences, and how sustainable growth might be attained.

Another consequence of COVID-19 is the devastation wrought on tourism markets worldwide. We looked at a key US market and found that the financial impact of the pandemic on New York City is six times that of the September 11 attacks, costing the city $1.2 billion in lost tourism-related tax revenue. New York can reinvigorate its tourism industry  by encouraging domestic travel and by reimagining business travel.

McKinsey reflected upon how the pandemic has affected mobility and where the sector is headed . Among the findings: half of the consumers in our recent Global COVID-19 Automotive & Mobility Consumer Survey stated a clear preference to travel less than they did before the COVID-19 pandemic. Among the forecasts: by 2035, in an accelerated scenario, the largest automotive markets in the world (that is, China, the European Union, and the United States) will be fully electric.

The pandemic has also reshaped the pharmaceuticals industry , and changes are still under way. We conducted a survey of senior executives in commercial roles at global pharma companies and found that more than 80 percent think that companies will fully embrace agile ways of working, and 66 percent believe that companies will move away from the traditional sales rep model because of restricted access, virtual interactions, and perceived low return on investment.

Here are some of this week’s other key findings from our research:

  • Quantum computing is about a decade away from widespread commercial application. Less well known, but also important, are two related technologies that could become available much earlier: quantum sensing and quantum communication . We explore the market landscape for both, looking at opportunities, risks, and demand.
  • Based on the results of our latest McKinsey Global Survey , we identify the different stages of a transformation’s life cycle  to understand where value is lost and what companies can do to preserve it. According to our analysis, three core actions are especially predictive of value capture.
  • One way to accelerate decarbonization in the shipping sector  is to implement “green corridors”: specific trade routes between major port hubs where zero-emission solutions are supported. A new report, The next wave: Green corridors , probes the feasibility of two such selected corridors—with encouraging results.

Two books in our Author Talks series address the workplace issues so prevalent in our research from this past year. Joan C. Williams, distinguished professor of law and chair of the Hastings Foundation, discusses her latest book, Bias Interrupted: Creating Inclusion for Real and for Good (Harvard Business Review Press, November 2021). Jennifer Moss, Harvard Business Review contributor and nationally syndicated radio columnist, shares her recent work, The Burnout Epidemic: The Rise of Chronic Stress and How We Can Fix It (Harvard Business Review Press, September 2021).

For McKinsey’s 2021 perspectives on the business impact of COVID-19 , visit our archive of several dozen briefing notes published throughout the year.

Matt Craven is a partner in McKinsey’s Silicon Valley office;  Linda Liu is a partner in the New York office, where Matt Wilson is a senior partner; and  Mihir Mysore is a partner in the Houston office.

This article was edited by Mark Staples, an executive editor in the New York office.

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

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Ten lessons from the first two years of COVID-19

Safeguarding Enterprise Prosperity: An In-depth Analysis of Financial Management Strategies

  • Published: 21 February 2024

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  • Rong Wang 1  

This research paper delves into the profound impact of public health emergencies on corporate finance, with a specific lens on the COVID-19 pandemic’s transformative effects. Corporate finance systems face unprecedented challenges in such crises, including fluctuations in consumer demand, escalating operational costs, profitability erosion, and cash flow constraints. These factors demand innovative financial strategies to ensure business resilience. The paper emphasizes the need for tailored financial systems, designed to navigate the unique challenges of health emergencies. Such systems should enable companies to mitigate financial distress and maintain operational continuity with minimal expenditure. The analysis highlights the critical role of knowledge transfer and collaboration across organizations and industries, fostering a shared understanding and best practices in crisis management. Our findings extend the existing literature by revealing the multifaceted financial challenges businesses face during health crises. This includes increased corporate social responsibility, heightened regulatory constraints, labor shortages, supply chain disruptions, and financing difficulties. These insights offer a nuanced perspective on crisis management, aiding businesses and policymakers in devising effective strategies for financial stability and resilience. The study concludes with theoretical and managerial implications, highlighting the importance of proactive financial management and robust financial buffers. It suggests that enterprises optimize their working capital and make swift, informed decisions to enhance their resilience and adaptability during crises. Additionally, it underscores the need for flexible and supportive measures from governments and regulatory bodies to aid businesses in navigating these unique challenges.

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  • Published: 16 June 2020

COVID-19 impact on research, lessons learned from COVID-19 research, implications for pediatric research

  • Debra L. Weiner 1 , 2 ,
  • Vivek Balasubramaniam 3 ,
  • Shetal I. Shah 4 &
  • Joyce R. Javier 5 , 6

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The COVID-19 pandemic has resulted in unprecedented research worldwide. The impact on research in progress at the time of the pandemic, the importance and challenges of real-time pandemic research, and the importance of a pediatrician-scientist workforce are all highlighted by this epic pandemic. As we navigate through and beyond this pandemic, which will have a long-lasting impact on our world, including research and the biomedical research enterprise, it is important to recognize and address opportunities and strategies for, and challenges of research and strengthening the pediatrician-scientist workforce.

The first cases of what is now recognized as SARS-CoV-2 infection, termed COVID-19, were reported in Wuhan, China in December 2019 as cases of fatal pneumonia. By February 26, 2020, COVID-19 had been reported on all continents except Antarctica. As of May 4, 2020, 3.53 million cases and 248,169 deaths have been reported from 210 countries. 1

Impact of COVID-19 on ongoing research

The impact on research in progress prior to COVID-19 was rapid, dramatic, and no doubt will be long term. The pandemic curtailed most academic, industry, and government basic science and clinical research, or redirected research to COVID-19. Most clinical trials, except those testing life-saving therapies, have been paused, and most continuing trials are now closed to new enrollment. Ongoing clinical trials have been modified to enable home administration of treatment and virtual monitoring to minimize participant risk of COVID-19 infection, and to avoid diverting healthcare resources from pandemic response. In addition to short- and long-term patient impact, these research disruptions threaten the careers of physician-scientists, many of whom have had to shift efforts from research to patient care. To protect research in progress, as well as physician-scientist careers and the research workforce, ongoing support is critical. NIH ( https://grants.nih.gov/policy/natural-disasters/corona-virus.htm ), PCORI ( https://www.pcori.org/funding-opportunities/applicant-and-awardee-faqs-related-covid-19 ), and other funders acted swiftly to provide guidance on proposal submission and award management, and implement allowances that enable grant personnel to be paid and time lines to be relaxed. Research institutions have also implemented strategies to mitigate the long-term impact of research disruptions. Support throughout and beyond the pandemic to retain currently well-trained research personnel and research support teams, and to accommodate loss of research assets, including laboratory supplies and study participants, will be required to complete disrupted research and ultimately enable new research.

In the long term, it is likely that the pandemic will force reallocation of research dollars at the expense of research areas funded prior to the pandemic. It will be more important than ever for the pediatric research community to engage in discussion and decisions regarding prioritization of funding goals for dedicated pediatric research and meaningful inclusion of children in studies. The recently released 2020 National Institute of Child Health and Development (NICHD) strategic plan that engaged stakeholders, including scientists and patients, to shape the goals of the Institute, will require modification to best chart a path toward restoring normalcy within pediatric science.

COVID-19 research

This global pandemic once again highlights the importance of research, stable research infrastructure, and funding for public health emergency (PHE)/disaster preparedness, response, and resiliency. The stakes in this worldwide pandemic have never been higher as lives are lost, economies falter, and life has radically changed. Ultimate COVID-19 mitigation and crisis resolution is dependent on high-quality research aligned with top priority societal goals that yields trustworthy data and actionable information. While the highest priority goals are treatment and prevention, biomedical research also provides data critical to manage and restore economic and social welfare.

Scientific and technological knowledge and resources have never been greater and have been leveraged globally to perform COVID-19 research at warp speed. The number of studies related to COVID-19 increases daily, the scope and magnitude of engagement is stunning, and the extent of global collaboration unprecedented. On January 5, 2020, just weeks after the first cases of illness were reported, the genetic sequence, which identified the pathogen as a novel coronavirus, SARS-CoV-2, was released, providing information essential for identifying and developing treatments, vaccines, and diagnostics. As of May 3, 2020 1133 COVID-19 studies, including 148 related to hydroxychloroquine, 13 to remdesivir, 50 to vaccines, and 100 to diagnostic testing, were registered on ClinicalTrials.gov, and 980 different studies on the World Health Organization’s International Clinical Trials Registry Platform (WHO ICTRP), made possible, at least in part, by use of data libraries to inform development of antivirals, immunomodulators, antibody-based biologics, and vaccines. On April 7, 2020, the FDA launched the Coronavirus Treatment Acceleration Program (CTAP) ( https://www.fda.gov/drugs/coronavirus-covid-19-drugs/coronavirus-treatment-acceleration-program-ctap ). On April 17, 2020, NIH announced a partnership with industry to expedite vaccine development ( https://www.nih.gov/news-events/news-releases/nih-launch-public-private-partnership-speed-covid-19-vaccine-treatment-options ). As of May 1, 2020, remdesivir (Gilead), granted FDA emergency use authorization, is the only approved therapeutic for COVID-19. 2

The pandemic has intensified research challenges. In a rush for data already thousands of manuscripts, news reports, and blogs have been published, but to date, there is limited scientifically robust data. Some studies do not meet published clinical trial standards, which now include FDA’s COVID-19-specific standards, 3 , 4 , 5 and/or are published without peer review. Misinformation from studies diverts resources from development and testing of more promising therapeutic candidates and has endangered lives. Ibuprofen, initially reported as unsafe for patients with COVID-19, resulted in a shortage of acetaminophen, endangering individuals for whom ibuprofen is contraindicated. Hydroxychloroquine initially reported as potentially effective for treatment of COVID-19 resulted in shortages for patients with autoimmune diseases. Remdesivir, in rigorous trials, showed decrease in duration of COVID-19, with greater effect given early. 6 Given the limited availability and safety data, the use outside clinical trials is currently approved only for severe disease. Vaccines typically take 10–15 years to develop. As of May 3, 2020, of nearly 100 vaccines in development, 8 are in trial. Several vaccines are projected to have emergency approval within 12–18 months, possibly as early as the end of the year, 7 still an eternity for this pandemic, yet too soon for long-term effectiveness and safety data. Antibody testing, necessary for diagnosis, therapeutics, and vaccine testing, has presented some of the greatest research challenges, including validation, timing, availability and prioritization of testing, interpretation of test results, and appropriate patient and societal actions based on results. 8 Relaxing physical distancing without data regarding test validity, duration, and strength of immunity to different strains of COVID-19 could have catastrophic results. Understanding population differences and disparities, which have been further exposed during this pandemic, is critical for response and long-term pandemic recovery. The “Equitable Data Collection and Disclosure on COVID-19 Act” calls for the CDC (Centers for Disease Control and Prevention) and other HHS (United States Department of Health & Human Services) agencies to publicly release racial and demographic information ( https://bass.house.gov/sites/bass.house.gov/files/Equitable%20Data%20Collection%20and%20Dislosure%20on%20COVID19%20Act_FINAL.pdf )

Trusted sources of up-to-date, easily accessible information must be identified (e.g., WHO https://www.who.int/emergencies/diseases/novel-coronavirus-2019/global-research-on-novel-coronavirus-2019-ncov , CDC https://www.cdc.gov/coronavirus/2019-nCoV/hcp/index.html , and for children AAP (American Academy of Pediatrics) https://www.aappublications.org/cc/covid-19 ) and should comment on quality of data and provide strategies and crisis standards to guide clinical practice.

Long-term, lessons learned from research during this pandemic could benefit the research enterprise worldwide beyond the pandemic and during other PHE/disasters with strategies for balancing multiple novel approaches and high-quality, time-efficient, cost-effective research. This challenge, at least in part, can be met by appropriate study design, collaboration, patient registries, automated data collection, artificial intelligence, data sharing, and ongoing consideration of appropriate regulatory approval processes. In addition, research to develop and evaluate innovative strategies and technologies to improve access to care, management of health and disease, and quality, safety, and cost effectiveness of care could revolutionize healthcare and healthcare systems. During PHE/disasters, crisis standards for research should be considered along with ongoing and just-in-time PHE/disaster training for researchers willing to share information that could be leveraged at time of crisis. A dedicated funded core workforce of PHE/disaster researchers and funded infrastructure should be considered, potentially as a consortium of networks, that includes physician-scientists, basic scientists, social scientists, mental health providers, global health experts, epidemiologists, public health experts, engineers, information technology experts, economists and educators to strategize, consult, review, monitor, interpret studies, guide appropriate clinical use of data, and inform decisions regarding effective use of resources for PHE/disaster research.

Differences between adult and pediatric COVID-19, the need for pediatric research

As reported by the CDC, from February 12 to April 2, 2020, of 149,760 cases of confirmed COVID-19 in the United States, 2572 (1.7%) were children aged <18 years, similar to published rates in China. 9 Severe illness has been rare. Of 749 children for whom hospitalization data is available, 147 (20%) required hospitalization (5.7% of total children), and 15 of 147 required ICU care (2.0%, 0.58% of total). Of the 95 children aged <1 year, 59 (62%) were hospitalized, and 5 (5.3%) required ICU admission. Among children there were three deaths. Despite children being relatively spared by COVID-19, spread of disease by children, and consequences for their health and pediatric healthcare are potentially profound with immediate and long-term impact on all of society.

We have long been aware of the importance and value of pediatric research on children, and society. COVID-19 is no exception and highlights the imperative need for a pediatrician-scientist workforce. Understanding differences in epidemiology, susceptibility, manifestations, and treatment of COVID-19 in children can provide insights into this pathogen, pathogen–host interactions, pathophysiology, and host response for the entire population. Pediatric clinical registries of COVID-infected, COVID-exposed children can provide data and specimens for immediate and long-term research. Of the 1133 COVID-19 studies on ClinicalTrials.gov, 202 include children aged ≤17 years. Sixty-one of the 681 interventional trials include children. With less diagnostic testing and less pediatric research, we not only endanger children, but also adults by not identifying infected children and limiting spread by children.

Pediatric considerations and challenges related to treatment and vaccine research for COVID-19 include appropriate dosing, pediatric formulation, and pediatric specific short- and long-term effectiveness and safety. Typically, initial clinical trials exclude children until safety has been established in adults. But with time of the essence, deferring pediatric research risks the health of children, particularly those with special needs. Considerations specific to pregnant women, fetuses, and neonates must also be addressed. Childhood mental health in this demographic, already struggling with a mental health pandemic prior to COVID-19, is now further challenged by social disruption, food and housing insecurity, loss of loved ones, isolation from friends and family, and exposure to an infodemic of pandemic-related information. Interestingly, at present mental health visits along with all visits to pediatric emergency departments across the United States are dramatically decreased. Understanding factors that mitigate and worsen psychiatric symptoms should be a focus of research, and ideally will result in strategies for prevention and management in the long term, including beyond this pandemic. Social well-being of children must also be studied. Experts note that the pandemic is a perfect storm for child maltreatment given that vulnerable families are now socially isolated, facing unemployment, and stressed, and that children are not under the watch of mandated reporters in schools, daycare, and primary care. 10 Many states have observed a decrease in child abuse reports and an increase in severity of emergency department abuse cases. In the short term and long term, it will be important to study the impact of access to care, missed care, and disrupted education during COVID-19 on physical and cognitive development.

