medical personal statement during covid

7 Personal Statement Examples That Survive COVID-19

Sam Benezra

As summer approaches, rising seniors across the United States have college applications on their mind. This time around, however, things are a little different. The outbreak of COVID-19 has disrupted daily life around the world, and many students are concerned about how it will affect their chances of getting accepted to the school of their choice.

Don’t fret too much about cancelled internships and extracurricular activities or postponed SAT dates. A number of colleges, including Yale , Harvard , and Emory University have released statements assuring applicants that their admissions will not be affected by any disruptions caused by COVID-19. Universities know what students are going through right now, and are understanding of the constraints.

Nevertheless, the coronavirus will surely alter what college applications look like over the next couple of years. Without the opportunity to make their extracurricular activities stand out, students will have to lean on other parts of their application, including the personal statement or essay.

The personal statement or essay is the soul of a college application. It is your opportunity to talk directly to colleges in your own voice. It is a space to tell admissions officers who you are, what you’re interested in, and maybe even to charm them a little bit. When admissions officers read your essay, they want to get a sense of your personality, your passions, and the way you see the world. 

Under the current circumstances, the role of the personal statement is even more important than in an average year.

“The reality is, the way that college admissions is going to go in the fall is not going to be based on numbers and scores the way it might have been in the past,” Nicole Hurd, founder and CEO of College Advising Corps, told TUN . “Everybody is going to have to be able to tell a story that is going to be much more based on experiences and aspirations and narrative than just on numbers.”

With that in mind, here is a guide to writing your personal statement during and after the coronavirus outbreak.

What do colleges want to see in personal statements or essays?

First and foremost, when admissions officers read your personal statement, they want to get a sense of who you are, not only as a student, but as a person. They want to know about the things that matter to you, the way you think, and how you respond to challenges.

“You may be surprised to hear this, but one of the reasons we enjoy reading your essays and stories every year is because we get to understand what a generation is thinking about,” Emory University Director of Recruitment and Talent Giselle F. Martin said in an open letter to juniors and sophomores in April. “We encourage you to take this time to think about what matters most to you. After all, there is no greater gift than time.”

Colleges are still looking for the same qualities in applicants that they always have — intelligence, leadership, creativity, passion, curiosity, and maturity.

In your personal statement, be true to yourself and your experiences. Tell a story from the heart, not one cut out from a college applications handbook.

What are the qualities that define a strong personal statement or essay?

Personal statements should be personal — It’s called a personal statement for a reason. Your personal statement should first and foremost be a story about you. Find inspiration in the big moments in your life, but also in the small moments — dinners with family, laughs with friends, etc.

Personal statements should be meaningful — You don’t have to write your college essay about a profound, life-changing moment. However, whatever topic you do choose should carry some meaning to you or else your readers will be asking themselves, “so what?”

Personal statements should be tight — Your personal statement should be tightly edited and have a strong narrative flow. Common App essays are restrained to a meager 650 words. It can be difficult to pack a whole lot of meaning into such a small space, so make sure every word counts and have a teacher or parent proofread.

Personal statements should be engaging — Hook your reader in and don’t let go. The goal of a personal statement is to make a lasting impression on whoever reads it. Boring essays simply won’t cut it!

What are the personal statement topics and questions?

The Common App allows students to respond to one of seven different personal essay prompts, including an open prompt that allows students to choose their own topic, or even write in their own prompt. 

• Identity and passions : “Some students have a background, identity, interest, or talent so meaningful they believe their application would be incomplete without it. If this sounds like you, please share your story.”
• Overcoming challenges, setbacks, and failures: “The lessons we take from obstacles we encounter can be fundamental to later success. Recount a time when you faced a challenge, setback, or failure. How did it affect you, and what did you learn from the experience?”
• Thinking critically: “Reflect on a time when you questioned or challenged a belief or idea. What prompted your thinking? What was the outcome?”
• Solving problems: “Describe a problem you’ve solved or a problem you’d like to solve. It can be an intellectual challenge, a research query, an ethical dilemma — anything of personal importance no matter the scale. Explain its significance to you and what steps you took or could be taken to identify a solution.”
• Personal growth: “Discuss an accomplishment, event, or realization that sparked a period of personal growth and a new understanding of yourself or others.”
• Inspiration and curiosity: “Describe a topic, idea, or concept you find so engaging that it makes you lose all track of time. Why does it captivate you? What or who do you turn to when you want to learn more?”
• Anything at all: “Share an essay on any topic of your choice. It can be one you’ve already written, one that responds to a different prompt, or one of your own design.”

You can access Common App essay prompts for the 2020-2021 application period here .

When brainstorming, try to come up with at least one idea for each prompt.

Are there tips for brainstorming personal statement topics?

The most challenging part of writing your personal statement is settling on a topic to write about or a story to tell. But while brainstorming can be difficult, it can also be a fun process. Here are a few tips to help you generate ideas:

Ask yourself questions — To start generating ideas, it can be helpful to start looking inward and asking some introspective questions, such as:

• What are you passionate about?
• What do you want colleges to know about you?
• What are some impactful moments in your life?
• Who are some meaningful people in your life?
• What’s a story you will never forget? Why will you never forget it?
• How do you spend your free time? Why?
• What are you looking forward to?
• What do you want to get out of your college experience?

Don’t feel the need to impress — Crazy stories do not necessarily make better stories. Don’t get caught up in the idea that you need to tell an overly exciting or dramatic story. Likewise, don’t use your personal statement to list off achievements and awards. The point of the essay is to shine a light on who you are, not what you’ve done.

Think about the small things — Oftentimes, the most personal essays are those that focus on the details of life. Think about your favorite movies, books, and music. Reminisce on conversations and disagreements, sports events and camping trips, road trips, and walks around your neighborhood.

Avoid clichés — College admissions officers read thousands of personal statements every year and, as a result, are experts in picking out clichéd essays. While any topic can make a great essay, it is harder for yours to stand out when it sounds similar to many others. Topics like sports championships and eye-opening travel experiences can make great essays, but they are also a little overplayed, so it might be harder for them to stand out.

Should you write about the coronavirus?

Probably not. While the COVID-19 pandemic has surely been an impactful moment in many of our lives, writing your personal statement about the pandemic may not be the best choice, simply because so many others will likely also be writing about it.

Virtually everyone in the world has been affected by the COVID-19 pandemic in some capacity and has a unique story about the event. Unfortunately, admissions officers who have to read through thousands of college essays each year will likely have a difficult time differentiating between yours and two hundred others on the same topic.

The best college essays are memorable and unique. They have the ability to stand out amongst a crowd and leave a lasting impression. As a result, the most out-of-the box essays are often the most compelling. Writing on a common topic can make it more difficult to catch your reader’s attention. 

Furthermore, when you are writing about mass events like the coronavirus, it can be easy to write more about the event and about others than about yourself, which is what admissions officers really want to know about.

That doesn’t mean that the coronavirus is completely off-limits as a topic. If you think you have a powerful story to tell, by all means, tell it. However, you should keep in mind that any essay on the coronavirus will have to be outstanding to catch the eye of an admissions officer. 

A better alternative would be to use the Common App’s added question for fall 2020 admissions on how the COVID-19 pandemic has affected you personally. 

“That’s definitely an opportunity for (applicants) to talk about what they were planning on doing and how that was taken away,” said Joe Korfmacher , a college counselor at Collegewise. “But it also gives them an opportunity to talk about what they did instead.”

Are there personal statement examples?

These personal statement examples illustrate what works for the students who wrote them.

• Prompt #1: Identity and Passions — Rocio’s “Facing the Hot Griddle”

In this essay, Rocio makes a tortilla, and in doing so, finds herself reflecting on her Guatemalan heritage and current life in the United States. She recounts some of the obstacles that she has faced as an immigrant and how, like masa harina being made into a tortilla, has been molded by her experiences and challenges.

• Prompt #2: Overcoming a Challenge — Heqing “Amy” Zhang’s “On the day my first novel was rejected, I was baking pies.”

In this essay, Amy Zhang recounts the experience of having her first novel rejected by a publishing house on the day of her church’s annual bake sale. With a unique narrative voice that highlights her storytelling skills, Zhang relates her feelings of disappointment and grief, and how these emotions helped her spin her next novel, which she would end up selling within three days.

• Prompt #3: Thinking Critically — Callie’s “Bridging Polarity”

In this essay, Callie reckons with the difference in beliefs between her friends that she grew up with in Texas and those in her new home of San Francisco. She recounts how a visit from a childhood friend led her to value different perspectives and to listen to those with opposing views.

• Prompt #4: Solving Problems — Seena’s “Growing Strawberries in a High School Locker”

Seena assigns himself a unique challenge: to grow strawberries inside an empty high school locker. What seemed initially like a simple task quickly grew into a complex project involving a solar-powered blue LED light, an automated plant watering system, and a 3-D printed, modified lock system that increased airflow into the locker. As Seena recounts this experiment, his innate curiosity, problem-solving, and disposition toward mechanical engineering are on full display.

• Prompt #5: Personal Growth — Anna’s “Returning to Peru”

Anna remembers how a trip to her father’s homeland in Peru helped instill in her a passion for protecting the environment. She recounts witnessing pollution, lack of clean water, and environmental degradation in impoverished areas of Lima and how it motivated her interest in environmental science and conservation.

• Prompt #6: Inspiration and Curiosity — Jillian Impastato’s quest to find women with tatt oos

Jillian Impastato dives into her fascination with the art of tattoos and the lives of women who have them. Intrigued by the symbology and the meaning attached to them, Impastato has embarked on something of an informal anthropology project in which she asks women she sees with tattoos questions. She hears their stories and learns about the relationships they have with the art on their bodies. All at once, this essay displays Impastato’s natural curiosity, her interest in art, her outgoing personality, and her willingness to pursue answers.