Training and supporting pediatrician-scientists, such as through NIH physician-scientist research training and career development programs ( https://researchtraining.nih.gov/infographics/physician-scientist ) at all stages of career, as well as fostering research for fellows, residents, and medical students willing to dedicate their research career to, or at least understand implications of their research for, PHE/disasters is important for having an ongoing, as well as a just-in-time surge pediatric-focused PHE/disaster workforce. In addition to including pediatric experts in collaborations and consortiums with broader population focus, consideration should be given to pediatric-focused multi-institutional, academic, industry, and/or government consortiums with infrastructure and ongoing funding for virtual training programs, research teams, and multidisciplinary oversight.

The impact of the COVID-19 pandemic on research and research in response to the pandemic once again highlights the importance of research, challenges of research particularly during PHE/disasters, and opportunities and resources for making research more efficient and cost effective. New paradigms and models for research will hopefully emerge from this pandemic. The importance of building sustained PHE/disaster research infrastructure and a research workforce that includes training and funding for pediatrician-scientists and integrates the pediatrician research workforce into high-quality research across demographics, supports the pediatrician-scientist workforce and pipeline, and benefits society.

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Department of Pediatrics, Division of Emergency Medicine, Boston Children’s Hospital, Boston, MA, USA

Debra L. Weiner

Harvard Medical School, Boston, MA, USA

Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

Vivek Balasubramaniam

Department of Pediatrics and Division of Neonatology, Maria Fareri Children’s Hospital at Westchester Medical Center, New York Medical College, Valhalla, NY, USA

Shetal I. Shah

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Joyce R. Javier

Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

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Pediatric Policy Council

Scott C. Denne, MD, Chair, Pediatric Policy Council; Mona Patel, MD, Representative to the PPC from the Academic Pediatric Association; Jean L. Raphael, MD, MPH, Representative to the PPC from the Academic Pediatric Association; Jonathan Davis, MD, Representative to the PPC from the American Pediatric Society; DeWayne Pursley, MD, MPH, Representative to the PPC from the American Pediatric Society; Tina Cheng, MD, MPH, Representative to the PPC from the Association of Medical School Pediatric Department Chairs; Michael Artman, MD, Representative to the PPC from the Association of Medical School Pediatric Department Chairs; Shetal Shah, MD, Representative to the PPC from the Society for Pediatric Research; Joyce Javier, MD, MPH, MS, Representative to the PPC from the Society for Pediatric Research.

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Weiner, D.L., Balasubramaniam, V., Shah, S.I. et al. COVID-19 impact on research, lessons learned from COVID-19 research, implications for pediatric research. Pediatr Res 88 , 148–150 (2020). https://doi.org/10.1038/s41390-020-1006-3

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research paper on covid 19 impact on business

REVIEW article

Covid-19 outbreak: impact on global economy.

\nSaira Naseer

  • 1 School of Economics and Management, Nanjing University of Science and Technology, Nanjing, China
  • 2 Department of Management Sciences, Kinnaird College for Women, Lahore, Pakistan
  • 3 Department of Obstetrics and Gynecology, Nishtar Hospital, Multan, Pakistan
  • 4 Riphah School of Business and Management, Riphah International University Lahore, Lahore, Pakistan
  • 5 Department of Finance, Babes-Bolyai University, Cluj-Napoca, Romania

COVID-19 has been considered the most significant threat since World War II and the greatest global health disaster of the century. Wuhan City, Hubei Province, China, reported a new infection affecting residents in December 2019. The Coronavirus Disease 2019 (COVID-19) has been named by the World Health Organization (WHO). Across the globe, it is spreading rapidly, posing significant health, economic, and social challenges for everyone. The content of this paper is solely intended to provide a visual overview of COVID-19 global economic impact. The Coronavirus outbreak is causing a global economic collapse. Most countries have implemented full or partial lockdown measures to slow the spread of disease. The lockdown has slowed global economic activity substantially, many companies have reduced operations or closed down, and people are losing their jobs at an increasing rate. Service providers are also affected, in addition to manufacturers, agriculture, the food industry, a decline in education, the sports industry, and of entertainment sector also observed. The world trade situation is expected to deteriorate substantially this year.

1. Introduction

Wuhan, China, reported 27 cases of novel pneumonia on December 31, 2019. The cause and origin of the novel pneumonia were unknown. Wuhan city, Hubei province, is a trendy industrial hub in central China, having a population of more than 11 million ( 1 ). Novel pneumonia patients experienced fever, dyspnea, and lung infiltrates on imaging and dry cough. The spreading of new unknown pneumonia related to Wholesale Seafood Market Wuhan, famous for trading bats, crocodiles, dogs, pigs, fish, snakes, marmots, and wild animal species poultry animals ( 2 ). A swab of the throat, taken on January 7, 2020, was analyzed by the Chinese Center for Disease Control and Prevention (CCDC) and was identified as Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). This disease is classified as COVID-19 ( 3 ). COVID-19 was designated a worldwide health emergency on January 30, 2020, with poor health systems most in danger.

The WHO didn't name the Chinese outbreak a pandemic, but it did call it a public health emergency. Amid the uncertain situation in Wuhan due to Cov-19, international trade and supply chains have been suspended, asset prices have been upended, and the decision-making process for multinational companies is challenging due to limited information. Central China's financial hub has been identified as Wuhan. Several of the world's 500 best companies are headquartered in Wuhan, including SAP, Microsoft, and Group PSA ( 4 ). In addition to being the country's most prominent steel and car producer, it is also a major trade and transportation hub. Economic development has outpaced China's national growth in recent years, with its GDP growing by 7.8% in 2019, rather than the national average of 6.1% ( 5 ). In response to the spread of this novel virus, business activities temporarily ceased, and numerous international firms evacuated their workers. The strict travel restrictions in Wuhan and different urban communities in Hubei are expected to harm global trade in China. Tourism, retail, and hospitality will all be negatively affected ( 6 ). More than 70 thousand cinema was closed in China ( 7 ); several airlines canceled flights from and to China, disrupting tourism and other activities. It is already beyond the Hubei borders that the novel virus is harming the economy. This influence severely causes stock markets to crash ( 8 – 10 ). The lockdown of Hubei province, with a population slightly smaller than the U.K. and France, threatened to hit the global economy was very exciting. Due to China's complete integration, after the United States, China is the second-largest economy, then the rest of the world. Global economic losses of $40 billion were estimated as a result of the SARS epidemic in China from 2002 to 2003 ( 11 ).

Currently, China's economic scale is 8–9 times higher than the epidemic of SARS. Financial experts worldwide say that the impact of COVID-19 on the world economy will be considerably vast in 2019. In 2019, China was estimated to contribute 39% to the global economy by the International Monetary Fund. Currently, China contributes 16.3% to the worldwide economy ( 12 ). It is suggested that the global economy was go-down if the nation's economy drops ( 13 ). As shown in Figure 1 , the Chinese economy has grown considerably from 2003 to 2019, contributing to the global economy.


Figure 1 . GDP growth in China and China's share of the global economy. Source: World Bank, OECD.

Due to the Lunar New Year holiday's extension, a sharp drop was seen in market value when China resumed its important businesses and industries on Monday, February 3, 2020. There was an 8.4% decline in the market value of the Shenzhen Composite, and a 7.7% decline was experienced by the benchmark Shanghai Composite, which is approximately a $375 billion decline in market value since August 2015; it is the sharpest 1-day decline in market value. The decline was also experienced in other businesses, such as transportation stocks, consumer services, and retail companies ( 14 ).

The 11 provinces of China, under strict control then, produced two-thirds of all the auto, the country's vehicles. Chinese auto parts are manufactured in these provinces, especially Hubei, for the South Korean market, Europe, and the United States. The experts believe there could be about 350 000 unit's production loss that might be possible if the production companies and manufacturing industries remain inactive until February 10, 2020. If the outbreak continues till the mid of March, this loss may be reached over 1.7 million, and it is expected that this decline could be reached up to 32.3% ( 15 ). Similarly, Standard & Poor's (S & P) believes that auto parts production in the United States may decline by 50%. Some automakers have expressed concerns about the shortage of auto parts. A lack of features in China has forced the Hyundai Motor Company to close its domestic factories. Automakers in the United States and Europe are similarly concerned that a shortage of spare parts could disrupt their business ( 16 ). Several industry analysts have forecast that China's automotive market will shrink. If the coronavirus outbreak continues into the second quarter, it will reach 3–5% in 2020.

According to the United Nations Tourism Organization (UNWTO) ( 17 ), China was a significant tourist source market during this outbreak and a major tourist destination. In 2019, approximately 6.3 million Chinese tourists traveled abroad for Lunar New Year, generating about US$73 billion in revenue. However, this number declined significantly in 2020 ( 18 ). According to reliable sources, this also substantially impacts tourism outside of China. Vietnamese tourism is expected to lose up to $ 7.7 billion in the first quarter due to cancellations of Chinese groups and the general economic downturn. In 2020, there will be an 80% decrease in Chinese tourists visiting Thailand, reducing Thailand's revenue by the U.S. $ 3.1 billion ( 19 ). Indonesia, Singapore, South Korea, Malaysia, Cambodia, Hong Kong, Japan, Australia, and other nations will be affected, in addition to Vietnam and Thailand ( 20 ).

The economic consequences of this outbreak are enormous in China and even around the world, considering the loss of trade, and tourism, rise in unemployment, industry recession, a decline in sustainability and quality of life, the decline in the education sector, and the effect on the agriculture industry, impact on the food industry, the fall of the sports industry, deterioration of the entertainment sector, and aspects of the global supply chain. In the first quarter, Bloomberg Market Diagnosis predicts China's GDP growth will fall by 4.5%. Global GDP is expected to decline by about 0.42% in the first quarter due to the outbreak, as shown in Figure 2 ( 21 ).


Figure 2 . Growth deviation in percentage points from Q1 2020. Source: Bloomberg economics.

2. Methodology

The research mainly included reviewing previous studies and determining COVID-19's global economy hit. According to experts, the virus disrupted global supply chains and closed industries. This interruption impacts worldwide demand and production. The research methods included a review of previous studies, determining global recession due to the natural disaster, and determining vital economic indicators, such as the rise in unemployment, the industry hit hard by the recession, the slump in manufacturing activity, a bad year for trade, the global economy shrinkage in 2020, the decline in Sustainability and Quality of Life, the decline in Education Sector, resultant Effects on the Agriculture Industry, and reduction in the entertainment sector. In addition, as explained in Figure 3 , the search approach was used for this research topic. In this study, many research databases were consulted to search for relevant papers and download them from the database (Google Scholar, Scopus Index Journals, Emerald, Elsevier Science Direct, Springer, and Web of Science). Our primary emphasis was on items published in academic publications, including research articles, feedback pieces, brief remarks, discussions, BBC news, world bank source, and review articles. The reports were utilized to search for numerous keywords, such as “impact of COVID-19 internationally,” “impact of COVID-19 on a macro level,” and “spillover effects of COVID-19 on micro-level globally,” etc.; in summary, a keyword list and the complete text have been created. In the beginning, searching for keywords produced a significant volume of published material.


Figure 3 . Methodology search for finalized articles for investigations. Source: Author's constructed.

Since 2020, it has been challenging to assess all papers; the literary display has constraints. The research searched 92 articles in the database mentioned above. It removed 39 irrelevant publications since they were copied from a previous search. The framework consists of two things:

(i) Articles focused on “Global COVID-19 Impacts, impact on the global economy, and sustainable mitigation strategies.”

(ii) Search phrases linked to study requirements.

Our search produced 60 articles. We scan “Web of Science and Google Scholars” to improve search results and verify cited papers. This study analyses 60 papers' research subjects, techniques, settings, and theories explained in Figure 4 . This study explores connected domains to provide future research prospects.


Figure 4 . Framework of the study. Source: Author's constructed.

3. The global economy hit by coronavirus pandemic

Johns Hopkins University data shows that as a result of the coronavirus, 270 million people have been infected, and 190,000 have died. Several countries and cities worldwide have prevented the virus from spreading further. Some measures include closing borders, shutting down schools and workplaces, and prohibiting huge gatherings. Global economic activity was halted by the “Great Lockdown” due to the global financial crisis, harming businesses and causing job losses. “We are facing a real global crisis since no country is immune,” IMF chief economist Gita Gopinath wrote earlier this month ( 22 ). Some facts and graphs illustrate how the Coronavirus epidemic has affected the global economy.

3.1. The rise in unemployment

In some economies, the number of unemployed has increased due to global lockdown measures, as shown in Figure 5 .


Figure 5 . Coronavirus padamic hit jobs. Source: Bureau of Labor Statistics of the U.S.; National Bureau of Statistics of China, Deutsche Bundesbank, Australian Bureau of Statistics, Statistics Korea, Refinitiv.

In the U.S., the world's biggest economy, almost 26 million jobs have been lost in the previous 5 weeks ( 23 ). Unemployment in March topped 4.4%, the highest level since August 2017. It is not limited to the United States. There has also been increased unemployment in Australia and South Korea, and some economists believe this trend will continue.

3.2. The industry hit hard by the recession

Numerous significant economies, notably the United States and China, depending on the service industry for employment and economic development. During the Pandemic, many stores closed, and customers stayed home due to a lockdown imposed by both countries. Amazon and some other retailers reported an increase in online sales, but this did not stop the decline ( 24 ). Despite lifting the locking measures, economists warn that consumers may not regain their consumption. Even after China allowed companies to reopen gradually, analysts at the Oxford Economic Research Institute observed that China's retail industry did not improve rapidly, as illustrated in Figure 6 .


Figure 6 . Plunge in retail sales. Source: U.S. Census Bureau, National Bureau of Statistics of China, Refinitiv.

Reports indicate that consumer spending will not return immediately after restrictions are lifted due to the slow improvement in household spending. According to IHS Market, the global service industry, transportation, real estate, and business activities in the travel and tourism industries show significant decline ( Figure 7 ).


Figure 7 . Services activity in major economies. Source: IHS Market, Caixin, au Jibun Bank, Refinitiv.