• Prompt #7: Anything At All — Madison’s “On Potatoes”

Madison presents herself with a not-so-simple question: “If you had to choose one food to eat for the rest of your life, what would it be?” After weighing the options, she settles on the nutritious and versatile potato. She uses this as a jumping-off point to discuss her own disposition to variance and diversity. The potato becomes a clever metaphor for her innate curiosity and openness to new ideas.

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How to Write About Coronavirus in a College Essay

Students can share how they navigated life during the coronavirus pandemic in a full-length essay or an optional supplement.

Writing About COVID-19 in College Essays

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Experts say students should be honest and not limit themselves to merely their experiences with the pandemic.

The global impact of COVID-19, the disease caused by the novel coronavirus, means colleges and prospective students alike are in for an admissions cycle like no other. Both face unprecedented challenges and questions as they grapple with their respective futures amid the ongoing fallout of the pandemic.

Colleges must examine applicants without the aid of standardized test scores for many – a factor that prompted many schools to go test-optional for now . Even grades, a significant component of a college application, may be hard to interpret with some high schools adopting pass-fail classes last spring due to the pandemic. Major college admissions factors are suddenly skewed.

"I can't help but think other (admissions) factors are going to matter more," says Ethan Sawyer, founder of the College Essay Guy, a website that offers free and paid essay-writing resources.

College essays and letters of recommendation , Sawyer says, are likely to carry more weight than ever in this admissions cycle. And many essays will likely focus on how the pandemic shaped students' lives throughout an often tumultuous 2020.

But before writing a college essay focused on the coronavirus, students should explore whether it's the best topic for them.

Writing About COVID-19 for a College Application

Much of daily life has been colored by the coronavirus. Virtual learning is the norm at many colleges and high schools, many extracurriculars have vanished and social lives have stalled for students complying with measures to stop the spread of COVID-19.

"For some young people, the pandemic took away what they envisioned as their senior year," says Robert Alexander, dean of admissions, financial aid and enrollment management at the University of Rochester in New York. "Maybe that's a spot on a varsity athletic team or the lead role in the fall play. And it's OK for them to mourn what should have been and what they feel like they lost, but more important is how are they making the most of the opportunities they do have?"

That question, Alexander says, is what colleges want answered if students choose to address COVID-19 in their college essay.

But the question of whether a student should write about the coronavirus is tricky. The answer depends largely on the student.

"In general, I don't think students should write about COVID-19 in their main personal statement for their application," Robin Miller, master college admissions counselor at IvyWise, a college counseling company, wrote in an email.

"Certainly, there may be exceptions to this based on a student's individual experience, but since the personal essay is the main place in the application where the student can really allow their voice to be heard and share insight into who they are as an individual, there are likely many other topics they can choose to write about that are more distinctive and unique than COVID-19," Miller says.

Opinions among admissions experts vary on whether to write about the likely popular topic of the pandemic.

"If your essay communicates something positive, unique, and compelling about you in an interesting and eloquent way, go for it," Carolyn Pippen, principal college admissions counselor at IvyWise, wrote in an email. She adds that students shouldn't be dissuaded from writing about a topic merely because it's common, noting that "topics are bound to repeat, no matter how hard we try to avoid it."

Above all, she urges honesty.

"If your experience within the context of the pandemic has been truly unique, then write about that experience, and the standing out will take care of itself," Pippen says. "If your experience has been generally the same as most other students in your context, then trying to find a unique angle can easily cross the line into exploiting a tragedy, or at least appearing as though you have."

But focusing entirely on the pandemic can limit a student to a single story and narrow who they are in an application, Sawyer says. "There are so many wonderful possibilities for what you can say about yourself outside of your experience within the pandemic."

He notes that passions, strengths, career interests and personal identity are among the multitude of essay topic options available to applicants and encourages them to probe their values to help determine the topic that matters most to them – and write about it.

That doesn't mean the pandemic experience has to be ignored if applicants feel the need to write about it.

Writing About Coronavirus in Main and Supplemental Essays

Students can choose to write a full-length college essay on the coronavirus or summarize their experience in a shorter form.

To help students explain how the pandemic affected them, The Common App has added an optional section to address this topic. Applicants have 250 words to describe their pandemic experience and the personal and academic impact of COVID-19.

"That's not a trick question, and there's no right or wrong answer," Alexander says. Colleges want to know, he adds, how students navigated the pandemic, how they prioritized their time, what responsibilities they took on and what they learned along the way.

If students can distill all of the above information into 250 words, there's likely no need to write about it in a full-length college essay, experts say. And applicants whose lives were not heavily altered by the pandemic may even choose to skip the optional COVID-19 question.

"This space is best used to discuss hardship and/or significant challenges that the student and/or the student's family experienced as a result of COVID-19 and how they have responded to those difficulties," Miller notes. Using the section to acknowledge a lack of impact, she adds, "could be perceived as trite and lacking insight, despite the good intentions of the applicant."

To guard against this lack of awareness, Sawyer encourages students to tap someone they trust to review their writing , whether it's the 250-word Common App response or the full-length essay.

Experts tend to agree that the short-form approach to this as an essay topic works better, but there are exceptions. And if a student does have a coronavirus story that he or she feels must be told, Alexander encourages the writer to be authentic in the essay.

"My advice for an essay about COVID-19 is the same as my advice about an essay for any topic – and that is, don't write what you think we want to read or hear," Alexander says. "Write what really changed you and that story that now is yours and yours alone to tell."

Sawyer urges students to ask themselves, "What's the sentence that only I can write?" He also encourages students to remember that the pandemic is only a chapter of their lives and not the whole book.

Miller, who cautions against writing a full-length essay on the coronavirus, says that if students choose to do so they should have a conversation with their high school counselor about whether that's the right move. And if students choose to proceed with COVID-19 as a topic, she says they need to be clear, detailed and insightful about what they learned and how they adapted along the way.

"Approaching the essay in this manner will provide important balance while demonstrating personal growth and vulnerability," Miller says.

Pippen encourages students to remember that they are in an unprecedented time for college admissions.

"It is important to keep in mind with all of these (admission) factors that no colleges have ever had to consider them this way in the selection process, if at all," Pippen says. "They have had very little time to calibrate their evaluations of different application components within their offices, let alone across institutions. This means that colleges will all be handling the admissions process a little bit differently, and their approaches may even evolve over the course of the admissions cycle."

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To or not to write about COVID19 for my personal statement?

I feel like COVID19 will be a very common topic in this year's essay pool - I don't want to take the risk of writing a cliche/over-done topic.

However, I think my experience with COVID19 was unique? My entire family got infected and March-June were my peak moment of uncertainty in many different ways (my family's health, my own health, our ability to afford things, and of course academics + extracurriculars). I also feel like I have a lot to say about what I learned, how I've grown, how my experience connects to my extra-curriculars, and how it connects to my goal of learning about public health (I think? I'd say I'm undecided).

With all of this said, would you advise me to or not to write about my experiences for my personal statement? If you do think I could/should write about COVID19, do you have suggestions for how I should approach the essay and how I could make my essay stand out from the crowd? Thank you!

(I could talk about this in my additional information section but I was intending to talk about other things there so I don't know....thoughts?)

Earn karma by helping others:

On the Common App (not sure about other application sites), there will be a spot this year specifically to talk about COVID-19 within the "additional information" section and how it impacted you! I'd recommend putting most of your experience with it in this section.

Here's the link to the prompt: https://www.commonapp.org/blog/COVID-19-question-common-app (NOTE: Common App has said that the COVID section word count of 250 words will not take away from the other 650 words you are allotted in the Additional info section, so you are still able to talk about your other personal circumstances).

I personally think if you ultimately talk about your interest in health in your personal statement, you could briefly mention COVID but it should not be the main focus of your essay. Ultimately, if it doesn't naturally fit into what you're writing for your personal statement, then don't force it since you have the extra COVID section.

I agree wholeheartedly!

I had no idea that this section would exist in the additional information section :O Thank you so much both of you!

It wouldn’t appear until the new application opens on August 1 just FYI

The goal of every college essay is to reveal more about who you are, what you care about, and your goals. Your collective essays should also work together as a portfolio. Since there's a specific space in the Common App to discuss how Covid-19 impacted your life, also writing your personal statement about it may seem repetitive. As @mb56 said, you'll have extra space beyond the traditional Additional Information section just to talk about Covid-19, so you'll still be able to mention other special circumstances.

So, it's generally not a great idea to write the Common App essay about the pandemic. The exception is if you want to focus on a specific aspect of how your life changed, rather than how Covid-19 broadly impacted your life. You should also try to focus less on the virus, and more about the change. For instance, if you started writing a book during the pandemic (or some other self-driven extracurricular), that could be a more unique topic.

If you want to talk about your public health ambitions, that's something that could be mentioned in a "Why This Major" or Academic Interest essay. You could also discuss it in the Additional Information section about the pandemic.

I hope this helps, and let me know if you have more questions!

Thank you for this! I especially agree that talking about COVID19 in my essay would be repetitive and would take away valuable space. It feels a bit difficult for me to think of how to limit myself to a specific topic though.... I think I might pick another topic then :(

I heard from a John Hopkins Webinar (but of course this is applicable to any school) that they would rather see a personal statement about you, your strongest attributes, what you would bring to their community, what you are passionate about, what that shows about you, etc. I am sure that you could include a bit of this experience in there and how it has shaped the characteristic about you that you want to talk about in the personal statement. Also, I feel like you could elaborate much more about your experience with Covid-19 in the additonal info section without it being formally written. I hope this helped!