Growing economies tend to create more wealth and jobs. It is measured as the change in the overall value of goods and services produced over 3 or 12 months. In 2020, the IMF predicted a 4.4% contraction in the global economy. According to analysts, this will be worse than the Great Depression. Among the major economies, China was the only one to grow in 2020. Its growth rate was 2.3%. According to the IMF, global growth is expected to be 5.2% in 2021. India and China are expected to lead the way with growth of 8.8 and 8.2%, respectively. The recovery is expected to be slow in the U.K. and Italy, two big, services-reliant economies that have been hit hard by the outbreak ( Figure 8 ).


Figure 8 . Majority of countries in recession. Source: IMF.

3.3. The slump in manufacturing activity

Manufacturers have been impacted by the trade war between the U.S. and China for the past two years and have been under pressure again while the coronavirus spreads worldwide (see Figure 9 ).


Figure 9 . Manufacturing in significant economies. Source: IHS Market, Caixin, au Jibun Bank, Refinitiv.

Due to the COVID-19 epidemic, non-Chinese firms that received their raw materials or components from Asian vendors (sometimes known as “intermediate products”) were impacted. However, due to the authorities' efforts to contain the virus, the operation of the Chinese plant was suspended for longer than expected. Lockdown measures have hit more and more manufacturing companies as more and more countries implement them. A few are forced to close temporarily, while others are restricted from accessing intermediate materials and goods. In addition, a reduction in commodity demand has made manufacturing more challenging. As shown in Figure 10 , the production of U.S. factories in Europe and Asia declined in the past month.


Figure 10 . Coronavirus impact on factory output. Source: U.S. Federal Reserve, National Bureau of Statistics of China, Refinitiv.

3.4. A lousy year for trade

In 2020, it was expected that global trade would slow even more than it has in 2019. An anticipated decline in merchandise trade is shown below (see Figure 11 ).


Figure 11 . Decline in merchandise trade. Source: World Trade Organization forecast.

The World Trade Organization forecasts that global trade could decline by 12.9 or 31.9% this year, depending on how global economic conditions develop ( 25 ). According to the WTO, imports and exports in all regions will decline by double-digits in 2020.

3.5. The global economy shrinkage in 2020

Numerous institutions have drastically reduced their global economic forecasts due to the Coronavirus pandemic. Global economic contraction is expected to reach 3% this year, according to the International Monetary Fund ( 26 ). Figure 12 shows only a few economies (including China and India) will grow in 2020.


Figure 12 . Economic forecasts (2020). Source: IMF World Economic Outlook.

Although the economy is expected to bounce back next year, the recovery will only be a part of the reason because the level of activity will be lower than in 2021 before the virus hit” ( 27 ). In 2020 and 2021, the pandemic crisis may cause the global economy to lose nearly $9 trillion, more than Japan and Germany combined.” wrote the organization's chief economist Gopinath.

3.6. The decline in sustainability and quality of life

Politics, ecology, and the economy influence sustainable development ( 28 ). These factors also dictate how people should live so future generations may experience the same quality of life. According to Garfin et al. ( 29 ), tiny changes in human existence steadily impact the future. The future generations will not recognize the changes in their lives as a response to change; they will assume that individuals before them had comparable lives. The COVID-19 Pandemic has altered human existence's political, environmental, and economic elements, which affect psychological growth and sustainability. This impacts people's living standards and quality of life. The COVID-19 era resulted in social problems and international crises in the early 2020's ( 30 ). According to Arden and Chilcot ( 31 ), progress and development have halted, and the epidemic has disrupted the financial stability of industrialized and developing nations. COVID-19 measures such as social isolation and locking up reduce the quality of life because of the resulting stress and sadness ( 32 ).

Most people are losing employment and money worldwide ( 33 ). Profit margins and sales have fallen. Many nations have created methods to rescue their economies and populations' mental health from the epidemic, although regaining economic stability will take years. COVID-19 and related crises have harmed mental health, particularly among job losers. Employees' mental health is damaged by their unpleasant, contentious relationship with the company. The international economy has stopped, and millions have perished as COVID-19 caused unemployment, illness, and despair. The coronavirus triggered a large-scale psychological experiment that would impact life. Knowing that the Pandemic harms mental health reduces life quality and motivates prevention. Sustainable management improves worker wellbeing, according to Topa et al. ( 34 ). Anxiety, stress, and exhaustion affect behavior ( 35 ). Lockdown endangers lives; on the other hand, PTSD, hunger, and mental issues are rising. COVID-19 kills people.

3.7. The decline in education sector

Coronavirus outbreak affects global schooling. Due to the coronavirus outbreak, several educational institutions closed worldwide (“Impact of Coronavirus Pandemic on Education,” 2020). According to Education UNESCO ( 36 ), over half of the world's students were affected by Worldwide closures observed by the United Nations Educational, Scientific, and Cultural Organization (UNESCO). This event severely disrupted many students' academic and professional ambitions; consequently, coronavirus damaged over $600 billion in businesses. In 2020, educators and students throughout the globe felt the rippling impact of the coronavirus as institutions and universities were urged to close.

On the whole, 44 countries on four continents had school cancellations, affecting hundreds of millions of pupils. Schools without an online learning platform were disproportionately affected. Moody's lowered the U.S. higher education outlook from stable to “negative” because 30% of U.S. colleges and universities already had inadequate operational performance, and it was difficult for them to react to the financial and academic reforms needed to deal with the coronavirus pandemic ( 37 ). As the coronavirus pandemic developed seriously in Italy, France, and Spain, several U.S. universities urged study-abroad students to return home. However, the epidemic encouraged online and remote learning, while only a minuscule proportion of the world's education is taught online ( 38 ). COVID's worldwide influence was considerable, according to UNESCO data showed that by 2021. The COVID pandemic impacted around a 10.5 million learners worldwide, or 0.7% of all registered students, yet there was only one country-wide learning shutdown by 2021 ( 39 ). In the first quarter of 2022, 6 country-wide closures and 43.5 million impacted students, or 2.8% of all registered students. This caused students to have more debt, take longer to graduate, and break their academic dreams during COVID-19 from 2020 to 2022 ( 40 ).

3.8. Resultant effects on the agriculture industry

Due to the COVID-19 epidemic, the resiliency of the agriculture industry has been put to the test. The cost of agricultural goods has decreased by 20% due to a worldwide slump in demand from hotels and restaurants. Nations have implemented several preventative measures over the globe to halt the rapidly escalating spread of the disease ( 41 ). This involves separating oneself from their social circle, minimizing the amount of needless travel one does, and not attending any churches. If people are urged to self-isolate after contacting suspected virus carriers, the number of available inspectors and delivery workers may be affected ( 42 ). This will have significant repercussions for perishable products, such as food that is high in fat and protein, such as meat and vegetables. In addition, markets have taken matters into their own hands by prohibiting floor trading, which has harmed the capability of commodities exchange ( 43 ). One example from more recent times is the Chicago Mercantile Exchange. “Panic purchasing” complicates shortages beyond what's available in supermarkets. Concern has been voiced by the American Veterinary Medical Association (AVMA) over the inadequate supply of animal medications made available by several prominent drug suppliers.

3.9. The decline in travel and tourism

The hotel business has also suffered from COVID-19's travel ban. Community lockdowns, social isolation, stay-at-home orders, and travel and mobility limitations have led to the temporary closure of numerous hospitality enterprises and diminished demand for those permitted to continue operating ( 44 ). The coronavirus has affected hospitality the most. Hourly employees in the hospitality and tourism industries faced severe difficulties due to the economic downturn. Marriott International, which has around 174,000 employees, furloughed tens of thousands of those people. In addition, Hilton Worldwide informed its lenders on March 5, 2020, that it would be borrowing a precautionary $1.75 billion as part of a revolving loan ( 45 ). This move was made to save money and to keep the company's flexibility” in light of the volatility in the global markets. The U.S. hotel industry's income per available room declined by 11.6% on March 7, 2020, while China's occupancy rates plunged 89% by January 2020 ( 44 ). Other U.S. hotel corporations want $150 billion in direct employee help, owing to a drop in demand and a $1.5 billion loss since mid-February ( 46 ). Since March 1, 2020, German hotel occupancy has dropped 36%. Rome's occupancy rate is 6%, whereas London's is 47% ( 47 ). The COVID-19 crisis has caused worldwide distortions in the hospitality sector and the European hotel market slumps.

3.10. Effects on the food industry

Due to consumer purchasing during COVID-19, the food industry has been under much pressure, particularly in food delivery and retailing. The food supply chain affected farmers, distributors, consumers, and labor-intensive food-processing businesses. Many factories restricted, halted, or temporarily ceased production owing to COVID-19 employees who were unwilling to go to work, assuming they would become sick at work, mainly in meat-processing food firms during the epidemic ( 48 ). Because of this, there was a growing fear that there may be a scarcity of food, and panic purchasing has led to an increase of £1 billion worth of food stored in households throughout the United Kingdom ( 49 ). The rising demand for food goods has also impacted online meal delivery. In addition, food banks have been affected by people shopping in a panic and storing food in response to the decline in contributions ( 50 ). Despite government assurances, businesses have made substantial adjustments, including limiting the number of products consumers might purchase, creating more than 30,000 new jobs to refill shelves, and introducing special shopping hours for the elderly, vulnerable populations, and NHS goods ( 51 ).

3.11. The decline of the sports industry

COVID-19 influenced the scheduling of athletic events, including some of the biggest competitions in the sport's history. The highly anticipated football event, Euro, was pushed back a year, and the playoffs won't occur until at least June of the following year ( 52 ). The athletes and their nations agreed to postpone the games until 2021. Many tournaments, including the British Open, were canceled or moved. Pandemic cancellations cost billions ( 53 ). Tokyo's Olympics and Paralympics were postponed. The 2020 English hockey games were postponed. MLR's 2020 season was canceled, and all MLB season games in Mexico and Puerto Rico were canceled ( 54 ).

Due to the Portuguese government's declaration of an emergency, all sports activities will be postponed until further notice. The World Snooker Championship scheduled to take place in Sheffield has been delayed ( 55 ). The 2020 European Aquatics Championship in Hungary was postponed until August. Sponsors and organizers of the aborted games lost billions. In 2021 and 2022, numerous nations restarted sports, but the number of participants at sports arenas was limited, and face masks were required.

3.12. The decline of the entertainment sector

Pandemic affected cinema, theater, and entertainment. The 2020 coronavirus pandemic cost the entertainment industry $5 billion in losses, and several Hollywood films delayed their release. Consequently, most of the 120,000 below-the-line entertainment jobs lost were stage roles. The shutdown lost 150,000 members and 120,000 jobs, and the IATSE requested the government to include the entertainment industry in its stimulus package ( 56 ). From February 23 to March 1, 2020, the COVID-19 epidemic in Italy cost millions of euros every week. Film screenings, theaters, live music, dancing, and exhibits lose money (Khan et al., 2022). Collectively, unemployment in the entertainment business surged to new highs, but it was uncertain whether it would receive government stimulus funding. Some senators contended that the entertainment business contributes less to the economy than the finance and industrial sectors ( 57 ). Entertainment activities resumed in 2021 and 2022, but the industry's performance didn't approach pre-COVID levels due to weak economic recovery. 221,762,724 and 498,162,785 tickets were sold in 2020 and 2021, compared to 1,314,169,169 and 1,225,910,803 in 2018 and 2019. COVID reduced the number of moviegoers by 83%. In 2020 and 2021, box office revenue was $2,033,566,047 and 4,568,154,099. In 2018 and 2019, it was $11,972,083,658 and 11,229,345,558. Film revenue plummeted by 83.1% under COVID over pre-COVID ( 58 ).

4. Challenges and mitigation strategies

The suggested study approach advises concentrating on economic policies that have extended the medical crisis and combining monetary, industrial, and other sectors to settle worldwide and financial market issues. Figure 11 illustrates the study's structure and topics.

4.1. Policy challenges

Economic analysts have used aggressive strategies to handle short-term irregularities in nations that can endure the outbreak without fabrications. The rapid evolution of the global health catastrophe into international corporate trade and economic calamity has left experts throughout the globe stunned. As the epidemic's fiscal effect develops, analysts concentrate more on immediate monetary repercussions than longer-term factors like debt accretion. Due to the poor elasticity of budgetary and financial assistance under conservative criteria, many strategists have limited their ability to react to the present crisis, given the recent drop in global economic growth, mainly production and trade, since the flu pandemic began influencing international policymaking. Initially, the Pandemic's fiscal effect was anticipated to be a temporary supply of items as employees self-quarantined via social interaction to reduce the outbreak's breadth. As corporations store cash, these growing financial impacts may create liquidity and credit limitations in international monetary markets and hurt economic development. Some viewers wonder whether these economic undercurrents portend full-scale worldwide financial difficulties.

According to the World Bank's Global Economic Prospects report from June 2021, some impoverished countries and rising economies are still battling COVID-19. Two-thirds of emerging markets and developing economies won't recoup per capita income losses by 2022. The Pandemic has reversed poverty-reduction benefits and created insecurity in low-income nations where vaccinations have lagged. Many countries had already pledged or implemented steps to help epidemic-affected economies. These nations decided on the kind of help to give (loans vs. direct payments), the amount needed, and how to define resources and financing conditions if any. Several governments have taken surprise fiscal and monetary measures to fight the crisis ( 59 ). These economies lack financial resources, and the medical care system is overworked and vulnerable. The downturn or upcoming recession harms all nations; thus, global leaders must overcome COVID-19's consequences on their economies quickly and aggressively. Therefore, according to Fernandes ( 60 ), global action is required to lay down a proposed framework with international cooperative macroeconomic policies to restore confidence and address the feasible solution to the post-COVID crisis barriers to overcome the expected great recession by using collective action with the following research questions ( Figure 13 ).

• How can governments negotiate and cooperate to overcome severe revenue declines, strains on public budgets, and the prospect of sovereign evasions and a 2021–2025 recession?


Figure 13 . The proposed study framework for significant development. Source: Author's development.


Figure 14 . Sectorial impacts of climate change with adaptation and mitigation measures. Source: Author's constructed.

4.2. Mitigation strategies

Immediate and decisive policy actions are required not just to control the epidemic and save lives but also to safeguard the most vulnerable members of our society from economic disaster and maintain economic development and financial stability factors shown below in Figure 14 .

4.3. Fiscal issues

Wealthy nations have launched massive health and public expenditure measures to combat the COVID-19 epidemic. Poorer countries have fewer fiscal and monetary alternatives, and international organizations may aid. Most wealthy countries have ramped up expenditures and used monetary policy to soften the shock of lockdowns and other measures that have closed enterprises and left many jobless. But underdeveloped nations, beginning to react more vigorously, may have fewer alternatives. Plan, coordinate, and execute a business continuity plan for COVID-19. According to Building a Resilient Recovery: How We Can Emerge Stronger from the COVID-19 Pandemic, Ensure revenue collection and agency operations to fund and manage crisis responses.

4.4. Policies for macroeconomics and development

National authorities and multilateral organizations worldwide are exploring extraordinary policy steps in response to the rising health crisis and dismal economic prospects. Central banks in developed and developing nations slashed interest rates, injected liquidity, and provided emergency financing for enterprises and families. About 60 monetary authorities have scored rates since the crisis began, typically in emergency meetings ( 61 ). Direct wage or income assistance measures may mitigate short-term socioeconomic consequences while retaining recovery capability. Tax deferrals, government-subsidized short-term labor, mortgage moratoriums, and immediate cash handouts are examples. Social assistance programs must target the elderly and those in vulnerable jobs during the crisis.

4.5. Manage vital supply and demand

Addressing fundamental supply and demand concerns may avoid shortages, price surges, and misery. Food and medication manufacturing and delivery need reliable transportation, energy, and communications. The crisis-management agency must form committees with the private sector and critical operators to assess daily the flow of essential products and services and the health of employees and vital people ( 62 ).

4.6. Foreign currency supply and demand

There is a good chance that the governments will have to limit foreign currency transactions to stop a run on the local currency caused by a rise in the amount of money in circulation. This is because a rise in the amount of money in circulation directly causes an increase in circulation. For the government to manage its foreign reserves effectively, it must be able to compute the cash flow required to fund the importation of food, medicines, energy, and other essential commodities for at least 6 months while also considering the flows of external debt.

4.7. International organizations have a significant influence

International organizations have authority in mediation, conflict settlement, peacekeeping, and penalties. They assist global health and monetary policies ( 63 ). COVID-19 showed how important international institutions are to our health, economy, and security. United Nations, World Bank Group, and other global and regional institutions' concerted, cohesive response to the crisis's socioeconomic repercussions. As noted above, international organizations must urge for more “unconventional monetary policies” integrated with fiscal stimulus in developing nations, providing them with policy latitude to determine how to do so. They should also push developing country leaders to create a central crisis office ( 64 ). We need international funding to limit the epidemic and protect the most vulnerable. International collaboration may improve results. The post-virus global economy will have slowed growth, increased fragility, and more division. The IMF, OECD, G7, G20, World Bank, and Regional Development Banks must back focused, efficient, and proven-to-work measures in economies that need them to deal with the health, economic, employment, and social effects of the Pandemic on workers in all sectors of the economy, including self-employed and non-permanent, casual, and informal workers, and all businesses, tiny and medium-sized ones (SMEs). The world economy needs to change right away in the real world.

4.8. Getting and making investments easier

The term “foreign direct investment,” abbreviated as “FDI,” has emerged as essential in providing developing nations with financial resources, employment, advanced technology, and managerial expertise. Several underdeveloped countries have reaped significant dividends from these investments in accelerated economic growth and improved overall quality of life. Foreign direct investment could be a big part of the money needed to reach the Sustainable Development Goals by 2030 in areas like basic infrastructure, food security, preventing and adapting to climate change, and health and education ( 65 ). To achieve this goal, governments need to improve the efficiency with which they attract private investment, direct that investment toward sustainable development sectors, and make the most of the economic, social, and environmental benefits that result from that investment.

4.9. Sector-specific policy implications

Upon the onset of the crisis, many economists felt unable to respond. The globally synchronized halt in economic growth, particularly in manufacturing and commerce that preceded the viral breakout was made possible by currency flexibility and consistent government backing ( 62 ). In addition to liquidity and credit market difficulties, the need for supply-side information has encouraged financial analysts to acquire this understanding. If a person loses their job, they might not be able to pay their mortgage or rent before banks offer credit deferment or a way to get money. Mortgage fraud could hurt the market for mortgage-backed securities, mortgage funds, and the economy's growth ( 60 ). Losses on the financial markets happen worldwide and pull people's wealth, especially pensioners with fixed incomes and people who own securities. Investors in mortgage-backed securities have sold some of their shares. Markets haven't always been able to handle traditional policy tools like financial aid. With this instability, it's hard to know how to fix the world economy.

1. Trust and demand recovery necessitate supporting macroeconomic measures in this situation. Employers may use the ETC to pay salaries. Companies may benefit from interest-free loans to offset lost revenue.

2. Despite its flaws, the healthcare business has earned a lot of money mass-producing masks, hand sanitizers, and surgical equipment. Another recession-hit company might make medical equipment. It lacks the required hospitals and quarantine facilities. Updating and dispersing medical facilities may reduce viral transmission.

3. Online buying is trendy and will rise despite the uncertain economy. COVID-19 has natural and long-lasting repercussions for social contact and entertainment, making the tourist business obsolete and leaving many jobless.

5. Conclusion

Multiple industries may be impacted by a disease outbreak, including the capital market, labor market, foreign trade, consumer spending, and production. Because of the lockdown and the risk of spreading the disease, it's taking longer to make things people need. The products' supply chain has been broken, and national and international businesses will lose money. Revenue growth is slowing down because of poor cash flow in the market. There have been thousands of job losses due to the shutdown of industries. A disruption of the production process in several sectors has also negatively affected the GDP of many countries. This article demonstrates the global economic impact of the COVID-19 Pandemic in a straightforward but vivid manner. The virus has claimed thousands of lives and posed considerable challenges to countries. Bloomberg economists say it's too early to know the disease's full impact because it hasn't reached its peak yet. Capital economists estimate that if urgent action is not taken to reduce Wuhan 2019-nCoV as soon as possible, the first quarter of this year can bring China losses of up to $ 62 billion. In comparison, the world will suffer over $280 billion. The World Bank estimates that even a weak influenza pandemic, such as the H1N1 outbreak of 2009, could reduce global GDP by half, or about $300 billion.

5.1. Future study recommendation

It is the right time and place to study the effects of COVID-19 on the global economy and monetary policy of different countries. Even though there are some problems, the research on COVID-19 may lead to many good things. This could lead to new ideas and tests. In light of the COVID-19 crisis, the hidden assumptions in current research need to be looked at separately. The present study provides a roadmap on the literature tying the COVID-19 Pandemic to worldwide harm, directing future research on this new topic. COVID-19 receives regular media attention, although its relationship to monetary and public policy literature is weak. Researchers and policymakers must work together to create additional COVID-19 research. It would assist handle current and future problems. COVID-19 has complicated economic, health, and societal repercussions, making it a sensitive subject. This article focuses on the essential concerns and issues related to COVID-19 to help scholars and policymakers comprehend its worldwide influence on diverse industries.

Author contributions

SN and KA contributed the ideas of the original draft. SN and SK wrote the introduction, literature review, and empirical outcomes sections. SP, HS, and MA helped to collect and visualize data of observed variables. SN, HS, and KA constructed the methodology section in the study. All authors contributed to the article and approved the submitted revised version.

This work was supported by a grant of the Romanian Ministry of Education and Research, CNCS - UEFISCDI, project number PN-III-P4-ID-PCE-2020-2174, within PNCDI III.

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.

Publisher's note

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

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Keywords: COVID-19, pandemic, sectors, mitigation strategies, global economy

Citation: Naseer S, Khalid S, Parveen S, Abbass K, Song H and Achim MV (2023) COVID-19 outbreak: Impact on global economy. Front. Public Health 10:1009393. doi: 10.3389/fpubh.2022.1009393

Received: 17 August 2022; Accepted: 27 December 2022; Published: 30 January 2023.

Reviewed by:

Copyright © 2023 Naseer, Khalid, Parveen, Abbass, Song and Achim. 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.

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

  • Open access
  • Published: 16 February 2024

A qualitative study examining the impact of COVID-19 on capacity for sustainability of tobacco control programs

  • Jessica Gannon 1 &
  • Sarah Moreland-Russell 1  

BMC Health Services Research volume  24 , Article number:  215 ( 2024 ) Cite this article

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The coronavirus (COVID-19) pandemic presented a significant stressor on the public health system in the United States. While we know the immediate effects of the pandemic on public health programming, no literature has examined the resultant long-term impact on programmatic capacity for sustainability. This paper aims to identify the impact that the COVID-19 pandemic had on state tobacco control program’s capacity for sustainability.

From December 2018 to January 2022, we conducted 46 technical assistance calls with tobacco control program employees from 11 states. Calls were audio recorded and professionally transcribed. We analyzed calls ( n  = 20) that took place during the COVID-19 pandemic. Thematic analysis focused on the impact the COVID-19 pandemic had on tobacco control program’s capacity for sustainability.

We identified six domains of sustainability that were impacted by COVID-19: (1) funding stability ; (2) organizational capacity ; (3) partnerships ; (4) c ommunication ; (5) strategic planning ; and (6) program adaptation .


Our study is the first to identify the impact of the pandemic on capacity for sustainability of tobacco control programs. Having an understanding of COVID-19’s influence on these sustainability domains could help with future public health programming during significant public health events and emergency preparedness.

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Retrospectively registered 02-07-2018.

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The coronavirus (COVID-19) pandemic presented a significant stressor on the public health system in the United States. In the emergent response to the pandemic, state and territorial health departments implemented aggressive measures to support coordinated pandemic mitigation efforts [ 1 , 2 ]. Nested within state and territorial health departments, state-level public health programs reallocated resources, including staff and funding, to support the aforementioned mitigation efforts. In addition to having to comply with new strict public health measures, the reallocation of resources limited and, in some cases, prevented the implementation of fundamental public health programming [ 3 , 4 , 5 ] potentially threatening the continuation and sustainability of some programs.

We define capacity for sustainability as the presence of structures and processes which allow a program to leverage resources to effectively implement and maintain evidence-based policies and activities [ 6 ]. In addition, the capacity for sustainability can be broken down into eight main domains as defined by the Program Sustainability Framework [ 6 ]. These domains include: organizational capacity, program evaluation, program adaptation, communications, strategic planning, funding stability, environmental support, and partnerships. The literature has documented several factors that effect fundamental public health programming across several of these domains. For instance, Pascoe et al. documented the effect of workforce turnover (organizational capacity) on evidence-based program sustainability [ 7 ]. In addition, Trust For America’s Health (a policy and research organization), annually documents the effect of consistent underfunding (funding stability) of public health programs [ 8 ]. The Program Sustainability Framework has been applied to numerous public health programs due to its applicability across areas at the local, state, and national levels [ 6 ]. For example, Tabak and colleagues [ 9 ] used the Program Sustainability Framework to perform a qualitative study exploring differences in high- and low-capacity local health departments. Another study [ 10 ] used the domains of the Program Sustainability Framework to explore the factors influencing the sustainability capacity of a coordinated approach to chronic disease prevention in state and territory health departments using a mixed-methods approach. Their qualitative interviews indicated that leadership, communications, partnerships, funding stability, and policy change were perceived as keys to success of the transition to a coordinated approach to chronic disease management. In addition, state tobacco control programs have been encouraged to use the framework and its corresponding assessment tool to create their sustainability plans as required by the Centers for Disease Control & Prevention (CDC)’s Office on Smoking and Health [ 11 ].

Among tobacco control programs, the framework has been used to assist states in program sustainability planning [ 12 ]. This process has helped state level tobacco control programs determine which program components were necessary to maintain the program and sustain its benefits over time. Across these planning events, states have highlighted a number of domains in which they needed to focus their efforts, including communications, program adaptation and environmental support.

While we know the immediate effects of the pandemic on public health programming, no literature has examined the resultant long-term impact on programmatic capacity for sustainability. It is important to understand the threats to sustainability so that programs can better plan for and re-build their capacity for sustainability long term. This paper aims to identify the impact that the COVID-19 pandemic had on state tobacco control program’s capacity for sustainability. The findings from this study will help public health programs plan for and mitigate disruption across sustainability domains during future public health emergencies to ensure ongoing effectiveness and sustainability of their programs.

The present work is part of a larger study titled the Plans, Actions, and Capacity to Sustain Tobacco Control (PACT) study. The PACT study sought to build capacity for sustainability of evidence-based state tobacco control programs (TCPs) through in-person action planning training and access to ongoing technical assistance from our research team [ 13 ]. Evidence-based state TCPs are defined as the comprehensive efforts implemented in each state to fulfill requirements outlined in the Best Practices for Comprehensive Tobacco Control Programs—2014 [ 14 ]. This includes five main components: 1. State and community interventions; 2. Mass-reach health communication interventions; 3. Cessation interventions; 4. Surveillance and evaluation activities; and 5. Infrastructure, administration, and management. The in-person action planning trainings took place during 2018 and 2019. Each state participating in the training was asked to include TCP staff and stakeholders (i.e. advocates, coalition members, volunteers, community based organizations, academics, etc.) who can represent the many aspects of the comprehensive tobacco control program. During these trainings, participants actively engaged in developing a sustainability action plan specific to their state TCP. These sustainability action plans included domain-specific objectives from the Program Sustainability Framework and included time-sensitive activities to be carried out by present stakeholders. The plans were designed to be implemented during the two years following participation in the training. The trainings followed the same structure, but were tailored to each state based on the chosen domain for their action plan. Following the in-person training, state TCPs received on-going technical assistance to trouble-shoot the action plans they designed and provide resources to continue their progress. As part of the provided technical assistance, we conducted 46 calls with TCP employees from 11 states. These calls took place over the phone or through Zoom from December 2018 to January 2022. In addition, from April 2020 through January 2022, we conducted a qualitative phenomenology to assess the potential effects of the pandemic on sustainability planning. Specifically, we added, “ How has the COVID-19 pandemic impacted the overall sustainability of your TCP? ” and “ Have the challenges you’ve experienced in implementing your sustainability action plan been a result of the COVID-19 pandemic, or were they present prior to COVID-19? ”

We recorded audio of the calls and had them professionally transcribed through rev.com. We obtained informed consent from participants prior to recording the calls and received ethical approval for this study from the Washington University in St. Louis Institutional Review Board. All the methods included in this study are in accordance with the declaration of Helsinki.

Study participants

The PACT study used four criteria to select state TCPs to participate in the randomized control trial: policy progress, resources, need, and previous participation in a sustainability action planning training. States were randomized into control or intervention by stratifying the 50 states in the US into quadrants based on the states’ needs (adult smoking rates) and their tobacco control policy environments (American Lung Association’s (ALA) smoke-free scores, 2015) [ 15 ]. Three states with different degrees of funding (percentage of CDC recommended funding level actually spent) [ 16 ] were selected from each quadrant. We then selected the closest match for each state based on the same three characteristics. Each pair was randomized into control ( n  = 12) or intervention ( n  = 12). One intervention state dropped out of the study, leaving eleven intervention states (AL, FL, HI, ID, IL, MI, MS, NH, NJ, OH, and UT). Vitale et al. [ 13 ] provides additional details about state selection and recruitment. For the purposes of this study, we focused on the ten intervention states who participated in technical calls during the COVID-19 pandemic. For our technical assistance calls with state TCPs, we asked to speak with the individual most knowledgeable about their state’s work on building capacity for sustainability. This was generally the TCP director or program manager.