Thank you! I think I'll probably do "snapshots" of my life and this would be one of the "snapshots" I talk about, but not the main focus. And then I'll probably talk more in depth in the additional info section. And I just signed up for a Johns Hopkins webinar now hehe :))

I think it is not the what but the how. Maybe you could place the what in the section about impact from the pandemic and focus on the how:

How did this became a life changing experience for you? How did it alter your character, core values and beliefs? How do you see things now in hindsight?

For sure there will be a plethora of Covid related essays, make sure that yours is unique. Best of luck !

Thank you for the guiding questions, very helpful!

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• COVID-19 and your mental health

Worries and anxiety about COVID-19 can be overwhelming. Learn ways to cope as COVID-19 spreads.

At the start of the COVID-19 pandemic, life for many people changed very quickly. Worry and concern were natural partners of all that change — getting used to new routines, loneliness and financial pressure, among other issues. Information overload, rumor and misinformation didn't help.

Worldwide surveys done in 2020 and 2021 found higher than typical levels of stress, insomnia, anxiety and depression. By 2022, levels had lowered but were still higher than before 2020.

Though feelings of distress about COVID-19 may come and go, they are still an issue for many people. You aren't alone if you feel distress due to COVID-19. And you're not alone if you've coped with the stress in less than healthy ways, such as substance use.

But healthier self-care choices can help you cope with COVID-19 or any other challenge you may face.

And knowing when to get help can be the most essential self-care action of all.

Recognize what's typical and what's not

Stress and worry are common during a crisis. But something like the COVID-19 pandemic can push people beyond their ability to cope.

In surveys, the most common symptoms reported were trouble sleeping and feeling anxiety or nervous. The number of people noting those symptoms went up and down in surveys given over time. Depression and loneliness were less common than nervousness or sleep problems, but more consistent across surveys given over time. Among adults, use of drugs, alcohol and other intoxicating substances has increased over time as well.

The first step is to notice how often you feel helpless, sad, angry, irritable, hopeless, anxious or afraid. Some people may feel numb.

Keep track of how often you have trouble focusing on daily tasks or doing routine chores. Are there things that you used to enjoy doing that you stopped doing because of how you feel? Note any big changes in appetite, any substance use, body aches and pains, and problems with sleep.

These feelings may come and go over time. But if these feelings don't go away or make it hard to do your daily tasks, it's time to ask for help.

Get help when you need it

If you're feeling suicidal or thinking of hurting yourself, seek help.

• Contact your healthcare professional or a mental health professional.
• Contact a suicide hotline. In the U.S., call or text 988 to reach the 988 Suicide & Crisis Lifeline , available 24 hours a day, seven days a week. Or use the Lifeline Chat . Services are free and confidential.

If you are worried about yourself or someone else, contact your healthcare professional or mental health professional. Some may be able to see you in person or talk over the phone or online.

You also can reach out to a friend or loved one. Someone in your faith community also could help.

And you may be able to get counseling or a mental health appointment through an employer's employee assistance program.

Another option is information and treatment options from groups such as:

• National Alliance on Mental Illness (NAMI).
• Substance Abuse and Mental Health Services Administration (SAMHSA).
• Anxiety and Depression Association of America.

Self-care tips

Some people may use unhealthy ways to cope with anxiety around COVID-19. These unhealthy choices may include things such as misuse of medicines or legal drugs and use of illegal drugs. Unhealthy coping choices also can be things such as sleeping too much or too little, or overeating. It also can include avoiding other people and focusing on only one soothing thing, such as work, television or gaming.

Unhealthy coping methods can worsen mental and physical health. And that is particularly true if you're trying to manage or recover from COVID-19.

Self-care actions can help you restore a healthy balance in your life. They can lessen everyday stress or significant anxiety linked to events such as the COVID-19 pandemic. Self-care actions give your body and mind a chance to heal from the problems long-term stress can cause.

Take care of your body

Healthy self-care tips start with the basics. Give your body what it needs and avoid what it doesn't need. Some tips are:

• Get the right amount of sleep for you. A regular sleep schedule, when you go to bed and get up at similar times each day, can help avoid sleep problems.
• Move your body. Regular physical activity and exercise can help reduce anxiety and improve mood. Any activity you can do regularly is a good choice. That may be a scheduled workout, a walk or even dancing to your favorite music.
• Choose healthy food and drinks. Foods that are high in nutrients, such as protein, vitamins and minerals are healthy choices. Avoid food or drink with added sugar, fat or salt.
• Avoid tobacco, alcohol and drugs. If you smoke tobacco or if you vape, you're already at higher risk of lung disease. Because COVID-19 affects the lungs, your risk increases even more. Using alcohol to manage how you feel can make matters worse and reduce your coping skills. Avoid taking illegal drugs or misusing prescriptions to manage your feelings.

Take care of your mind

Healthy coping actions for your brain start with deciding how much news and social media is right for you. Staying informed, especially during a pandemic, helps you make the best choices but do it carefully.

Set aside a specific amount of time to find information in the news or on social media, stay limited to that time, and choose reliable sources. For example, give yourself up to 20 or 30 minutes a day of news and social media. That amount keeps people informed but not overwhelmed.

For COVID-19, consider reliable health sources. Examples are the U.S. Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO).

Other healthy self-care tips are:

• Relax and recharge. Many people benefit from relaxation exercises such as mindfulness, deep breathing, meditation and yoga. Find an activity that helps you relax and try to do it every day at least for a short time. Fitting time in for hobbies or activities you enjoy can help manage feelings of stress too.
• Stick to your health routine. If you see a healthcare professional for mental health services, keep up with your appointments. And stay up to date with all your wellness tests and screenings.
• Stay in touch and connect with others. Family, friends and your community are part of a healthy mental outlook. Together, you form a healthy support network for concerns or challenges. Social interactions, over time, are linked to a healthier and longer life.

Avoid stigma and discrimination

Stigma can make people feel isolated and even abandoned. They may feel sad, hurt and angry when people in their community avoid them for fear of getting COVID-19. People who have experienced stigma related to COVID-19 include people of Asian descent, health care workers and people with COVID-19.

Treating people differently because of their medical condition, called medical discrimination, isn't new to the COVID-19 pandemic. Stigma has long been a problem for people with various conditions such as Hansen's disease (leprosy), HIV, diabetes and many mental illnesses.

People who experience stigma may be left out or shunned, treated differently, or denied job and school options. They also may be targets of verbal, emotional and physical abuse.

Communication can help end stigma or discrimination. You can address stigma when you:

• Get to know people as more than just an illness. Using respectful language can go a long way toward making people comfortable talking about a health issue.
• Get the facts about COVID-19 or other medical issues from reputable sources such as the CDC and WHO.
• Speak up if you hear or see myths about an illness or people with an illness.

COVID-19 and health

The virus that causes COVID-19 is still a concern for many people. By recognizing when to get help and taking time for your health, life challenges such as COVID-19 can be managed.

• Mental health during the COVID-19 pandemic. National Institutes of Health. https://covid19.nih.gov/covid-19-topics/mental-health. Accessed March 12, 2024.
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Open Access

Peer-reviewed

Research Article

Knowledge and experience of physicians during the COVID-19 Pandemic: A global cross-sectional study

Contributed equally to this work with: Rania Mansour, Smrithi Rallapalli, Hamreet Kaur Baidwan

Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Resources, Validation, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

Affiliation St George’s Hospital Medical School, St George’s University of London, London, United Kingdom

Roles Formal analysis, Methodology, Project administration, Supervision, Writing – review & editing

Affiliation Population Health Research Institute, St George’s University of London, London, United Kingdom

Affiliation Neuroscience Research Center, Faculty of Medical Sciences Lebanese University, Hadath, Lebanon

• Rania Mansour, 
• Smrithi Rallapalli, 
• Hamreet Kaur Baidwan, 
• Mohammad S. Razai, 
• Linda Abou-Abbas

• Published: July 29, 2022
• https://doi.org/10.1371/journal.pgph.0000639
• Reader Comments

Physicians are on the frontline of the COVID-19 pandemic with responsibility to manage the disease. The aim of this study is to investigate physicians’ knowledge, attitudes, perceptions and experiences, as well as preventative practices regarding the COVID-19 pandemic and COVID-19 vaccinations. Further, we explore physicians’ recommendations for future pandemics. A mixed-methods online survey was disseminated to physicians globally. The survey was distributed via social media from August 9–30, 2021. Data collected included sociodemographic characteristics, knowledge, attitudes, and practices towards COVID-19, concerns regarding vaccinations, and perspectives on policies implemented. Descriptive statistics were reported, and qualitative data were analysed using inductive thematic analysis. A total of 399 physicians from 62 countries completed the survey, with similar participation from High Income Countries and Low- or Middle-Income Countries. Most physicians (87%) revealed a good level of knowledge while only half (54%) reported adhering to adequate preventative measures. More than half of participants (56%) indicated that the policies implemented to handle COVID-19 by their public health agencies were insufficient or disorganised. While most physicians reported increased mental stress (61%) and described their experience with COVID-19 using negative terminology (63%), most physicians (87%) indicated they are willing to continue working in healthcare. Physicians globally possessed good knowledge of COVID-19 and COVID-19 vaccinations; yet improvements in ensuring compliance with preventative measures is warranted. Findings from this study have important implications. As recommended by physicians, efforts to manage pandemics should involve (1) strengthening health systems, (2) minimising adverse effects of infodemics, (3) delegating decision-making roles appropriately, and (4) acknowledging global responsibility.

Citation: Mansour R, Rallapalli S, Baidwan HK, Razai MS, Abou-Abbas L (2022) Knowledge and experience of physicians during the COVID-19 Pandemic: A global cross-sectional study. PLOS Glob Public Health 2(7): e0000639. https://doi.org/10.1371/journal.pgph.0000639

Editor: Md Anwarul Azim Majumder, The University of the West Indies, BARBADOS

Received: January 3, 2022; Accepted: June 30, 2022; Published: July 29, 2022

Copyright: © 2022 Mansour et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: The datasets generated during and/or analysed during the current study are available in a data repository, accessible via the following DOI: https://doi.org/10.24376/rd.sgul.19990817.v1 .