Technical assistance call interview guide development

The semi-structured technical assistance (TA) call interview guide focused on the progress, changes, and challenges experienced in implementing the sustainability action plan, as well as resources needed by states to move forward with their action plans. The TA call interview guide primarily included open-ended questions followed by specific questions to garner a more detailed response from participants. The TA call interview guide questions were refined with input from the research team. Prior to the calls, we provided participants with the TA call interview guide questions. A full list of TA call interview questions can be seen in Table  1 .

Data analysis

We conducted a thematic analysis of the qualitative responses using a deductive approach, in which the authors referenced their codebook to guide the process. The codebook consisted of four parent codes and sixteen sub-codes. We used these codes to inform emerging themes. We uploaded the transcribed TA calls to NVivo 20 software for coding. Three researchers coded transcripts until they achieved acceptable levels of inter-rater reliability [ 17 ] (kappa = 0.72). The remaining transcripts were coded by a single coder who identified and summarized themes using an inductive approach. Themes were reviewed by another researcher to ensure that they worked in relation to the coded data. For the purposes of this study, we analyzed TA calls that took place during the COVID-19 pandemic ( n  = 20) and we focused on the primary codes regarding the impact the COVID-19 pandemic had on tobacco control program’s capacity for sustainability. We used the Program Sustainability Framework [ 6 ] to structure the final themes and sub-themes presented in this paper.

Each state received an average of 2 calls/year during their two years of participation in the study. The average number of transcripts for each state during the COVID-19 pandemic was 2 with a range of 1 to 3. Our calls lasted an average of 31 min. Main themes aligned with domains from the Sustainability Framework that emerged from TA calls regarding the impact COVID-19 had on tobacco control program’s capacity for sustainability: (1) funding stability ; (2) organizational capacity; (3) partnerships ; (4) communication ; (5) strategic planning ; and (6) program adaptation .

Funding stability

Funding stability involves creating a stable financial base that withstands changes in economic and political cycles [ 6 ]. Our thematic analysis showed that state TCPs endured challenges with funding stability throughout the pandemic, including concern for future budget cuts and difficulty spending down their regular program budget due to COVID-19.

Concern for future budget cuts due to COVID-19

Respondents reported being concerned that their TCP budget would be reduced due to the pandemic. They shared feelings of apprehension around how their state would cover the increased costs associated with the pandemic.

… COVID has changed so much and there are just so many unemployed and so much money is going toward that right now… But when the state is looking where to pay its bills, they look at special funds. Those are things that they might be able to cherry pick like, “Do we really need to do this?”

Difficulty spending down regular program budget due to COVID-19

Respondents also reported having difficulty spending down their regular program budget because they were not carrying out their usual programming during the pandemic.

The challenges of spending down your budget when you can’t engage people.

Some states proactively created messaging to their state legislature about the importance of keeping their TCP funded despite having a surplus of money left over at the end of their fiscal year.

I’ve been working with our bureau director and some of our other partners on messaging for this, just the importance of don’t cut funding. This was a special year, it was a different year, if there’s unspent funds or underspending when it comes to specific tobacco things, that’s not a reason to cut any funding from the programs.

Organizational capacity

Organizational capacity involves having the resources and support needed to manage your program effectively [ 6 ]. A number of our findings about the impact of the COVID-19 pandemic on TCPs aligned with the organizational capacity domain; specifically it being difficult to do tobacco control work due to staff working on COVID-19 duties; hiring freezes due to COVID-19; and COVID-19 impacting service delivery at the local level.

Difficult to do tobacco control work due to staff working on COVID-19 duties

Many state TCPs felt their organizational capacity was diminished as they focused their efforts on COVID-19 response work, rather than tobacco control work.

And the tribes that we work with have been impacted pretty heavily. All the tobacco coordinators at one point in time were or still are in full COVID-19 response. And so their work has… There hasn’t been as much as there would normally be. One of our epidemiologists has been assigned to COVID since March, full-time. And our second epidemiologists, we had two, was assigned full-time to COVID until just a couple of months ago. So a lot of our stats are down.

Hiring freezes due to COVID-19

During the pandemic, some state health departments were on hiring freezes in an effort to curb discretionary spending within their states. Due to these hiring freezes, TCPs were not able to fill vacant positions and thus had lower organizational capacity to carry out their work.

So, it’s kind of like a both ends situation. COVID presented us with a set of problems where we were on a hiring freeze, and I couldn’t hire for the position for quite some time. And I had to develop a work around to initiate a hiring process for this position, because it was very critical to our program.

COVID-19 impacted service delivery at the local level

Other state TCPs reported the impact of the COVID-19 pandemic on organizational capacity was primarily at the local level, rather than the state level.

I think COVID has impacted service delivery at the local level more than it has at the state level… Definitely we’re stretched a little bit thin… but on average, I would say it hasn’t really affected service delivery. At the local level where they are having to do a lot more of the contact tracing and COVID relief efforts, my understanding is that some health districts have been impacted more severely than others… .


The partnerships domain is defined as creating connections between a program and its stakeholders [ 6 ]. Partners play a vital role in program sustainability, by making connections for programs, serving as champions during adversity, and filling in gaps in services. Findings from our thematic analysis indicate challenges with the partnerships domain including local health department partners were pulled into COVID-19 response work; priorities of external partners were not on tobacco control; and difficulty keeping external partners engaged while being virtual.

Local health department partners pulled into COVID-19 response work

State TCPs noted that staff from their local health departments were assigned to work on COVID-19 response.

… chronic disease was pulled in almost immediately into COVID response. And so, that impacted all of my staff and their ability to do this work, but a lot of our partners have been pulled in too. So, our local health department’s staff that typically we would be just paying to do tobacco work have been reassigned to COVID work… it definitely derailed the work over the last year honestly.

Priorities of external partners were not on tobacco control

Additionally, respondents shared that it was difficult to engage their external partners because their priorities were not focused on tobacco control.

It’s just more of a challenge now too with COVID because I know everybody has their own priorities, to keep those new partners engaged and active so we’re still working to do that. And somehow even in this COVID environment, revitalize the efforts of the [Organization] and get people energized and interested in participating again, so that’s an ongoing thing that we’re dealing with.

Difficulty keeping external partners engaged while being virtual

Partner engagement also suffered due to the virtual work environment. Respondents reported it was difficult to maintain partnerships while working remotely.

I think the hardest thing is maintaining partners in the virtual environment… people are feeling their partnership’s weakening… I think that’s really what there’s a real need for in terms of how to utilize the virtual environment and make it work for you to maintain your partnerships.


The communications domain was also impacted by the COVID-19 pandemic. In our review of themes associated with the communications domain, difficulty keeping tobacco control on the public health agenda as a priority and using communications as a strategy to maintain tobacco as a public health priority aligned with our findings.

Difficulty keeping tobacco control on the public health agenda as a priority

In addition to keeping tobacco control a priority among partners, respondents also reported having difficulty communicating that tobacco control was still a priority within public health despite the pandemic.

…we are having a hard time, and I think that this is the sentiment across many states at the state and local level, with communication and communication messaging to keep tobacco control as a priority in the midst of COVID. With a lot of staff at the local level being reassigned to COVID related activities, and some of our partners shifting priorities to address COVID more than maybe some of their other chronic disease program, it’s becoming very difficult to stress the importance of tobacco control.

Using communications as a strategy to maintain tobacco as a public health priority

To combat the lack of priority given to tobacco control, some state TCPs focused their communication efforts on the link between tobacco control and COVID-19.

So, we’ve been doing quite a bit of media lately, but it’s been paid media. My team is very much so interested in elevating the message between the linkage with COVID and tobacco, because COVID has definitely been overshadowing, like I said, the chronic disease areas, and it’s almost as if tobacco isn’t even a risk factor. Right?

Strategic planning

The strategic planning domain is defined as using processes to guide a program’s directions, goals, and strategies [ 6 ]. One theme associated with this domain, delaying strategic planning due to COVID-19, aligned with our findings.

Delaying strategic planning due to COVID-19

Respondents reported that the COVID-19 pandemic pushed some TCPs to delay their strategic planning process. Respondents noted that it would be possible to carry out the strategic planning process virtually, but saw benefit in waiting until they could have their first meeting in-person.

And I will also take a step back and say, we’re due to have our state tobacco plan updated and we’ve not pursued that because we really feel like it will be important to have a kickoff meeting for that that’s in person. We know you can do it virtually, but if we are willing to wait another six months or even year, we just feel like it’ll be so much more fruitful to be able to do that.

Program adaptation

In our review of themes associated with the program adaptation domain, difficulty adapting school programs; adapting program related communications; and planning for future program adaptation aligned with our findings.

Difficulty adapting school programs

Respondents reported challenges in adapting their school-based programs to meet the ever-changing academic schedules carried out during the pandemic.

So it’s been difficult to maintain interaction with the youth in schools during this time, with the fluctuating schedules and the same thing for community engagement. I see that one with our community coalitions, they’re continuing to do their work and they’re following virtual formats wherever necessary, but that has been a challenge for us as well and we knew it would be a challenge.

Adapting program related communications

Additionally, respondents reported needing to adapt communications within their program due to the COVID-19 pandemic. In particular, respondents shared needing to restructure how they carried out their meetings in a virtual work environment.

I think the other piece that probably ties into what [Name] was just mentioning about, particularly since COVID, we’re having to rebuild how we have meetings and come together and communicate, and that’s something that we need to work on… .

Planning for future program adaptation

Finally, respondents shared asking their partners to create contingency plans for their programs outlining adaptations they would make should the pandemic continue to disrupt their work.

So one of the things that we did when we developed scopes for this past fiscal year, ‘21. We asked each of our funded partners to come up with a contingency plan because we knew that COVID was still going to be a challenge. And we were like, “Okay, if this is still the situation, how are you going to ensure that your deliverables are carried out next year?”

This paper identifies the impact of COVID-19 on tobacco control program’s capacity for sustainability. Using qualitative interviewing and thematic analysis, we identified six sustainability domains outlined by the Program Sustainability Framework that were impacted by COVID-19: (1) funding stability ; (2) organizational capacity (3) partnerships ; (4) communication ; (5) strategic planning ; and (6) program adaptation .

Schell et al. [ 6 ] noted that the domains of the Program Sustainability Framework can be divided into internal domains (Organizational Capacity, Program Adaptation, Program Evaluation, Communications, and Strategic Planning) and external domains (Funding Stability, Political Support, and Partnerships). The internal domains are primarily managed by the program itself, while the external domains are impacted by factors outside of the program. Findings from our thematic analysis show that both internal and external domains were impacted by COVID-19. Our study also provides a real-world example of the interconnectedness of the sustainability domains, where an impact on one domain can lead to an impact on the other domains [ 10 ].

Within the organizational capacity and partnerships domains, our findings highlight the impact of the pandemic at the local level of TCPs. Many local health department partners were pulled into COVID-19 response work, which limited their ability to support and contribute to tobacco-related work. Respondents also acknowledged that challenges with organizational capacity were primarily being felt at the local level, rather than the state level. These findings align with the National Association of County and City Heath Officials’ (NACCHO) 2020 Forces of Change survey which found 82% of local health departments reassigned staff from various programs to support pandemic response activities [ 18 ]. The survey also found that 65% of local health departments saw a reduction in their provision of tobacco, alcohol, and other drug prevention services [ 18 ].

Findings related to the strategic planning domain are concerning, as strategic planning is critical to sustainability [ 6 ] and considered to be the “glue that holds sustainability efforts together” [ 19 ]. Without a strategic plan in place, programs risk losing focus on their direction and long-term goals. This can lead to a program that reacts only to the day-to-day demands of their work. Thus delayed strategic planning during COVID-19 could have long lasting impacts on program goals and future sustainability efforts.

The results related to the funding stability domain highlight the concerns related to the threat of funds being taken away and reallocated to other programs. While a threat to funding is not an uncommon event in tobacco control programming, this threat was distinct– funds were available, but were being resourced to address the pandemic. In addition, some tobacco control programs experienced difficulty in spending their programmatic budgets throughout the pandemic because regular programming was not occurring. These findings are unsurprising given the continued cuts in funding for overall prevention and public health programming [ 8 ]. The Federal government’s Prevention and Public Health Fund, which was originally created to expand and sustain the United States investment in prevention and public health programs [ 20 ], is at roughly half the funding level Congress should have provided due to the redirection of money to other programs and legislation [ 8 ].

While the majority of our findings point out the challenges to building capacity for sustainability among TCPs during the pandemic, our results related to the communications and program adaptation domains highlight the way TCPs pivoted to respond to these challenges. At the start of the pandemic, TCPs diverted resources to COVID-19 response. With priorities shifting to the pandemic, TCPs felt that they were being overshadowed by the broader public health crisis unfolding. In response, some TCPs developed public health messaging about the increased risk of COVID-19 as a smoker [ 21 ]. This strategy aligns with recommendations from Carter et al. [ 5 ] for TCPs to take the liberty to create contingency plans for their programs as the pandemic continued to disrupt programming. This forethought allowed them to plan for program adaptions should the pandemic continue to disrupt their work.

Two domains from the Program Sustainability Framework were not present in our data: environmental support and program evaluation. While our findings did not align with either of these sustainability domains, they still might have been impacted by the COVID-19 pandemic. For example, Kintziger et al. [ 22 ] studied the impact of COVID-19 response on the delivery of other public health services and found a significant decline (decrease of 36%) in the number of individuals in the public health workforce working in program evaluations during the pandemic as staff were shifted to COVID-19 response. We also know that public health programs were facing widespread pressure from outside forces, and a lack of public trust in public health occurred during the pandemic [ 23 ].


Our study has a few limitations. First, although the respondents in our study represented a diverse group of states with different levels of funding and policy progress, they make up only a fraction of TCPs in the United States. Therefore we may not have captured all impacts COVID-19 had on TCPs capacity for sustainability. We also had a limited number of TA calls with states during the pandemic. When the study first began, we carried out TA calls on a quarterly basis. During the early months of the pandemic (March 2020– November 2020), we paused TA calls in an effort to not over-burden state TCPs based on guidance from our practice advisory group. For that reason, we may not have captured the initial impacts of the pandemic on state TCPs capacity for sustainability. When we restarted our TA calls it was more difficult to engage some of the state TCPs and schedule calls, thus we had an unequal number of technical assistance calls with each state. There were also states who concluded their participation in the PACT study shortly after we restarted our TA calls. For these reasons, one state TCP’s experience during the pandemic may have been more evident than another state’s because we had more calls with them. Despite these limitations, we were able to capture the wide range of impact the pandemic had on TCP capacity for sustainability.

Our study is the first to identify the impact of the COVID-19 pandemic on capacity for sustainability of tobacco control programs. Using the Program Sustainability Framework [ 6 ] we identified six domains of sustainability that were impacted by COVID-19: funding stability; organizational capacity; partnerships; communication; strategic planning; and program adaptation. Having an understanding of COVID-19’s influence on these domains could help with future public health programming during significant public health events and emergency preparedness. While this research was conducted with state TCPs, these results are likely applicable to other public health programs. Evidence indicates that the COVID-19 pandemic resulted in a significant disruption in public health and in health service delivery across the globe [ 24 ]. COVID-19 pressurized public health and other health systems stretching them beyond their capability to effectively implement public health services directed for the prevention and treatment of non-communicable diseases [ 25 , 26 , 27 ]. While state and local level programs are required to have an emergency preparedness response plan in place, the COVID-19 pandemic exposed some of the gaps in these plans. Using the sustainability framework as a guide, state and local planners can review the components of their plan and highlight areas specifically impacted by COVID-19 and at risk of fail during future response efforts. For instance, emergency preparedness and response plans should include a protocol for how to carry out other non-communicable preventative and curative services during an event. Based on our study results, the protocol should include components that address staffing, funding and stakeholders needed to effectively continue state public health programming. Future research should focus on examining how the pandemic impacted other chronic disease prevention program’s capacity for sustainability to understand whether similar results occurred across public health programs. Additionally, future research should identify how to mitigate disruption of these sustainability domains to ensure the ongoing effectiveness of public health programs.

Data availability

The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.

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We would like to acknowledge the state Tobacco Control Programs who participated in TA calls with our research team and spoke honestly about their experiences. We would like to thank the other research members of our study who provided guidance and input during this phase of the study. We would also like to thank the Prevention Research Center at Washington University in St. Louis for administrative assistance and support through all phases of our study.

This study was funded by the National Cancer Institute of the National Institutes of Health under award number R01CA203844. The findings and conclusions in this manuscript are those of the authors and do not necessarily represent the official positions of the National Institutes of Health.

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Conceptualization and Study design: JG; Data acquisition: JG and SMR; Formal analysis: JG and SMR; Writing, review, and editing: JG and SMR; All authors read and approved the final manuscript.

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Correspondence to Jessica Gannon .

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This study received ethical approval from the Washington University in St. Louis Institutional Review Board (IRB#201801196). Informed consent was obtained from participants prior to recording calls.

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All the methods included in this study are in accordance with the declaration of Helsinki.

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Gannon, J., Moreland-Russell, S. A qualitative study examining the impact of COVID-19 on capacity for sustainability of tobacco control programs. BMC Health Serv Res 24 , 215 (2024). https://doi.org/10.1186/s12913-024-10633-9

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Received : 30 May 2023

Accepted : 24 January 2024

Published : 16 February 2024

DOI : https://doi.org/10.1186/s12913-024-10633-9

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BMC Health Services Research

ISSN: 1472-6963

research paper on covid 19 impact on business

This paper is in the following e-collection/theme issue:

Published on 14.2.2024 in Vol 10 (2024)

Impact of the COVID-19 Pandemic on People Living With Rare Diseases and Their Families: Results of a National Survey

Authors of this article:

Author Orcid Image

Original Paper

  • Maurizio Macaluso 1, 2 , MD, DrPH   ; 
  • Marc E Rothenberg 2, 3 , MD, PhD   ; 
  • Thomas Ferkol 4 , MD   ; 
  • Pierce Kuhnell 1 , MS   ; 
  • Henry J Kaminski 5 , MD   ; 
  • David W Kimberlin 6 , MD   ; 
  • Michael Benatar 7 , MD, PhD   ; 
  • Mirna Chehade 8 , MD   ; 
  • The Principal Investigators of the Rare Diseases Clinical Research Network – Cycle 4 9

1 Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States

2 Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States

3 Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States

4 Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States

5 Department of Neurology and Rehabilitation Medicine, George Washington University, Washington, DC, United States

6 Division of Pediatric Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, United States

7 Department of Neurology, University of Miami, Miami, FL, United States

8 Mount Sinai Center for Eosinophilic Disorders, Departments of Pediatrics and Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States

9 See Acknowledgments

Corresponding Author:

Maurizio Macaluso, MD, DrPH

Division of Biostatistics and Epidemiology

Cincinnati Children's Hospital Medical Center

3333 Burnet Ave - MLC 5041

Cincinnati, OH, 45229

United States

Phone: 1 513 636 2710

Email: [email protected]

Background: With more than 103 million cases and 1.1 million deaths, the COVID-19 pandemic has had devastating consequences for the health system and the well-being of the entire US population. The Rare Diseases Clinical Research Network funded by the National Institutes of Health was strategically positioned to study the impact of the pandemic on the large, vulnerable population of people living with rare diseases (RDs).

Objective: This study was designed to describe the characteristics of COVID-19 in the RD population, determine whether patient subgroups experienced increased occurrence or severity of infection and whether the pandemic changed RD symptoms and treatment, and understand the broader impact on respondents and their families.

Methods: US residents who had an RD and were <90 years old completed a web-based survey investigating self-reported COVID-19 infection, pandemic-related changes in RD symptoms and medications, access to care, and psychological impact on self and family. We estimated the incidence of self-reported COVID-19 and compared it with that in the US population; evaluated the frequency of COVID-19 symptoms according to self-reported infection; assessed infection duration, complications and need for hospitalization; assessed the influence of the COVID-19 pandemic on RD symptoms and treatment, and whether the pandemic influenced access to care, special food and nutrition, or demand for professional psychological assistance.

Results: Between May 2, 2020, and December 15, 2020, in total, 3413 individuals completed the survey. Most were female (2212/3413, 64.81%), White (3038/3413, 89.01%), and aged ≥25 years (2646/3413, 77.53%). Overall, 80.6% (2751/3413) did not acquire COVID-19, 2.08% (71/3413) acquired it, and 16.58% (566/3413) did not know. Self-reported cases represented an annual incidence rate of 2.2% (95% CI 1.7%-2.8%). COVID-19 cases were more than twice the expected (71 vs 30.3; P <.001). COVID-19 was associated with specific symptoms (loss of taste: odds ratio [OR] 38.9, 95% CI 22.4-67.6, loss of smell: OR 30.6, 95% CI 17.7-53.1) and multiple symptoms (>9 symptoms vs none: OR 82.5, 95% CI 29-234 and 5-9: OR 44.8, 95% CI 18.7-107). Median symptom duration was 16 (IQR 9-30) days. Hospitalization (7/71, 10%) and ventilator support (4/71, 6%) were uncommon. Respondents who acquired COVID-19 reported increased occurrence and severity of RD symptoms and use or dosage of select medications; those who did not acquire COVID-19 reported decreased occurrence and severity of RD symptoms and use of medications; those who did not know had an intermediate pattern. The pandemic made it difficult to access care, receive treatment, get hospitalized, and caused mood changes for respondents and their families.

Conclusions: Self-reported COVID-19 was more frequent than expected and was associated with increased prevalence and severity of RD symptoms and greater use of medications. The pandemic negatively affected access to care and caused mood changes in the respondents and family members. Continued surveillance is necessary.


The COVID-19 pandemic, caused by the SARS-CoV-2, emerged in the fall of 2019 in Wuhan, China, and rapidly spread throughout the world. In March 2020, the World Health Organization (WHO) declared the outbreak to be a pandemic, and as of August 30, 2023, the WHO has reported >770 million confirmed cases and >6.9 million confirmed deaths attributable to the disease [ 1 , 2 ]. More than 103 million cases and 1.1 million deaths from COVID-19 have occurred in the United States [ 1 , 3 ], with devastating consequences for the health system [ 4 , 5 ] and the well-being of the entire population [ 6 ].

The Journal of Medical Internet Research and affiliated JMIR publications, including JMIR Public Health and Surveillance , have extensively documented the global impact of the COVID-19 pandemic; a total of 99 articles have reported the results of web-based surveys and analyses of internet browsing patterns and social media postings (search terms “Rare disease” and “COVID-19,” run on July 7, 2023). For example, during the early months of the pandemic, an artificial intelligence–based analysis of >902,000 tweets was used to identify sentiments regarding COVID-19 in the United States [ 7 ], and large-scale web-based surveys were conducted in China [ 8 , 9 ], South Korea [ 10 ], Russia [ 11 ], and Spain [ 12 ]. Several surveys have documented a negative impact on anxiety and depression, self-reported well-being, and quality of life in the general population [ 11 - 16 ] and in vulnerable groups such as pregnant women [ 17 - 19 ], university students [ 20 - 22 ], older people [ 23 , 24 ], and health care workers [ 25 , 26 ].

Despite the extensive JMIR literature on the impact of the pandemic, only a single study described the experience of people living with rare diseases (RDs), which documented the impact of the pandemic on conversation patterns in the Reddit platform (subreddit r/CysticFibrosis) [ 27 ]. Indeed, the literature on the impact of the pandemic on people living with RDs is sparse even 3 years into the pandemic. A PubMed search (search terms “Rare disease” and “COVID-19,” run on July 6, 2023) identified 148 potential matches, but review of the abstracts indicated that most publications were case reports, discussion papers, or other reports that do not entail data collection from people living with RDs: only 25 articles reported results of cross-sectional surveys or longitudinal studies of patients with RD or their caregivers [ 28 - 52 ]. Large studies (≥50 participants) in Asia [ 29 , 37 , 40 ], Europe and the United Kingdom [ 30 , 33 , 36 , 41 , 49 , 51 ], the United States [ 45 , 52 ], and Brazil [ 43 ] reported variable impact of the pandemic, including increased risk of acquiring COVID-19 [ 33 , 37 , 39 ], increased COVID-19–related mortality [ 33 , 37 ], increased anxiety and depression and other psychological problems [ 29 , 30 , 36 , 41 , 51 , 52 ], low quality of life [ 41 , 51 ], difficulties with access to care [ 36 , 40 , 43 , 45 , 52 ], and difficulties complying with public health recommendations such as masking [ 49 ].

According to US laws, an RD is defined as a condition affecting <200,000 individuals at a given time [ 53 , 54 ]. The Genetic and Rare Disease information system of the National Center for Advancing Translational Sciences lists >10,000 RDs [ 55 , 56 ]. Although each condition is rare, the aggregate prevalence may amount to 30 million [ 55 ]. RDs are often difficult to diagnose [ 57 , 58 ], most often lack specific treatments [ 59 ], and place a significant burden on families and society [ 60 ]. Some people with RDs have primary respiratory manifestations [ 61 ], immunocompromised states [ 62 ], and chronic comorbidities including intellectual disabilities [ 63 ]. People with RDs report a lower quality of life than the general population [ 64 ]; they are vulnerable and dependent on the health care system [ 65 ].

The Rare Diseases Clinical Research Network (RDCRN) is funded by 10 of the National Institutes of Health (NIH) to promote progress in the diagnosis and treatment of RDs. The RDCRN comprises 20 Rare Disease Clinical Research Consortia and a Data Management and Coordinating Center, >200 research sites worldwide, and many patient advocacy groups that ensure that patients’ voices are heard. The RDCRN has been active for 2 decades, and >40,000 people have participated in its studies [ 66 ].

The RDCRN was strategically well placed to study the impact of the pandemic among people living with RDs in the United States. We designed a cross-sectional survey to describe the characteristics of the COVID-19 infection in this population, to determine whether patient subgroups were affected more frequently or experienced increased severity, to determine whether the pandemic changed RD symptom and treatment patterns, and to understand the broader impact of the pandemic on people living with an RD and their families.

We designed a cross-sectional survey to describe the characteristics of the COVID-19 infection in the population with RD. People who lived in the United States, had an RD, and were aged <90 years (including children of any age) were eligible for the survey. There were no explicit exclusion criteria beyond failure to meet the eligibility criteria. The survey was advertised through the internet, social media, an NIH press release, and outreach by patient advocacy groups. Interested individuals were asked to access a dedicated web page and complete a REDCap (Research Electronic Data Capture; Vanderbilt University [ 67 ]) survey instrument on the web ( Multimedia Appendix 1 ).

The data collection instrument was designed ad hoc by the authors in spring 2020, with contributions from all the principal investigators of the RDCRN consortia (included as a group author as “The Principal Investigators of the Rare Diseases Clinical Research Network - Cycle 4” refer to the collaborators list), based on their expert knowledge of RDs. The instrument comprises 8 sections:

  • Section 1 includes eligibility and preliminary information criteria on whether the patient or a surrogate is interested in participating, whether the target respondent lives in the United States and has an RD, and whether the respondent has participated in RDCRN research;
  • Section 2 explains the study and asks for consent offering three options: (1) respond to the survey, provide contact information, and allow contact for follow-up and opportunities for participating in RD research; (2) allow linkage of the survey results with data about the same individual provided as part of RDCRN studies; and (3) respond to the survey without any identifiers (one-time, anonymous response);
  • Section 3 is restricted to individuals who agree to provide identifiers and includes name, date of birth, address, telephone number, and email address to allow future contacts;
  • Section 4 includes sociodemographic variables (state of residence, age, sex, race and ethnicity), RD diagnosis including symptoms and comorbidities during the months preceding the COVID-19 epidemic in the United States, treatments received during the same period, smoking habits, and use of tetrahydrocannabinol-containing products and psychoactive drugs. It also includes questions about COVID-19–related symptoms that the respondent may have experienced before the beginning of the pandemic and any changes in RD symptoms and treatment experienced after the beginning of the pandemic in the United States (March 2020);
  • Section 5 ascertains whether the respondent had a positive COVID-19 test or a clinical diagnosis of COVID-19 respiratory syndrome; and
  • Sections 6 to 8 separately address respondents who did not acquire COVID-19 (section 6), acquired it (section 7), or did not know (section 8).

All these sections include a checklist of symptoms compatible with COVID-19; ask whether the pandemic interfered with access to medical care, RD treatment, and special food related to RD management; whether stay-at-home orders affected their mood or behavior; and whether the respondent or family members had to seek professional help to cope with stress and anxiety. A final question asks if the target respondent died during the interval leading to the survey. In addition to the abovementioned common questions, section 7 asks additional questions about the course of the COVID-19 infection, the need for hospitalization and special treatment (assisted ventilation), the duration of the illness, and whether the respondent received investigational drugs to treat COVID-19.

Study Size Considerations

We aimed at enrolling 5000 participants based on a precision analysis, rather than a power analysis, because the survey was not designed to test specific hypotheses. At the time of planning the survey, the WHO estimates suggested that the prevalence of COVID-19 infection may be between 1% and 2%. Thus, if the patients with RD experienced the same risk as the general population, the target sample size would provide information on approximately 50-100 COVID-19 cases. As the 95% CI of 50 observed events was 37-66 based on the Poisson distribution, our estimate of the overall prevalence of COVID-19 infection among respondents would be very precise. The precision of survey measures of more common characteristics and experiences among respondents (eg, changes in access to treatment) would be much higher. Furthermore, given a sample size of 50 cases, the 95% CI of a simple mean would be between +0.25 and –0.25 SD units from the mean, affording adequate precision of measures such as the average duration of hospitalization, and estimates of rates for any categorization of the case group into 5-10 subgroups would also yield adequate precision in describing the variation in risk across population subgroups.