Funding: The author(s) received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.

Introduction

Coronavirus disease (COVID-19), caused by SARS-CoV-2 virus, has so far claimed the lives of more than 6.2 million people as of 10 May 2022 including healthcare professionals (HCPs) [ 1 – 3 ]. According to reports from Amnesty International and the World Health Organization (WHO) more than 115,000 HCPs have died from COVID-19, leaving an irreplaceable gap in pandemic response worldwide [ 4 – 6 ]. The impact of COVID-19 on HCPs has been summarized by the WHO and consists of four concerns: (1) availability and distribution of healthcare personnel and equipment, (2) health of physicians, including the risk of burnout and mental disorders, (3) social wellbeing, such as discrimination and concern for family, and (4) working conditions, such as lack of incentives, psychological support, or vaccinations [ 6 ]. Nevertheless, HCPs continue to serve on the frontline against COVID-19, often following local, national, and international preventative and treatment guidelines on the prevention and treatment of COVID-19. Further, the response and mitigation measures to control the pandemic have been updated regularly around the world and COVID-19 vaccines have been manufactured and deployed at a rapid pace. It is therefore essential that HCPs have access to relevant updated information to protect themselves against COVID-19 and to ensure appropriate patient management.

To our knowledge, previous cross-sectional studies exploring the knowledge and experiences of HCPs towards COVID-19 were primarily conducted within the first six months of the pandemic. Given the numerous changes to the guidelines since the beginning of the pandemic, these studies may not represent the current knowledge and experience of physicians. Furthermore, the majority of these studies were conducted within one country [ 7 – 22 ]. Results from a systematic review in November 2020 exploring these national studies revealed that HCPs possessed adequate knowledge of the disease and generally had positive attitudes towards the pandemic [ 13 ]. However, an updated systematic review in May 2021 demonstrated that HCPs had poor compliance to particular safety practices [ 23 ]. One global study conducted in March 2020, revealed that HCPs had poor knowledge regarding the virus’s mode of transmission and symptom onset [ 24 ]. Additionally, very few studies have been conducted on HCP’s perceptions of COVID-19 vaccines. These studies were also conducted on a national level and have shown that increased knowledge is an important predictor of vaccine hesitancy among HCPs [ 25 , 26 ].

This global cross-sectional mixed-methods study investigates the knowledge, attitudes, perceptions, and practices (KAPP) of physicians towards COVID-19 disease and COVID-19 vaccines. Understanding the experiences of physicians globally can highlight gaps in policies and educational interventions that have been aimed at physicians and the public. Physicians’ reflections and their recommendations for future health emergencies are also explored. Future pandemics are considered inevitable due to the presence of high-risk factors such as overpopulation, poverty, and global warming [ 27 – 30 ]. The findings of this study and the recommendations of physicians from 62 countries will likely inform the development of future policies within health systems to support frontline health care providers during health emergencies.

Study design and data collection

A mixed-methods cross-sectional study using an online survey was conducted to obtain responses from physicians globally between the 9 th and 30 th of August 2021. The online survey was distributed via social media, particularly E-mail and WhatsApp, using a snowballing technique [ 31 ]. The invitation letter included a brief description of the study and a URL link to the survey. Physicians were identified via professional groups and academic institutions. In this study, a physician is defined as a medical doctor who practices medicine and includes surgical, non-surgical, and public health specialties. Informed consent was obtained by participants on the first page of the online questionnaire along with clear statements that participation was voluntary and uncompensated. To ensure quality control and to maximise completeness of the data, incomplete surveys and responses from non-physicians were removed from the analysis.

Sample size calculation

The sample size was calculated using the online RAOSOFT sample size calculator [ 32 ]. The required sample size would be at least 377 participants for a global survey with an estimated population of more than 20,000 physicians (the largest estimate possible), in addition to an anticipated response of 50%, confidence level of 95%, and 5% margin of error.

Survey instrument and scoring system

A structured questionnaire was designed on Microsoft Forms by the authors to cover important aspects of KAPP of physicians. The survey instrument was initially developed based on previous surveys [ 9 , 11 , 24 ]. The final questionnaire ( S1 File ) was modified for relevance based on the most recent information from the WHO Online Resources for COVID-19, as of July 07, 2021.

The final questionnaire was divided into eight sections: (1) Sociodemographic characteristics ; (2) Sources of information ; (3) Knowledge section : a total of 16 items were designed to measure physicians’ knowledge about the COVID-19 disease and vaccines. All items were single best answer questions. Correct options were assigned 1 point and incorrect options 0 points. The total knowledge score was a sum of scores. Based on Bloom’s cut-off point [ 11 ], overall knowledge was categorised as good if above 60% and poor if below 60%. Cronbach’s alpha coefficient for the knowledge questions was 0.936. (4) Practice section : five questions were used to evaluate utilisation of various preventative measures. The three answer options included “always”, “occasional”, or “never”. The latter two were assigned 0 points, and the former was assigned 1 point. The total practice score was a sum of scores. Physician’s overall practice was categorised based on Bloom’s cut-off point [ 11 ] as good if above 80%, and poor if below 80%. Cronbach’s alpha coefficient for the practice questions was 0.638. (5) Physicians’ perspective on vaccinations ; (6) Physicians’ perspective on policies implemented ; (7) Physicians’ subjective attitudes towards the pandemic; (8) Physicians’ personal reflections (Describe your COVID-19 experience in one word; What are your recommendations for future pandemics?).

Content validity of the final version was assessed by three experts who specialise in the field of infection control and emergency preparedness. The survey was then pilot tested in a sample of 10 physicians to check the acceptability, clarity, readability, and relevance of all items. Physicians did not report any problems in understanding the questionnaire. On average, the survey was completed within 10 minutes. The data of the pilot study was removed from the final analysis.

Statistical analysis

Statistical analysis was carried out using the statistical software SPSS (Statistical Package for Social Sciences), version 22.0. Descriptive statistics were reported using means and standard deviations (SD) for continuous variables and frequency with percentages for categorical variables.

Thematic analysis

Data from the two open-ended questions was summarised using an inductive thematic analysis approach [ 33 ]. Three team members independently coded a sample of the data until a consensus was reached and a coding framework was formulated. Two members independently coded the remaining data and negotiated agreements on discrepant codes. Three members reviewed the codes, sorted codes into descriptive categories based on patterns, and subsequently grouped descriptive categories to generate major themes.

The study was approved and given favourable ethics opinion by the St George’s, University of London Research Ethics Committee (SGREC) under study title “Knowledge and Perspectives of Health Care Providers on COVID-19: A Global Cross-Sectional Study” with REC Reference: 2021.0127. The overall study was guided by the STROBE (STrengthening the Reporting of OBservational studies in Epidemiology) Statement for cross-sectional studies [ 34 ].

Baseline characteristics of study participants

Table 1 summarises participant characteristics. A total of 411 HCPs participated in our survey, 399 of whom were physicians, including 224 (56%) male, and 174 (44%) female. The majority were between 46–55 years old (n = 108, 27%), and practising in internal medicine (n = 80, 20%), surgery (n = 80, 20%), or general practice (n = 72, 18%). Most physicians had been practising medicine for 10 years or longer (n = 292, 73%) and most respondents identified as frontline workers (n = 268, 67%). Physicians from 62 unique countries responded to the survey, with similar participation from High Income Countries (n = 214, 54%) and Low- or Middle-Income Countries (n = 185, 46%), as identified by the World Bank [ 35 ]. Fig 1 provides a visual representation of respondents per country.

• PPT PowerPoint slide
• PNG larger image
• TIFF original image

This map depicts the countries from which responses were received. More than 20 responses were received from countries shaded in red (Canada, United States of America, Spain, United Kingdom, Lebanon, Philippines). The dark orange indicate that 11 to 20 physicians responded from that country, whereas the light orange shade indicates that 5 to 10 physicians from that country responded to the survey. Less than 5 responses were received from countries shaded in yellow. No responses were received from countries in grey. Republished from https://www.mapchart.net/ under a CC BY license, with permission from Minas Giannekas, original copyright 2022.

https://doi.org/10.1371/journal.pgph.0000639.g001

https://doi.org/10.1371/journal.pgph.0000639.t001

Sources of knowledge

Primary sources of knowledge amongst respondents were News Media and Official Government Websites ( Table 2 ). Most physicians (51%) indicated Official Government Websites as their most-used source. The majority of respondents (43%) indicated social media as their least-used source.

https://doi.org/10.1371/journal.pgph.0000639.t002

Physicians’ knowledge towards COVID-19 virus and vaccines

Of all physician respondents, 349 (87.5%) participants had good knowledge about COVID-19 disease and COVID-19 vaccines ( Table 3 ). Poor knowledge was observed for questions concerning the nature of disease (52%) and treatment of disease (59.9%). Conversely, good knowledge was observed in responses regarding transmission of disease (71.5%), actions dealing with cases (72.5%), and nature of vaccines (89.5%). The mean total knowledge score was 11.07 (SD = 1.49). No differences between various physician specialties, frontline worker status, or residency in LMIC versus HIC were observed.

https://doi.org/10.1371/journal.pgph.0000639.t003

Physicians’ practice towards COVID-19

Table 4 summarises preventative practices against COVID-19. Of the 399 respondents, 214 (54.1%) reported adequately adhering to preventative measures while working. The most prevalent practise among physicians was Item 3: I wash my hands with soap or rub my hands with hydro-alcoholic gel during my work shift (94.2%). Conversely, less than half of all respondents reported wearing gloves (Item 2) while working (39.6%). The mean score for overall preventative practices towards COVID-19 is 3.47 (SD = 1.18). No differences between residency in LMIC versus HIC were observed.

https://doi.org/10.1371/journal.pgph.0000639.t004

Physicians’ experience towards COVID-19 vaccinations and policies

Most physicians (63%) indicated being worried about distribution of vaccines to the general population and half (50%) were concerned with the long-term side effects of vaccinations ( Fig 2 ). Table 5 summarises physicians’ perceptions towards the COVID-19 vaccines. The majority of physicians (n = 283, 71%) indicated Pfizer-BioNTech as most effective; while 195 (49%) physicians indicated that the AstraZeneca (Covishield and Vaxzevria) vaccine has the highest risk for complications, followed by the Janssen (n = 39, 9.8%) and Sputnik V (n = 38, 9.5%) vaccines. Most physicians (96%) indicated having received the COVID-19 vaccine; only 10% of physicians were/are hesitant to receive a vaccine.

Physicians’ perceptions (n = 399) regarding (a) various COVID-19 vaccine concerns and (b) policy actions implemented for the COVID-19 pandemic by their public health agencies and health care facilities.

https://doi.org/10.1371/journal.pgph.0000639.g002

https://doi.org/10.1371/journal.pgph.0000639.t005

With regards to physicians’ experience with COVID-19 policies, most physicians (60%) indicated that policies implemented by their healthcare facility were adequate in handling COVID-19, only 42% specified that the policies implemented by their public health agencies were adequate ( Fig 2 ).

Physicians’ attitudes towards COVID-19

With regards to attitudes ( Table 6 ), high ratings of agreement (i.e., ≥ 50% agreement) were reached regarding questions of increased workload (Item 3), subjective mental stress (Item 4), worrying about the future (Item 8), and fear of contracting the virus and passing it on to family or friends (Item 9). Importantly, most physicians (n = 247, 87%) indicated that they are willing to continue working in the health system after the pandemic (Item 10).

https://doi.org/10.1371/journal.pgph.0000639.t006

Physicians’ experiences of COVID-19

A total of 389 participants responded to the question: Describe your experience with COVID-19 in one word. A total of 168 unique words were organised under 20 descriptive subthemes and subsequently grouped into three major themes, namely (1) Negative experience (n = 253, 65%), (2) Positive experience (n = 23, 6%), and (3) Neutral experience (n = 113, 29%). Fig 3 presents a visual representation of physicians’ experiences of COVID-19 (n = 389) one-word descriptions. Table 7 summarises the thematic analysis of physician experiences. No significant differences between demographic variables (including physician specialties, frontline worker status, or residency in LMIC versus HIC) were observed in association with a negative, positive, or neutral experience. However, participants who indicated the policies implemented by their healthcare facilities were inadequate (i.e., disorganized or inefficient) were more likely to also describe their experience with COVID-19 using negative terminology (X 2 (6) = 29, p < 0.0001). There were no differences in one-word responses based on participants’ perspectives on policies implemented by public health agencies.

This word cloud depicts physician’s responses regarding their experience with COVID-19 pandemic. The bigger and bolder the word appears, the more often it was mentioned among responses. Responses were thematically analysed into three distinct themes: Negative Experiences (n = 253, 65%), Positive Experiences (n = 23, 6%), and Neutral Experience (n = 113, 29%). The top three most utilized words were “Exhausting” (n = 30), “Challenging” (n = 27), and “Stressful” (n = 22). See Table 7 for all responses.

https://doi.org/10.1371/journal.pgph.0000639.g003

https://doi.org/10.1371/journal.pgph.0000639.t007

Physicians’ recommendations for future pandemics

A total of 387 participants responded to the question: What recommendations do you have for future pandemics? Inductive thematic analysis of responses revealed twenty-seven distinct subthemes organised into seven major themes, described below. Table 8 summarises physicians’ recommendations, and S1 Table provides detailed codes and exemplar quotes from the thematic analysis.

https://doi.org/10.1371/journal.pgph.0000639.t008

Theme 1: Holistic preparation.

This theme represents preparing for future pandemics through education, prevention, and pre-emptive policy development and implementation. Physicians called for “more research” on pandemics and ensuring that the public, politicians, and interdisciplinary medical teams were continuously educated on the risks of a pandemic. One physician recommended to “build specific structures against pandemics”, while another suggested to “minimize human-animal interactions”. Mostly however, physicians specified to “learn from mistakes” and “ensure that any knowledge gained from the past is applied proactively for future pandemics”. One physician voiced the need to “have a better pandemic preparedness strategy, don’t wait for the 2nd/3rd wave” and another revealed “now is the time to prepare”.

Theme 2: Execution of response measures.

This theme included actionable items relating to pandemic response and highlighted the importance of attending to the emotional wellbeing of people. On the threat of the pandemic, physicians pointed out the need for “less denial” and to “take it seriously earlier”. Others revealed the need for accountability: “the country responsible for the outbreak must take responsibility and admit”. Some physicians (n = 9, 2%) called for clear and standardised guidelines, “have a manual of operation and follow it”. However, a need for flexibility was also voiced, “allow MDs to treat patients according to their judgement and do not limit them to strict guidelines”. Additionally, physicians proclaimed a need to “act quickly and definitively” and “be rapid and safe in your response”. Some physicians noted the need for “early diagnosing, tracing, and isolating cases”. Others recommended implementing stricter protective measures stating: “quarantines should be stronger”, “earlier ban in travel”, and “mask mandates”. Physicians expressed the need for local decision making, “decision-making at the local and state levels according to the degree of incidence”. A portion of physicians agreed on the significance of vaccinations, recommending better accessibility, compliance, and distribution of vaccinations. They noted a need for the world to “achieve herd immunity through vaccination” and some called for “mandatory vaccination”. Physicians also recommended addressing the morale of the public: “don’t panic”, “be realistic”.

Theme 3: Health system strengthening.

Physicians recommended for health systems with stronger infrastructure and comprehensive resources for its physicians. Physicians also called for a health system that prioritises “physician health and safety” and promotes transparency among its constituents. Some physicians voiced a need for the health system to employ an interdisciplinary approach: “We should have programs that cover the entire spectrum from physical, psychological, social, and spiritual health as a continuum”. Another physician highlighted the “need to develop medical infrastructure in low-income countries”. Physicians suggested having a system that allows for “decentralized participatory planning on part of government agencies”. Physicians also communicated the need for a health system that is “not business oriented” and “invests more in mental health and financial support of entire population”. To strengthen the health system, physicians expressed a demand for adequate material resources (e.g., “have adequate stock of PPE”), additional human resources (e.g., “provide more trained manpower”), “improve epidemic control centres”, and an “established task force all year round”.

Theme 4: Appropriate delegation of roles.

Physicians specifically highlighted the role of politicians and their responsibility to form a more “empathetic political system” that can respond to the pandemic. Physicians (n = 34, 7%) stated a need to differentiate the role of science and healthcare professionals from the role of politicians. This was recommended particularly during policy-development, “strengthen the position of the clinicians in the decision-making”. On several occasions, physicians recommended the need for “less politics, more science”, that “policymakers should listen more to health professionals’’, and that “politicians should stop managing what they can barely comprehend”. Additionally, physicians recommended, “put public health physicians and epidemiologists at the front”. Other physicians focused on the role of the WHO and the need to “re-organize it”.

Theme 5: Minimise adverse effects of infodemics.

This theme captures physicians’ input towards minimising the spread of misinformation. Physicians particularly called for “much better and more timely public health communications needed” and to “improve social communication to avoid fake news”. Physicians stated a need to ensure that the content of information distributed is relevant and credible, “Prevent fake news from spreading, if possible. People believe it.” With regards to inter-departmental communication, physicians recommended standardising and/or centralising the distribution of pandemic-related communications, “One central body and not 50 different emails about the same advice from different departments”. On the role of communication with the public, “Don’t let social media give information to the public without peer review. The information system must be more open (data access) but it is necessary to identify the right communicator.”

Theme 6: Global responsibility.

This theme encompasses physicians’ views on the significance of global unity during pandemics. Physicians recommended global action through “better planning with pandemic resistant health systems”. Physicians also indicated the necessity for global transparency, one wrote: “China did respond too slowly and did not communicate about the severity of the situation and did not react to control outbreak”. Physicians also emphasised a need for “global coordination, solidarity, and equity”, and stated that “the world needs to learn to work together”. Additionally, physicians specified demands for a “global initiative to reduce social inequality” and “equitable vaccine distribution all over the world”.

Uncertainty.

Few physicians expressed uncertainty towards providing recommendations, stating they were “unsure”. Other participants acknowledged the limitations of their role in being able to provide recommendations, one respondent explicitly noted “I’m not a public health expert!”.

Main findings in light of other evidence

The results of this global survey revealed international agreement on the burden of care experienced by physicians during the COVID-19 pandemic and particularly when working in underprepared communities or institutions. Most physicians in this study possessed good overall knowledge of COVID-19; this is in line with previous studies [ 36 – 38 ]. Additionally, physicians relied on official government websites as their primary source of information, as supported by an earlier study among HCPs [ 24 ]. This suggests that physicians have been consistently utilising reliable sources to acquire information regarding COVID-19 and correlates with the good knowledge observed. However, respondents in this study exhibited poor knowledge on domains relating to the nature and treatment of disease. Previous studies on this are inconsistent, with some physicians displaying good knowledge of the disease [ 39 ] and others showing poor knowledge [ 40 ]. The discrepancy between studies could be due to differences in programmes delivered by health facilities in supporting and educating physicians, reduced accessibility to evidence-based information in some settings, as well as differences in national-level protocols for the management and treatment of disease. With regards to preventative practices towards COVID-19, many physicians reported occasionally wearing masks and/or gloves. Although this may reflect poor adherence to safety measures by physicians, it could also be due lack of available or accessible Personal Protective Equipment (PPE) such as masks and/or gloves. Access to PPE was particularly limited in both HICs and LMICs during the initial stages of the pandemic due to lack of preparedness of health systems, disruption of global supply chains and mismanagement [ 41 , 42 ].