Ethical Considerations

As the survey was conducted on the web, the REDCap survey instrument verified the eligibility of a prospective participant, provided an explanation of the objectives and process of data collection, verified consent, and gathered the required information. First, the instrument assessed the eligibility of the intended participant (ie, the person was living with an RD, was living in the United States, and was aged <90 years), automatically terminating data collection from ineligible individuals; ascertained whether the intended participant or a surrogate would be completing the survey; and ascertained whether the potential participant had participated in the RDCRN research. Next, it provided a comprehensive explanation of the study objectives and process and asked whether (1) the participant agreed to respond to the survey, provide contact information, and allow future contact for follow-up interviews and opportunities to participate in RD research; (2) if agreeing to (1), the participant further agreed to allow linkage of the survey results with data about the same individual provided as part of the RDCRN studies; or (3) the participant agreed to respond to the survey without any identifiers (1-time, anonymous response). The explanatory language clarified that no adverse events were expected except for a possible breach of confidentiality for participants who agreed to provide identifiable information and that the study team intended to minimize the risk of a confidentiality breach by keeping identifiers and survey responses in separate files and by presenting the study results in a format that would not allow the reidentification of individual patients with RD. No compensation was offered for participating in this study. The institutional review board (IRB) at Cincinnati Children’s Hospital Medical Center reviewed and approved the research protocol, all recruitment materials, and the survey instrument, including the language explaining the survey and asking for consent. The IRB granted a waiver of documentation of informed consent (IRB ID 2020-0299).

Data Analysis

In this report, we aimed to address the following outstanding questions in the field:

  • How frequent was the self-reported laboratory or clinical diagnosis of COVID-19 among people living with RDs? Did this differ from the expectation based on population rates?
  • How frequent were COVID-19–related symptoms according to self-reported COVID-19 status?
  • What were the characteristics of COVID-19 infection (duration of the infection, need for hospital admission, and complications of the infection among COVID-19 cases)?
  • Did COVID-19 status influence changes in the frequency and intensity of RD-related symptoms and in the frequency of RD-related treatment?
  • Did the COVID-19 epidemic change access to care, access to special food and nutrition, demand for professional assistance to address stress and coping among people who live with RD, and was the impact affected by COVID-19 status?

We used simple descriptive statistics (frequencies and percentages for count variables and means, medians, and ranges for continuous variables) and provided 95% CIs as a measure of the precision of the estimates for survey results. Statistical hypothesis testing was used for select analyses.

To identify participants who acquired COVID-19, we used the answer to the simple survey question, “Did you acquire COVID-19?” which allowed the answers yes, no, or do not know ( Multimedia Appendix 1 , survey item 5.1). The 3-category answer was a pragmatic approach to identifying cases of infection because at the time we conducted the survey, access to laboratory tests remained limited.

We estimated the denominator at risk of infection considering each respondent at risk every day from the beginning of the pandemic to the day they reported acquiring COVID-19 (the outcome event) or the day they filled out the survey, whichever was earlier, as is done in retrospective cohort studies. We computed exact 95% CIs for the number of cases and the corresponding incidence rate under the assumption that the number of cases follows the Poisson distribution. We compared the monthly number of self-reported COVID-19 cases with the number expected based on data reported by the New York Times [ 68 ], computed by multiplying the national monthly infection rate by the number of respondents who were at risk of acquiring a COVID-19 infection during that month. The cases reported in the New York Times database are a mix of laboratory-confirmed cases and cases meeting the state-determined diagnostic criteria. We present the observed and expected cases in a graph and test the null hypothesis that the number of observed cases equals the expected value using an exact Poisson distribution method.

For all respondents before the beginning of the pandemic ( Multimedia Appendix 1 , survey instrument item 4.9) and in separate sections for the respondents who answered yes, no, or do not know to the question “Did you acquire COVID-19?” ( Multimedia Appendix 1 , survey instrument items 6.1, 7.3, and 8.3), the instrument asked the question, “Did you have symptoms related to COVID-19? (answer options: Yes/No),” offering a checklist of 20 symptoms (new or increased cough, fever >38.0 °C, new or increased shortness of breath, sore throat, stuffy nose, runny nose, chest pain, sneezing, wheezing, headache, muscle aches, loss of taste, loss of smell, conjunctivitis or pink eye, confusion, seizures, weakness, and other).

For 65 RD-related symptoms grouped into 18 categories, the instrument asked the questions “Please check if you had any of the following symptoms before the COVID-19 pandemic began in the USA. Think about your symptoms in January-February 2020. Check all that apply” (answer options: yes or no) and “Did anything change after the beginning of the pandemic (March 2020)?” (If the previous answer was “No,” answer options: yes or no; if the previous answer was “Yes,” answer options: symptom absent, less severe, same severity, or more severe; Multimedia Appendix 1 , survey instrument item 4.6).

For 91 medications and treatments grouped into 15 categories, the instrument asked the questions “Please check if you used any of the treatments before the COVID-19 pandemic began in the USA. Think about the medications you took or treatments you routinely received in January-February 2020. Check all that apply” (answer options: yes or no) and “Did anything change after the beginning of the pandemic (March 2020)?” (If the previous answer was “No,” answer options: yes or no; if the previous answer was “Yes,” answer options: treatment not used, lower dosage, same dosage, or higher dosage; Multimedia Appendix 1 , survey instrument item 4.7).

We computed odds ratios (ORs) and their 95% CIs to illustrate the strength of the association between self-reported infection and specific COVID-19–related symptoms as well as the number of symptoms.

To assess changes in the prevalence or intensity of a specific COVID-19 symptom, we compared the number of patients who reported the symptom appearing during the pandemic (ie, the symptom was absent before the beginning of the pandemic but was present afterward) with the number of patients who reported the symptom disappearing (ie, the symptom was present before the beginning of the pandemic but was not present afterward) and used an exact binomial test of the null hypothesis that the 2 counts were equal (ie, the parameter of the binomial distribution was 0.5).

To assess changes in the prevalence and intensity of a specific RD symptom, we compared the number of patients who reported the symptom appearing or increasing in intensity during the pandemic with the number of patients who reported the symptom disappearing or decreasing in intensity and used the exact binomial test of the null hypothesis that the 2 counts were equal. We used the same logic and statistical test to assess the changes in the prevalence of the use or dosage of a specific medication. We used heat maps to summarize the changes in COVID-19–associated symptoms, RD symptoms, and RD treatment before and after the beginning of the pandemic.

The instrument asked the question, “Do you have other diseases or complications related to the rare disease? Check all that apply,” offering a list of 26 comorbidity categories ( Multimedia Appendix 1 , survey instrument item 4.8).

We computed ORs and their 95% CIs to illustrate the strength of the association between self-reported infection and specific comorbidities, reporting the exact P value for the test of the null hypothesis of no association (ie, OR=1). We regarded a finding as statistically significant if the statistical testing of a specified null hypothesis yielded a P value <.05.

Enrollment of participants for this study began on May 2, 2020, and ended on December 15, 2020; a total of 3413 respondents completed the survey. Most of the surveys (2643/3413, 77.44%) were completed between May and July (Figure S1 in Multimedia Appendix 1 ). Respondents approximately represented the geographic distribution of the US population (Table S1 in Multimedia Appendix 1 ): 25.76% (870/3377) were from the Midwest (21% expected) [ 69 ], 18.86% (637/3377) from the Northeast (18% expected), 33.43% (1129/3377) from the South (38% expected), and 21.94% (741/3377) from the West (24% expected). The diagnoses studied by the RDCRN accounted for 61.27% (2091/3413); and the most common diagnoses were myasthenia gravis (594/2091, 28.41%), amyotrophic lateral sclerosis (289/2091, 13.82%), eosinophilic esophagitis or eosinophilic gastrointestinal disease below the esophagus (203/2091, 9.71%), mitochondrial disease (174/2091, 8.32%), cystic fibrosis (87/2091, 4.16%), and primary ciliary dyskinesia (67/2091, 3.2%).

Two-thirds (2212/3413, 64.81%) of the respondents were female. Only 1.93% (66/3413) of the respondents reported being exclusively Black, 6.36% (217/3413) of the respondents reported other races or >1 race, and 89.01% (3038/3413) of the respondents were White (Table S2 in Multimedia Appendix 1 ). Approximately 5% (156/3413, 4.57%) reported Hispanic or Latino ethnicity, whereas most (2844/3413, 83.33%) of the respondents did not report ethnicity. Most of the respondents (2646/3413, 77.53%) were adults aged ≥25 years (Table S2 in Multimedia Appendix 1 ). The distribution by sex, race and ethnicity, and age was similar across disease categories, with the exception that most male respondents with eosinophilic esophageal or gastrointestinal diseases were aged <25 years. More detailed information on the demographic characteristics of the respondents by RD category is provided in Table S3 in Multimedia Appendix 1 .

Overall, 80.6% (2751/3413) of the respondents reported that they had not acquired the COVID-19 infection, 2.08% (71/3413) of the respondents reported having acquired it, and 16.58% (566/3413) of the respondents did not know. Of the 71 respondents who reported acquiring the infection, 51 (72%) reported having a positive laboratory test. By contrast, only 15.2% (86/566) of the respondents who did not know reported having been tested (no positive test). We estimated that the self-reported cases represent the incidence over a total of 3219 person-years at risk, with an average annual incidence rate of 2.2% (95% CI 1.7%-2.8%).

Self-reported COVID-19 cases were twice as many as would be expected on the basis of the population incidence rates (71 vs 30.3; P< .001) and were concentrated in March to April 2020 (37 vs 11 expected) and in October to December 2020 (15 vs 5 expected; Figure 1 ), whereas self-reported cases were only slightly higher than expected in May to September 2020 (19 vs 14.2).

Approximately all respondents who acquired COVID-19 had symptoms (66/71, 93%). For 15 (83%) of the 18 symptoms, they reported experiencing the symptom more often after the beginning of the pandemic than before. Respondents who reported not acquiring COVID-19 had symptoms less often after the beginning of the pandemic than before for 16 (89%) of the 18 symptoms. The respondents who did not know displayed an intermediate pattern ( Figure 2 ).

Specific COVID-19–related symptoms were strongly associated with self-reported infection; loss of taste (OR 38.9, 95% CI 22.4-67.6) or smell (OR 30.6, 95% CI 17.7-53.1), high fever (OR 14.5, 95% CI 8.7-24.1), and confusion (OR 12.7, 95% CI 6.80-23.7) were the strongest correlates of self-reported infection ( Table 1 ).

Reporting multiple COVID-19–related symptoms was strongly associated with acquiring COVID-19 (>9 symptoms vs none: OR 82.5, 95% CI 29-234 and 5-9 symptoms: OR 44.8, 95% CI 18.7-107). Those who did not know were also more likely to report COVID-19–related symptoms and multiple symptoms than those who reported not acquiring the infection ( Table 1 ). Respondents who acquired COVID-19 had demographic characteristics like others; most of the respondents were female (53/71, 75%), non-Hispanic White (59/71, 83%), and representative of the distribution of RD diagnoses reported by all respondents (results not shown in detail). The survey investigated 36 possible RD comorbidities, and 58.54% (1998/3413) of the respondents reported ≥1 comorbidities. Those who acquired COVID-19 (OR 1.60, 95% CI 1.00-2.50) and those who did not know (OR 1.40, 95% CI 1.20-1.70) were more likely to report RD comorbidities than those who did not acquire the infection. Individual associations between RD comorbidities and self-reported COVID-19 infection were weak (Table S4 in Multimedia Appendix 1 ).

Respondents who acquired the infection reported a significantly increased occurrence or severity for 35% (23/65) of the RD-related symptoms from before the beginning of the COVID-19 pandemic to survey completion, no change for 52% (34/65) of the symptoms, and no significant decrease for any symptoms. Those who did not know reported significantly increased occurrence or severity for 37% (24/65) of the symptoms, no change for 51% (33/65) of the symptoms, and a significant decrease for 8% (5/65) of the symptoms. Those who did not acquire COVID-19 had increased occurrence or severity for 17% (11/65) of the symptoms, no change in 49% (32/65) of the symptoms, and significant decreases for 31% (20/65) of the symptoms ( Figure 3 ).

Respondents who acquired the infection reported significantly increased frequency or dosage for 5% (5/91) of the medications (azithromycin, inhaled albuterol, inhaled glucocorticoids, ibuprofen, and aspirin), whereas the frequency or dosage of other medications did not change significantly. Those who did not know did not have significant changes for most medications but had a significant decrease in frequency or dose for 3% (3/91) of the medications. Those who did not acquire COVID-19 reported no significant change for 51% (46/91) of the medications and significant decreases in use or dosage for 34% (31/91) of the medications ( Figure 4 ).

Among those who reported acquiring the infection, the COVID-19 illness experience was not severe; symptoms lasting on average <30 days; hospitalization (7/71, 10%), and mechanical ventilator support (4/71, 6%) were relatively uncommon. However, 1 respondent in this group died, and many reported that either their RD complicated the COVID-19 illness (30/71, 44%) or that the infection worsened their baseline symptoms (39/71, 55%; Table 2 ).

The pandemic affected access to health care: 61% (42/69) of the respondents who acquired COVID-19 and 75.02% (2382/3175) of the other respondents experienced delays in obtaining an appointment, their appointment was done using telemedicine, or their appointment was postponed ( Table 3 ).

In addition, access to treatment for the RD was affected. On the basis of nonmissing values, 25.99% (715/2751) of the respondents who did not acquire COVID-19, 32.7% (185/566) of the respondents who did not know, and 41% (29/71) of the respondents who acquired COVID-19 experienced delays in obtaining treatment or their therapies were interrupted during the pandemic. Access to food was uninterrupted for most of the respondents, but as many as 26% (18/70) of those who acquired COVID-19 had delays or an interruption in the supply of specialized diets ( Table 3 ). The most pronounced disruption was in access to specialized treatment such as physical or speech therapy, with approximately 56% (32/57) of the respondents experiencing an interruption of treatment. Respondents who acquired COVID-19 reported more frequently (11/68, 16%) experiencing health events that would ordinarily require hospitalization but were managed without admission. Moreover, about 1 (13/67, 19%) of out 5 respondents reported that stay-at-home orders affected their mood or behavior in a way that required medical attention, and most of the respondents (480/2717, 17.67% to 28/71, 39%) noted that they or immediate family members sought professional support to cope with stress or anxiety, with the largest proportion (28/71, 39%) among those who acquired COVID-19 ( Table 3 ). For all but 2 items in Table 3 , the variation in responses across the 3 groups defined by self-reported COVID-19 status was statistically significant. Six deaths were reported, but 5 were among the respondents who did not acquire COVID-19.

research paper on covid 19 impact on business

a OR: odds ratio.

research paper on covid 19 impact on business

a Test of the null hypothesis that proportions do not vary across the 3 groups. Percentages are reported based on nonmissing values. Missing values are not reported for readability.