Almost all physicians in our study indicated that they have received the COVID-19 vaccine, and only a small percentage were/are hesitant to receive the vaccine. The degree of vaccine hesitancy among this population of physicians is echoed in other studies [ 43 ]. Additionally, about half of physicians in this study were concerned about the rapid development of vaccines. Data from HICs suggests the rapid pace of vaccine development as one of the primary reasons for vaccine hesitancy [ 44 ].

COVID-19 revealed a lack of adequate policies, preparedness, and education necessary to combat a pandemic and control further outbreaks [ 45 – 47 ]. Further, the implementation of rapid pandemic control measures was at times delayed [ 48 ]. Our survey results indicate that many physicians perceived the policies and actions implemented by their healthcare facilities and public health agencies as being insufficient, which correlated with physicians’ overall experience with the COVID-19 Pandemic, where those who perceived their facilities as having inadequate policies were more likely to also describe their experience using negative terminology. Additionally, many physicians recommended a need to strengthen healthcare and political systems to better respond to pandemics. These findings are in line with physicians’ demands for better resources for future pandemics, since a better equipped health and political system is more likely to provide the necessary resources to tackle the pandemic. Previous studies support such recommendations, especially for evidence-based policy-making as a means to bridge the gap between clinical science and policy during the pandemic [ 49 – 52 ]. It is also recognised that policies to combat infectious disease outbreaks must be implemented rapidly while also meeting the needs of multiple sectors including public health, economy, and social welfare [ 53 ]. Implementing a One Health approach, recommended in this study, is crucial as the efforts of one sector, or many sectors working in silos, cannot eliminate the threat of a pandemic. As suggested by physicians in this study, the WHO has a unique responsibility in helping countries, especially LMICs, prepare for pandemics, as well as supporting efforts to initiate and mount an effective response. These recommendations highlighted the significance of early detection, risk communication with vulnerable groups, strategies for containment, and international collaboration [ 54 ].

The spread of misinformation during previous pandemics led to confusion, risk-taking behaviours, and mistrust between the public and healthcare professionals [ 55 – 57 ]. Furthermore, within a highly digital society, the risks of ‘infodemics’ could be dependent on effective communication strategies that counter unreliable news [ 58 ]. Hence, the recommendations in this study for better communication strategies are much warranted.

The call for global unity during pandemics, echoed by physicians in this study, is also essential. According to the Global Dashboard for Vaccine Equity, as of May 18, 2022 only 17.61% of individuals in low-income countries have been vaccinated with at least one dose, in comparison to 72.23% in high-income countries [ 59 ]. The continued inequitable vaccine distribution leaves millions of individuals vulnerable to being infected by COVID-19 and promotes the emergence and subsequent spread of deadly variants across the globe.

Recommendations for future policy development

In our study, physicians provided recommendations regarding future interventions and/or policies that may help mitigate the impact of future pandemics on civilians and healthcare professionals. Physicians recommended a strong need to:

• Strengthen health systems by preparing the healthcare sector for future pandemics; suggestions included to (a) invest in virology research, (b) train HCPs, (c) develop guidelines pre-emptively, and (d) arrange an emergency stockpile of material resources for clinicians including PPEs.
• Prevent infodemics by having healthcare professionals collaborate with politicians and social media outlets to guarantee that credible information is being sourced to the public.
• Delegate decision-making roles appropriately, by promoting an empathetic political system that understands the need for input from scientists and HCPs in dictating best-practices for pandemic management.
• Acknowledge global responsibility and the necessity for international collaboration and equity. This must be done by collaborative preparation and prevention as well as through the equitable distribution of resources.

Strengths and limitations

This is the first up to date mixed-method global study, to our knowledge, with a large sample size (399 physicians) in 62 unique countries including high and low- and middle-income settings. The survey questionnaire was also developed based on the most recent information from the WHO and was subsequently validated and piloted prior to distribution. Additionally, this study included both quantitative and qualitative findings, ensuring that the results obtained are grounded in participants’ experiences and allowing for better translation and implementation of population and behavioural research [ 60 , 61 ].

We acknowledge the following limitations. Online surveys pose specific challenges including the inability to calculate response rate, the potential for the data to not be representative, and the possibility of recall bias. A further limitation of social media research is inability to ensure respondents are truly physicians. To mitigate this limitation, our team (a) contacted known physicians directly, (b) included a screening question in the survey asking about physician status, and (c) collected data from more than the minimum sample size required for reliability. Snowballing may have also introduced bias, as participants identified in that way may share similar opinions [ 31 ]. Moreover, the survey does not account for local differences in pandemic response and management. Additionally, the results may not reflect the new knowledge acquired after the study, in particular the emergence of new variants and the introduction of new guidelines and practices. However, as new variants continue to emerge, the recommendations that physicians have expressed, in particular strengthening health systems and global collaboration, should be taken into consideration when developing guidelines. Lastly, the survey was designed and written in English, potentially introducing response bias.

Findings from this global survey indicated that most physicians possessed good knowledge of COVID-19 disease yet limited adherence to safety measures. Physicians were particularly concerned about the distribution of vaccines to the general population, and approximately one third indicated that the policies implemented by their healthcare facilities and public health agencies were insufficient in handling the pandemic. Although most physicians described their experience with COVID-19 in negative emotive language and agreed that the pandemic had led to increased mental stress, most were willing to continue working in the healthcare sector post-pandemic. Collectively, this study suggests that physicians may need to have a more dominant role in policymaking in addition to their role as clinical experts. Given that future pandemics are inevitable [ 62 ], exploring how and in what capacity clinicians will contribute to policy-making processes during health emergencies could be crucial.

Supporting information

S1 table. list of categories, themes, codes, based on thematic analysis of physicians’ recommendations for future pandemics..

https://doi.org/10.1371/journal.pgph.0000639.s001

S1 File. Study questionnaire.

https://doi.org/10.1371/journal.pgph.0000639.s002

Acknowledgments

The authors thank Dr Akshaya Bhagavathula (Al Ain, UAE) for providing critical comments during the study design phase, and together with Prof Dr Alkomiet Hasan (Augsburg, Germany) for permitting the modification of their surveys for use in this study. The authors also thank the World Medical Association (Ferney-Voltaire, France), the Muslim Doctors Association (London, UK), and the Center for Global Health at the Perelman School of Medicine at the University of Pennsylvania (Philadelphia, USA) for their help with distributing the survey. We would also like to thank all healthcare professionals who contributed their valuable time in completing this survey and promoting this project among their networks. MSR is funded by the NIHR as In-Practice Fellow. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care.

• 1. World Health Organization. Timeline of WHO’s response to COVID-19. 2021 [cited 6 Oct 2021]. Available: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/interactive-timeline?gclid=Cj0KCQjwxJqHBhC4ARIsAChq4avP4ybyhepByx7gyCxS7h9encZvza5zMFyfeDcx-RsUXug5PLZNsOMaAlUPEALw_wcB#event-115
• 2. World Health Organization. WHO Coronavirus (COVID-19) Dashboard | WHO Coronavirus (COVID-19) Dashboard With Vaccination Data. 2021 [cited 10 May 2022]. Available: https://covid19.who.int/
• 3. World Health Organization. Coronavirus disease (COVID-19). 2021 [cited 6 Oct 2021]. Available: https://www.who.int/news-room/q-a-detail/coronavirus-disease-covid-19
• 4. Amnesty International. COVID-19: Health worker death toll rises to at least 17000 as organizations call for rapid vaccine rollout—Amnesty International. 5 Mar 2021 [cited 6 Oct 2021]. Available: https://www.amnesty.org/en/latest/press-release/2021/03/covid19-health-worker-death-toll-rises-to-at-least-17000-as-organizations-call-for-rapid-vaccine-rollout/
• 5. World Health Organization. The impact of COVID-19 on health and care workers: a closer look at deaths. 2021. Available: https://apps.who.int/iris/handle/10665/345300
• 6. World Health Organization. The impact of COVID-19 on health and care workers: a closer look at deaths. Health Workforce Department—Working Paper 1. Geneva; 2021.
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• 28. Dodds W. Chapter 4 Disease Now and Potential Future Pandemics. The World’s Worst Problems. 2019. pp. 31–44. https://doi.org/10.1007/978-3-030-30410-2_4
• 32. Raosoft Inc. Sample Size Calculator by Raosoft, Inc. [cited 6 Oct 2021]. Available: http://www.raosoft.com/samplesize.html
• 35. The World Bank. World Bank Country and Lending Groups–World Bank Data Help Desk. 2021 [cited 6 Oct 2021]. Available: https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups
• 42. World Health Organization. Rational use of personal protective equipment for coronavirus disease 2019 (COVID-19)—Interim guidance. 2020. Available: https://www.who.int/csr/resources/publications/putontakeoff
• 54. Knobler S, Mahmoud A, Lemon S, Mack A, Sivitz L, Oberholtzer K. Learning from SARS: Preparing for the Next Disease Outbreak. Washington, DX: National Academies Press; 2004. https://doi.org/10.17226/10915
• 59. UNDP. Global Dashboard for Vaccine Equity—UNDP Covid-19 Data Futures Platform. 2021 [cited 18 May 2022]. Available: https://data.undp.org/vaccine-equity/
• 62. Norman J, Bar-Yam Y, Taleb N. Systemic Risk of Pandemic via Novel Pathogens-Coronavirus: A Note. New York; 2020 Jan.

Medical students' perceptions and motivations during the COVID-19 pandemic

Affiliations.

• 1 Centro de Desenvolvimento de Educação Médica e Departamento de Clínica Médica, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
• 2 Centro de Desenvolvimento de Educação Médica e Departamento de Clínica Médica, Universidade Federal de Roraima, Boa Vista, Brazil.
• 3 Centro de Desenvolvimento de Educação Médica e Departamento de Clínica Médica, Universidade de Pernambuco, Recife, Brazil.
• PMID: 33730091
• PMCID: PMC7968644
• DOI: 10.1371/journal.pone.0248627

Background: There has been a rapid increase in the number of cases of COVID-19 in Latin America, Africa, Asia and many countries that have an insufficient number of physicians and other health care personnel, and the need for the inclusion of medical students on health teams is a very important issue. It has been recommended that medical students work as volunteers, undergo appropriate training, not undertake any activity beyond their level of competence, and receive continuous supervision and adequate personal protective equipment. However, the motivation of medical students must be evaluated to make volunteering a more evidence-based initiative. The aim of our study was to evaluate the motivation of medical students to be part of health teams to aid in the COVID-19 pandemic.

Methods and findings: We developed a questionnaire specifically to evaluate medical students' perceptions about participating in the care of patients with suspected infection with coronavirus during the COVID-19 pandemic. The questionnaire had two parts: a) one part with questions on individual characteristics, year in medical school and geographic location of the medical school and b) a second part with twenty-eight statements assessed on a 5-point Likert scale (totally agree, agree, neither agree nor disagree, disagree and totally disagree). To develop the questionnaire, we performed consensus meetings with a group of faculty and medical students. The questionnaire was sent to student organizations of 257 medical schools in Brazil and answered by 10,433 students. We used multinomial logistic regression models to analyze the data. Statements associated with greater odds ratios for participation of medical students in the COVID-19 pandemic were related to a sense of purpose or duty ("It is the duty of the medical student to put himself or herself at the service of the population in the pandemic"), altruism ("I am willing to take risks by participating in practice in the context of the pandemic"), and perception of good performance and professional identity ("I will be a better health professional for having experienced the pandemic"). Males were more prone than females to believe that only interns should participate in the care of patients with COVID-19 (odds ratio 1.36 [coefficient interval 95%:1.24-1.49]) and that all students should participate (OR 1.68 [CI:1.4-1.91]).

Conclusions: Medical students are more motivated by a sense of purpose or duty, altruism, perception of good performance and values of professionalism than by their interest in learning. These results have implications for the development of volunteering programs and the design of health force policies in the present pandemic and in future health emergencies.

• Attitude of Health Personnel
• COVID-19 / prevention & control
• COVID-19 / psychology*
• Health Personnel / psychology
• Health Personnel / statistics & numerical data
• Motivation / physiology
• Pandemics / prevention & control
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• Perception / physiology
• SARS-CoV-2 / pathogenicity
• Schools, Medical / statistics & numerical data*
• Students, Medical / psychology*
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The Importance of Proper Death Certification During the COVID-19 Pandemic

• 1 Office of the Chief Medical Examiner, State of Connecticut, Farmington
• 2 Department of Pathology, Yale School of Medicine, New Haven, Connecticut
• Research Letter Variation in COVID-19 Hospitalizations and Deaths Across New York City Boroughs Rishi K. Wadhera, MD, MPP, MPhil; Priya Wadhera, MD, MS; Prakriti Gaba, MD; Jose F. Figueroa, MD, MPH; Karen E. Joynt Maddox, MD, MPH; Robert W. Yeh, MD, MSc; Changyu Shen, PhD JAMA

Death certificate data are used to monitor local, regional, and national mortality trends to improve public health and public safety. Accurate death certification related to coronavirus disease 2019 (COVID-19) is vital to understand the extent and progression of the pandemic. Death certificate data can inform the public and policy makers on the progress of the COVID-19 pandemic and provide important information about who is dying, where they are from, and what were their associated medical conditions. Public health mortality data are only as good as the quality of the death certificates, but proper death certification has been a long-standing challenge in the US. 1 - 3 The COVID-19 pandemic has highlighted shortcomings that may compromise an accurate count of COVID-19 deaths.

COVID-19 death certificates are typically completed by treating physicians. There is a known training gap regarding proper death certification, 1 , 2 , 4 which leads to improperly completed death certificates. This affects the quality of the public health data, which in turn limits the ability to track the evolving COVID-19 pandemic. Death certificate data can be used locally to guide disease surveillance and quarantine measures and optimize medical resources. These data are transmitted to the National Center for Health Statistics (NCHS) so the US can initiate broader responses to the pandemic. If the death certificates are inaccurate, local and national responses may be adversely affected.

An example illustrates this problem. A woman in her late 70s with dementia and a history of stroke that occurred years earlier had a 3-day history of an upper respiratory tract infection with fever, dyspnea, and cough. She resided at a skilled nursing home and several residents had been diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Her family did not want further testing or hospitalization, and the woman died several days later at the nursing home. She was not tested for SARS-CoV-2 and her cause of death was certified by the facility physician as “acute respiratory failure.” When her death was reported to the medical examiner’s office by the funeral director, the medical examiner reviewed the death certificate, spoke with the nursing home staff and family, and suspected the death was due to SARS-CoV-2 infection. An investigator performed a nasopharyngeal swab on the deceased woman, and laboratory testing of the swab detected SARS-CoV-2 RNA. A revised death certificate was issued with the cause of death indicated as novel coronavirus respiratory infection; dementia and remote stroke were listed as contributing conditions.

This case illustrates the shortcomings of death certificate data that lack an accurate description of the underlying medical illness and contributory conditions. The original death certificate would not have been categorized as a death due to COVID-19 and would not have offered additional public health data to aid in the understanding of the pandemic. By contrast, the revised death certificate identified the disease that set the sequence of fatal events in motion.

A US death certificate ( Figure ) typically has 4 separate lines (part I) and is divided into sections: proximate cause, immediate cause, and mechanism. The proximate (underlying) cause is defined as the etiologically specific disease that in a natural and continuous sequence, uninterrupted by an efficient intervening cause, produced the fatality and without which the death would not have occurred. This must be included for it to be a competent death certificate. The cause of death statement may include an immediate cause (eg, bronchopneumonia), but it is only required to include the proximate (underlying) cause. The contributing conditions section (part II) is for diseases that contribute to death but do not cause the disease listed in part I. For public health analysis of risk factors for deaths from COVID-19, the part II findings are essential. These become important discriminating factors, in addition to age, sex, race, and residence that are already included. A study showed that hypertension, obesity, and diabetes were common comorbidities among patients with COVID-19 who required hospitalization. 5

There are 58 fields total in US death certificates, with only the 9 related to cause of death shown here. The key fields are cause (part I), contributing conditions (part II), manner, dates of birth and death, sex, race/ethnicity, and locations of residence and death.

The NCHS recently released guidelines for the certification of COVID-19 deaths. 6 The deaths may be considered in 2 groups: those in which the person has died from direct complications of laboratory-confirmed SARS-CoV-2 infection (such as acute respiratory distress syndrome, secondary bronchopneumonia) and those with a compelling clinical history for SARS-CoV-2 infection but were either not tested for COVID-19 or the test was negative. For the first group, the part I cause of death is COVID-19 and part II may include other medical conditions that increased the likelihood of death due to COVID-19 (eg, obesity, diabetes).

Objective findings, such as laboratory tests, are an important part of medicine, but clinical realities must be considered. Tests for SARS-CoV-2 can have false-negative and false-positive results. Among some hospitalized patients, initial COVID-19 swab tests may be negative and subsequent tests may be positive. If these patients had died before the positive test, the deaths would not have been a laboratory-confirmed COVID-19 death. For instances in which a laboratory diagnosis of COVID-19 cannot be made but SARS-CoV-2 infection is suspected or likely, clinicians may use their diagnostic acumen based on the history and physical examination to certify the death as due to COVID-19 and the recommended phrasing is “acute respiratory illness due to probable COVID-19 infection.” 6

Every death certificate needs an etiologically specific (underlying) cause of death to be useful for public health and mortality surveillance. Cardiac and respiratory arrest or failure are terminal events and need not be listed on the death certificate and certainly cannot stand alone as the cause of death. Cardiopulmonary arrest and respiratory failure are synonyms for death; listing either on the death certificate does not add to the understanding of why the person died. The key question is: What disease caused the respiratory or cardiac failure? This involves an assessment of the medical history and clinical course. The medicolegal standard for the certification of a natural death is a probability (ie, the listed reason was more likely than not to have caused death). Individuals completing the death certificate are never required to be 100% certain. Practicing forensic pathologists typically certify hundreds of deaths per year. This experience and the availability 24 hours/day and 7 days/week make medical examiner and coroner offices excellent resources for questions.

Deaths that are reportable to the medical examiner vary by jurisdiction. In general, these officials have statutory jurisdiction related to diseases that may constitute a threat to public health. Therefore, all suspected and confirmed COVID-19 deaths should be reported. In some jurisdictions, the medical examiner’s office creates an electronic record and then triages the level of investigation needed for each. Autopsies are not necessary for most laboratory-confirmed COVID-19 deaths. In the above case example, the investigation resulted in laboratory testing and a revised death certificate.

Given that COVID-19 death certificates have considerable influence on local and national responses toward mitigation of disease transmission, additional effort is required by medical examiners to emphasize this to physicians and other health care professionals, nursing homes, and hospitals. This can be accomplished through collaboration with the department of public health by publishing and disseminating updated guidelines about which deaths need to be reported and what is acceptable death certificate terminology. State medical societies, hospital associations, and funeral director societies also can help distribute information. Medical examiners can publish frequently asked questions about COVID-19 and provide links to alerts from the US Centers for Disease Control and Prevention and the NCHS and educate funeral directors to report when the family or certifying physician has concerns about SARS-CoV-2 infection, but testing was not performed. These approaches serve as a reminder that the medical examiner’s office has an important role in the pandemic, is available to offer guidance at any time, and that proper death certification does matter.