Principal Findings

This study reports results from the largest survey assessing the impact of the COVID-19 pandemic on people living with RDs; >3000 individuals representing a wide range of RDs participated in the study. Women, adults, and White non-Hispanic individuals were overrepresented. Recruitment and data collection procedures may have discouraged the participation of minority groups, although the causes of their underrepresentation are probably broader. For instance, the racial and ethnic profile of the respondents living with myasthenia gravis was similar to that of the participants of a national registry [ 31 ], but it is possible that the registry also underrepresented minority groups. Similarly, in the National Amyotrophic Lateral Sclerosis Registry, of the estimated 25,000 prevalent cases in 2017, 64.97% (16,127/24,821) were White, 5.92% (1469/24,821) were Black. [ 70 ]. In 2012 pediatric Medicaid records, 59.38% (2872/4836) of the patients with eosinophilic esophagitis were White and 15.47% (748/4836) were Black, whereas race was missing for 11.81% (571/4836) of the patients [ 71 ]. Our survey was widely advertised and relied on outreach by patient advocacy groups. Participation of >1300 respondents with an RD not studied by the RDCRN suggests that our outreach was effective in the RD community.

Underrepresentation of minority groups may be related to the globally recognized barriers to access to RD diagnosis, specialized care and social support [ 72 , 73 ], and other determinants of lack of participation in research [ 74 , 75 ]. Spurred by these findings, the RDCRN has established a cross-consortia Diversity Committee to identify actions to support and expand the participation and engagement of research participants, family members, advocates, and research staff from underrepresented or marginalized communities.

COVID-19 infection was reported by a few respondents (71/3413, 2.08%), but the number was larger than expected. The excess cases were concentrated in the first months of the pandemic and at the end of the data collection period. Thus, individuals who experienced COVID-19 early may have been more motivated to participate in the study. Likewise, survey advertisements in late 2020 could have motivated the participation of patients with an RD who were experiencing the next surge in the epidemic in the United States. Although selection is possible, the number of self-reported infections must underestimate the incidence of COVID-19 in the RD community, as underscored by the large proportion (566/3413, 16.58%) of those who did not know if they acquired the infection. This group reported COVID-19–related symptoms far more frequently than those who did not acquire COVID-19. Given the lack of access to testing early during the pandemic, many individuals with mild COVID-19 infection may have never been diagnosed. An NIH serosurvey of a sample of the US population estimated that 5 undiagnosed SARS-CoV-2 infections occurred for every COVID-19 case, and that approximately 17 million undiagnosed infections occurred in the United States by mid-July 2020 [ 76 ]. These findings have been confirmed in independent assessments [ 77 , 78 ]. Thus, despite the uncertainty about the true number of cases, our results indicate that COVID-19 has had a large impact on the RD community.

Self-reported COVID-19 was not associated with specific RD conditions, but RD comorbidities were associated with increased odds of acquiring COVID-19. Respondents who acquired the infection described a mild disease, with few requiring hospitalization or critical care and only 1 death reported. A mild course of COVID-19 infections has been reported among patients with hereditary hemorrhagic telangiectasia in Italy [ 50 ], rare endocrine diseases in a European registry study [ 38 ], lysosomal storage diseases in London [ 79 ], and Gaucher disease in New York [ 42 ]; in a large group of patients with RD in Brazil [ 43 ]; and among people with myasthenia gravis in a subanalysis of this survey [ 52 ]. These reassuring findings are in contrast with higher COVID-19–related mortality among patients with RD in Hong Kong hospitals compared with in-patients from the general population [ 37 ] and people with neurological and neurodevelopmental diseases in a Genomics England cohort study [ 33 ]. We observed that the frequency and severity of RD-related symptoms worsened during the pandemic among those who reported acquiring COVID-19 or did not know compared with those who were uninfected, indicating that COVID-19 complicated the underlying RD.

We found a greater use of selected medications among those who acquired COVID-19, little change among those who did not know, and decrease in use and dosage of many medications among those who did not acquire COVID-19. We did not expect the uninfected respondents to report reduced medication use. The need for some medications may have normally decreased between the winter before the beginning of the pandemic and the early summer when most surveys were completed. Seasonal variation exists in the use of antibiotics and prescription drugs for asthma, cystic fibrosis, and other respiratory illnesses [ 80 - 83 ] but not for other medications evaluated in the survey. It is possible that the pandemic decreased access to care and reduced medication use among those who were not in immediate need, whereas respondents with confirmed or possible COVID-19 infection continued to use their medications. This interpretation is not fully supported by the survey responses, which suggest that the pandemic interfered with access to regular health care, treatment for the RD, and hospitalization less frequently with respondents who did not acquire COVID-19. Several studies involving patients with RD have reported reduced access to care [ 36 , 40 , 43 , 45 , 52 ], and of patient organizations [ 84 - 88 ] and providers [ 79 , 89 - 93 ] have reported increased difficulties in delivering care and services, negatively affecting patients with RD. However, some reports indicate that the rise in telehealth services has had a positive impact in the RD community [ 43 , 47 , 90 ]. Access to prescription medications for asthma and chronic obstructive pulmonary disease in Great Britain initially briefly increased and then declined to below prepandemic levels during 2020 [ 94 ].

We found that the pandemic caused greater mood changes, anxiety, and stress in both respondents and their family members to an extent that required medical attention. These effects were experienced by a significant proportion of all respondents.

Strengths and Limitations

This study had certain limitations. First, we could not determine whether respondents were representative of the RD population. However, this concern is mitigated by the representative geographic distribution and the large number of diagnoses reported by the respondents: 48.17% (1644/3413) reported a diagnosis that was not studied by the RDCRN, suggesting that the outreach effort was effective in the RD community at large. Demographics and self-reported outcomes did not vary considerably across RDs, suggesting that the same selection forces affected all respondents.

Second, the information collected pertains mostly to adult, White non-Hispanic people with RDs. Thus, we could not examine racial or ethnic disparities in the impact of the COVID-19 pandemic.

Third, the main motivation for conducting this survey was that most studies examining the impact of COVID-19 would focus on the general population and not on people living with an RD. We did not have access to a suitable comparison group; therefore, this report is based only on internal comparisons. Finally, data collection was based on self-reports, and we did not have external information to validate our observations. Our inference is based on internal comparisons, the validity of which relies on the assumption that between-group differences are unbiased.

Despite these limitations, this survey had substantial strengths. This is the largest survey conducted to learn about the experience of people living with RDs during the COVID-19 pandemic. The large number of respondents allowed a precise assessment of the prevalence and changes in symptoms and medications used during the early phase of the pandemic and robust internal comparisons among respondents who reported acquiring COVID-19 or were uncertain but had symptoms (ie, may have had an infection without a clinical or laboratory diagnosis). The survey provided a necessary assessment of the impact of the pandemic on the families of people living with RDs. Most participants stated their willingness to participate in follow-up surveys and future research. Thus, this survey provides a basis for evaluating the longitudinal impact of the pandemic on respondents and their families.


In conclusion, the incidence of self-reported COVID-19 infection in this survey of people living with RDs was higher than expected based on population rates, and many respondents were unsure if they had acquired the infection. COVID-19–related symptoms were strongly associated with self-reported infection and with unknown infection status. Although the clinical severity of the infection was not high, self-reported COVID-19 was moderately associated with RD comorbidities and was strongly associated with increased prevalence and severity of RD-related symptoms as well as greater use and dosage of certain medications. The pandemic negatively affected access to health care, RD treatment, and hospitalization; it caused mood changes and greater anxiety for respondents and their family members, requiring medical attention for some. These effects were experienced not only by those who acquired the infection but also by those who did not acquire COVID-19 during the early months of the pandemic or were unsure about it. Continued surveillance of this population is needed to inform interventions to mitigate the impact of COVID-19 and better prepare people with RDs, the health care system, and society for a future pandemic.


All Rare Diseases Clinical Research Network consortia were supported by the network’s Data Management and Coordinating Center (DMCC; U2CTR002818). Funding support for the DMCC was provided by the National Center for Advancing Translational Sciences and the National Institute of Neurological Disorders and Stroke. This survey was supported by an administrative supplement to the DMCC award (U2CTR002818-02S1). The authors were supported in part by the following awards: MM and PK (U2CTR002818 and U2CTR002818-02S1), MC and MER (U54AI117804), TF (U54HL096458), and HJK (U54NS115054). The authors would like to thank Ms Erin Fontaine for her outstanding assistance in preparing the manuscript and related material for submission.

The contributors associated with The Principal Investigators of the Rare Diseases Clinical Research Network – Cycle 4 are as follows: Brendan Lee, Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas; Helen Kim, Department of Anesthesia and Perioperative Care, Center for Cerebrovascular Research University of California San Francisco, CA, Department of Epidemiology and Biostatistics University of California San Francisco, CA; Hyder Jinnah, Departments of Neurology, Human Genetics and Pediatrics, Emory University School of Medicine, Atlanta, GA; Mustafa Sahin, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, Rosamund Stone Zander Translational Neuroscience Center, Boston Children's Hospital, Harvard Medical School, Boston, MA; Eva Morava-Kozicz, Department of Clinical Genomics, Mayo Clinic, Rochester, Minnesota; Stephanie Dugging Davis, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC; Adeline Vanderver, Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia; Florian Eichler, Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, MA; Michael Shy, Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, Iowa; Chester Whitley, Department of Pediatrics, University of Minnesota, Minneapolis, MN; Advanced Therapies Program, Department of Pediatrics, University of Minnesota, Minneapolis, MN; Michio Hirano, Department of Neurology, Columbia University Irving Medical Center, New York, NY; Robert Desnick, Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY; Jennifer Puck and Christopher Dvorak, Division of Pediatric Allergy, Immunology, and Blood and Marrow Transplantation, UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, CA; Elie Haddad, Department of Pediatrics and Department of Microbiology, Immunology and Infectious Diseases, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada; Andrea Gropman, Children's National Health System and The George Washington School of Medicine, Washington, DC; Peter Merkel, University of Pennsylvania, Philadelphia; Eileen King, Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Michael Wagner, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.

Data Availability

All participant-level data elements necessary to reproduce the analyses presented in the manuscript will be made available upon request. No direct personal identifiers of survey participants will be made available. Survey responses and computed variables used for the analyses presented in the manuscript will be made available in Excel workbooks (Microsoft Corporation) and SAS data sets (SAS Institute). Prospective users will be required to file a data access application including the objectives of data access and the intended use (including a data analysis plan). A data access committee will review the application and determine whether to grant access to the data. Users may be required to sign a data use agreement before obtaining access to the data. Data and supporting documents will be available through the Rare Diseases Clinical Research Network Data Repository (under development) as soon as the Data Repository is active. Please check the Rare Diseases Clinical Research Network website for updates.

Authors' Contributions

The principal investigators of the Rare Diseases Clinical Research Network (author group) contributed to the survey design, reviewed the manuscript, and approved the version to be published. All named authors (MM, MER, TF, PK, HJK, DWK, MB, and MC) contributed to the survey design, design of the analysis and interpretation of the results, and critical review of the manuscript and reviewed and approved the version to be published. MM and PK directed data acquisition and management and conducted the statistical analysis of the data. MM drafted the manuscript and finalized the version to be published. MM and PK take responsibility for the integrity of the work and agree to investigate and resolve any issues arising from the review process or from the readership of the journal.

Conflicts of Interest

MER is a consultant for Pulm One, Spoon Guru, ClostraBio, Serpin Pharm, Allakos, Celldex, Nextstone One, Bristol-Myers Squibb, Astra Zeneca, Ellodi Pharma, GlaxoSmith Kline, Regeneron or Sanofi, Revolo Biotherapeutics, and Guidepoint; has an equity interest in the first 7 organizations listed; and has received royalties from reslizumab (Teva Pharmaceuticals), PEESSv2 (Mapi Research Trust), and UpToDate. MER is an inventor of patents owned by Cincinnati Children’s Hospital. TF has National Institutes of Health (NIH) grant funding (HL096458, TR003860, AI146999, and HL125241) and received support from Parion Sciences and ReCode Therapeutics for clinical drug trial and observational study. He is a member of the ReCode Therapeutics Primary Ciliary Dyskinesia Clinical Steering Committee and has served as a consultant for TranslateBio and Arrowhead Pharmaceuticals. HJK is a consultant for Roche, Merck Serono, Cabeletta Bio, and UCB Pharmaceuticals and is the Chief Executive Officer and Chief Medical Officer of ARC Biotechnology, LLC, based on US Patent 8,961,98. HJK is the principal investigator of the Rare Disease Network for Myasthenia Gravis (MGNet), funded by National Institute of Neurological Disorders & Stroke (U54 NS115054) and of Targeted Therapy for myasthenia gravis (R41 NS110331). HJK is also coinvestigator for MV2C2 antibody as a new therapeutic for myasthenia gravis (R43NS124329). DWK is a site PI on a Gilead-sponsored study of remdesivir in pediatric patients. All money goes directly to his university (University of Alabama at Birmingham). MB is a consultant for Alector, Annexon, Arrowhead, Biogen, Denali, Novartis, Orphazyme, Roche, Sanofi, and UniQure. He has a provisional patent for determining the onset of amyotrophic lateral sclerosis. He has received research funding from the NIH and the Muscular Dystrophy Association and serves on the Board of Trustees for the Amyotrophic Lateral Sclerosis Association. MC is currently a consultant for Regeneron, Adare or Ellodi, Astra Zeneca, Sanofi, and Bristol-Myers Squibb. Previously, she was a consultant for Allakos, Shire or Takeda, and Phathom. She currently receives research funding from Regeneron, Allakos, Shire or Takeda, AstraZeneca, and Adare or Ellodi and has received funding from Danone. All other authors declare no other conflicts of interest.

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Edited by A Mavragani; submitted 23.04.23; peer-reviewed by J Long, M Gong, J Cebrino; comments to author 30.06.23; revised version received 20.09.23; accepted 15.12.23; published 14.02.24.

©Maurizio Macaluso, Marc E Rothenberg, Thomas Ferkol, Pierce Kuhnell, Henry J Kaminski, David W Kimberlin, Michael Benatar, Mirna Chehade, The Principal Investigators of the Rare Diseases Clinical Research Network – Cycle 4. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 14.02.2024.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Public Health and Surveillance, is properly cited. The complete bibliographic information, a link to the original publication on https://publichealth.jmir.org, as well as this copyright and license information must be included.

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