Death certificates serve as a valuable source of public health information that is readily available and quickly tracked and classified. The accuracy and quality of death certificate information cannot be understated. The cause of death statement must contain the underlying medical disease and any contributing comorbidities listed in part II. Well-reasoned and detailed documentation on death certificates allow local, national, and worldwide public health agencies to gather timely and accurate information to aid in the evaluation and management of the COVID-19 pandemic.

Corresponding Author: James R. Gill, MD, Office of the Chief Medical Examiner, State of Connecticut, 11 Shuttle Rd, Farmington, CT 06032 ( [email protected] ).

Published Online: June 10, 2020. doi:10.1001/jama.2020.9536

Conflict of Interest Disclosures: None reported.

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Gill JR , DeJoseph ME. The Importance of Proper Death Certification During the COVID-19 Pandemic. JAMA. 2020;324(1):27–28. doi:10.1001/jama.2020.9536

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Masks Strongly Recommended but Not Required in Maryland, Starting Immediately

Due to the downward trend in respiratory viruses in Maryland, masking is no longer required but remains strongly recommended in Johns Hopkins Medicine clinical locations in Maryland. Read more .

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Coronavirus (COVID-19): What Do I Do If I Feel Sick?

Reviewed By:

Lisa Lockerd Maragakis, M.D., M.P.H.

If you have a cough, a fever or difficulty breathing, and you are worried that you may have  COVID-19, here are recommendations from Lisa Maragakis, M.D., M.P.H.,  senior director of infection prevention at Johns Hopkins, on what to do, step by step.

Coronavirus: What do I do if I Feel Sick?

If you are concerned that you may have COVID-19, follow these steps to help protect your health and the health of others.

1. Stay home and call a health care provider

Unless it is an emergency, to reduce your risk of catching or spreading illness, stay home if you feel sick, even if your symptoms are mild. Do not go to work, school or public places, and avoid public transportation.

If your symptoms are severe or you feel like you need medical care, call before you go to your health care provider. Describe your symptoms over the phone.

If you have a medical emergency, call 911 and tell the dispatcher about your symptoms.

2. Answer questions to determine your risk

When you call a health care facility, you will be asked about your risks for COVID-19. Risk factors include being unvaccinated, attending indoor events, recent travel to certain areas or exposure to an infected person.

For instance, people calling Johns Hopkins Health System hospitals or clinics are asked:

• Have you had close contact with someone diagnosed with COVID-19, the disease caused by the new coronavirus? (Close contact means having been within 6 feet of that person for an extended time or being exposed to their cough or sneeze.)
• Do you have a cough, fever or chills, shortness of breath or difficulty breathing, muscle or body aches, sore throat, new loss of taste or smell, diarrhea, headache, new fatigue, nausea or vomiting, or congestion or runny nose?
• Has a public health officer said you were potentially exposed to COVID-19?

3. Follow your health care provider’s instructions

Based on your answers to these questions, the care provider will provide instructions over the phone. You will be told if you need to be evaluated, and if so, what to do next. Based on your risk for COVID-19, your health care provider may recommend that you:

• Continue to monitor your health and call back if you develop a fever or respiratory symptoms.
• Stay home and await further instructions.
• Report to a designated medical care facility for evaluation and treatment. It’s best to go alone to your appointment. Do not bring children or other family members unless you need assistance.
• Go to a clinic or emergency department if you have more severe symptoms, such as shortness of breath.

4. Practice hand hygiene and respiratory etiquette

• If you do leave your home to go to a care facility,  wear a mask so droplets from your breath, coughs and sneezes are less likely to infect others. 
• Wash your hands thoroughly (for at least 20 seconds) after sneezing, blowing your nose, coughing or using the bathroom, and before preparing or eating food.
• If you cough or sneeze, do so into the bend of your elbow, not your hand. Or use a tissue, and then throw it away immediately afterward.
• At home, clean often-touched surfaces such as doors and doorknobs, cabinet handles, bathroom hardware, tabletops, phones, tablets and keyboards regularly with disinfectant.

Learn other ways to protect yourself and others from COVID-19 .

5. Stay calm

The possibility of having a contagious illness can be scary, but doctors, nurses and other caregivers can help provide care to patients while avoiding spread of the illness in the community.

6. Consider being vaccinated for COVID-19

Once you feel better, talk to your doctor or health professional about getting vaccinated for the coronavirus. The COVID-19 vaccines are safe and effective, and the U.S. Centers for Disease Control and Prevention (CDC) recommends that people who have already had COVID-19 or tested positive should still get the COVID-19 vaccination. Studies show that vaccination provides a strong boost in protection in people who have recovered from COVID-19.

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Dear Doctor: What are common physical symptoms of long COVID, and how are they treated?

• Published: May. 08, 2024, 6:00 a.m.

Essentially, doctors treat each patient's concerns the same way they would if the person hadn't had COVID. POOL/AFP via Getty Images

• Dr. Keith Roach

DEAR DR. ROACH: I read last year that nearly 20 million Americans were living with long COVID, but I understand that the number is much higher now. Can you explain exactly what long COVID is and how it is treated? -- J.S.B.

ANSWER: Persistent symptoms after an infection are not unique to COVID. Many people will have cough or asthma exacerbations for weeks or even months after a bad flu infection.

Likewise, many people have symptoms (relating to many different body systems) after recovering from COVID. The Centers for Disease Control and Prevention and the World Health Organization differ on the amount of time after an infection that has to pass for it to be considered “long COVID” -- four weeks and three months, respectively.

The most common physical symptoms of long COVID are fatigue, shortness of breath and muscle aches. In one study of people who survived the initial wave of COVID, 45% had at least one persistent physical symptom.

The most common and persistent neurological/psychological symptoms are anxiety, depression, post-traumatic stress disorder and cognition problems (“brain fog”). Up to 25% of COVID survivors had one of these symptoms after their physical recovery. This was higher than other respiratory viruses, such as influenza.

For those who required an stay in the intensive care unit, over 75% had physical, psychological or cognitive symptoms after their discharge. These survivors are at the highest risk for prolonged and severe long-COVID symptoms.

There are many hypotheses for the underlying cause of long COVID symptoms, and although there is some evidence, it’s not clear whether there is one single cause or whether multiple mechanisms are possible.

I wish I could get better results from the available treatments. Essentially, we treat each patient’s concerns the same way we would if the person hadn’t had COVID. Emphasis on sleep, nutrition and exercise are critical. But we should still recognize that many people with long COVID have symptoms that are very similar to myalgic encephalomyelitis/chronic fatigue syndrome. As such, exercise should not be overdone, since this can worsen post-exertional symptoms.

DEAR DR. ROACH: Do MRI tests, especially of the head, contribute to hearing loss even when earplugs are used? -- M.D.

ANSWER: MRI scans are very loud, and exposure to loud noises can cause hearing loss. However, it’s the prolonged and repeated exposure to loud noises that is most likely to cause hearing damage, so MRI scans are not likely to be a problem. Earplugs are still a good idea, though.

There is nothing about the strong magnetic field in an MRI machine that adversely affects hearing. They just make a lot of noise due to the moving electrical coils. Some machines can cause levels up to 110 decibles -- as loud as a rock concert.

New MRI technology is coming that will dramatically reduce the amount of noise made during a scan.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected] or send mail to 628 Virginia Dr., Orlando, FL 32803.

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Robert F. Kennedy Jr. 'contracted a parasite' during travels, his team says after NYT report

Robert F. Kennedy Jr.'s campaign is responding following a report from the New York Times saying that years ago doctors found a dead worm in his brain.

The Times reported Wednesday that doctors noticed a dark spot in brain scans for Kennedy after he experienced memory loss in 2010 and concluded he had a brain tumor, according to a 2012 deposition. He received a call from another doctor who believed that it was not a tumor, and was instead a dead parasite.

The doctor believed the abnormality “was caused by a worm that got into my brain and ate a portion of it and then died,” Kennedy said in the deposition, per the New York Times.

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Kennedy told the Times he was also diagnosed with mercury poisoning likely from ingesting too much fish containing the heavy metal at the same time he learned about the parasite. Among other symptoms, mercury poisoning can cause irritability, indecision, headache, weakness or exhaustion and weight loss, according to the Centers for Disease Control and Prevention.

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In a statement to USA TODAY, Kennedy's campaign team seemed to confirm a previous issue with a parasite, but said the issue has been resolved.

"Mr. Kennedy traveled extensively in Africa, South America, and Asia in his work as an environmental advocate, and in one of those locations contracted a parasite," his press team said in an email. "The issue was resolved more than 10 years ago, and he is in robust physical and mental health."

The press team added: "Questioning Mr. Kennedy’s health is a hilarious suggestion, given his competition."

Kennedy, 70, is running as an independent in the 2024 presidential election and his name will appear on the ballot in Michigan , Utah, Hawaii and, his campaign says, in Delaware and California. Voters in those states will have the option to vote for Kennedy , Republican nominee and former president Donald Trump, 77, and Democratic nominee and current president Joe Biden, 81.

Kennedy is the son of Robert F. Kennedy, a former U.S. Senator who was assassinated during his presidential campaign in 1968, and the nephew of former President John F. Kennedy. Beyond his famous family, Kennedy has made a name for himself as an environmental attorney, activist and writer, and notably, spreading anti-vaccine rhetoric and COVID-19 misinformation.

Members of the Kennedy family have rejected his campaign, formally endorsing President Joe Biden in April at a campaign rally in Philadelphia.

Contributing: Natalie Alund