It’s been a long and uncertain road, with some groups shouldering a disproportionately greater burden of mental anguish from COVID-19. Yet now there’s a glimmer of hope. Has the page finally turned? The past two years have been a roller coaster, or, as University of Pennsylvania philosopher and psychology researcher James Pawelski describes it, an undulating graph with huge variations over time.
“First, it was this giant cliff,” he says about the pandemic’s early days. “Over that first summer, it leveled off a bit because the lockdowns worked. But then we had another spike. We waited on the vaccines and finally they arrive. We think we’re fine, we have two or three pretty open weeks during this last summer, but then there’s delta and it’s awful again.” After delta came omicron, which spread more easily than any variant before it.
“Somewhat naively, many of us thought the vaccines wouldn’t just be the light at the end of the tunnel but the end of the tunnel itself,” Pawelski adds. “Now we realize it’s a lot more complex.”
This complexity, coupled with uncertainty around COVID-19 and the pandemic itself—how long it will last, when new variants will emerge, how they will differ from those we already know—has taken a psychological toll on everyone. The degree of this varies, with certain groups shouldering a disproportionately greater burden due to their jobs or school shutdowns or the color of their skin.
With down-trending case counts and mask-optional guidelines from the Centers for Disease Control and Prevention (CDC), the United States is the closest it’s come to a pandemic turning point. Yet the long-term ramifications on individual and collective mental health remain unknown and likely will for some time.
“We’re seeing more stressed-out people, and anxiety as a whole has increased,” says Elizabeth Turk-Karan, a clinical psychologist at Penn Medicine’s Center for the Study and Treatment of Anxiety. “Everyone wants to go back to ‘normal,’ but I’m not sure what normal will look like. It may not look the same as before.”
Masks, social distancing, and a polarized public
Though there were signs that this coronavirus had the potential to stick around and morph, with experts hypothesizing what might happen, no one truly knew how the situation would play out. That’s partially because few people alive have ever lived through an experience of this magnitude.
Closest was the 1918 flu pandemic, with about 500 million people—then one-third of the world’s population—becoming infected. In that instance, the death toll reached 50 million worldwide, with about 675,000 deaths in the United States. For comparison, as of early March, almost 440 million people worldwide have gotten COVID-19 and nearly 6 million have died, including more than 950,000 in the U.S.
“I don’t think anybody expected the pandemic itself to last so long, and for mitigation measures that are pretty effective to be so difficult to put into place,” says Penn sociologist Pilar Gonalons-Pons. And yet, until the CDC’s recent guidance shift moving away from mask mandates in counties considered “low” or “medium” risk, conversations about mask wearing dominated school board meetings, legislative sessions, and dinner tables in many places across the country.
Masks weren’t the only polarizing COVID-19 mitigation measures, either. Research that Penn psychologist Adrianna (Anna) Jenkins and MindCORE postdoc Rista Plate published recently in Frontiers in Psychology found that Americans who most feared losing their social connections during the pandemic continued interacting with others rather than socially distancing—paradoxically skipping the action that could improve the situation faster.
The pandemic was unquestionably about physical health at its core. But there’s been a significant psychological component to it, too. In a paper that published in November 2020, Penn demographer Hans-Peter Kohler and colleagues confirmed that in March 2020, early days of the pandemic, nearly one-third of adults in the U.S. reported some level of depression or anxiety. Those feelings worsened between early and late March 2020, the period the researchers studied.
“Mental health sits at this intersection of physical health and your social world,” Plate says. “We know that a lot of social factors affect mental health and mental health influences a lot of social factors. They’re all pieces of a large and complex puzzle.” For almost two years now, certain groups have felt that mental weight more.
The communities hit hardest
Within weeks of COVID-19 arriving in the United States, disparities in how the virus plagued different groups started to surface. Compared to white populations, members of Black, Latinx, Asian, and other communities were getting and dying from COVID-19 at considerably higher rates.
Those differences persist: CDC data show that from March 2020 through early January 2022, Alaska Natives were hospitalized due to COVID-19 at more than three times the rate of white people and died at more than twice the rate. COVID-19 hospitalizations for Black and Latinx populations exceeded those of white populations by almost two-and-a-half times; death rates from the virus for those two groups nearly doubled those of white people.
“The pandemic uncovered the long-standing impact of systemic racism on health care,” says Howard Stevenson, a clinical psychologist and professor in Penn’s Graduate School of Education, where he runs the Racial Empowerment Collaborative.
“We know that health care systems and poverty function together in the way that you don’t have access to care or have less quality access to care as a function of race and class,” he adds. “Those are fundamental problems that, in a pandemic, become stark as opposed to invisible to most people. And when the murder of George Floyd happened, people could have a platform to interrogate race because they couldn’t avoid it.”
In a way, he notes, the requirement to socially distance from one another presented fewer distractions. That meant potentially more time to reckon with the situation, but also took an emotional toll on Black people. “We all had to stay home and watch,” he says. “For some people it was a first. For others of us, it’s been decades and centuries. It’s horrible to watch but some of us must endure these fears more frequently.”
Stevenson’s research focuses on interventions that can mitigate or prevent long-term negative effects of racism and racial stress on people’s physical, psychological, and emotional well-being. For Black Americans, he says, the combination of the pandemic’s uneven influence and another Black man dying at the hands of police led to significant mental health struggles.
“We think that we can problem-solve racial disparities by using or following or upholding the laws. But there are real emotional consequences of being mistreated because of your race, whether that’s happening in a classroom or an emergency room or a courtroom,” he says. “The idea is that those experiences over time, if they are frequent or unpreventable, they will have an effect on your body, your thoughts, and your feelings.”
That reality extends beyond African Americans, Stevenson adds, to the many groups that experienced incidents of physical and psychological assault, hate, and blame during the pandemic, often goaded by the attitude of and words from the highest levels of the U.S. government.
The parental struggle and gender imbalance
The past two years have seen parents struggling. When COVID-19 swept across the United States in early 2020, virtual schooling suddenly became the norm. Even with heroic efforts from teachers, parents—especially those of young kids—became de facto teachers themselves, as students from elementary age through high school and beyond shifted from in-person learning to a computer screen for hours every day.
Many people also began working from home. Curious about how that might affect the domestic division of labor in two-parent households, Penn doctoral student Allison Dunatchik started looking at data from a survey conducted in April 2020. The work, a collaboration with Penn sociologist Jerry Jacobs and colleagues from New York University and the University of Texas-Austin, found that moms were bearing the brunt of the burden, particularly for households where one or both parents continued to work outside the home.
“That’s where we saw gender inequalities really increase,” Dunatchik says. “Mothers really stepped up and served as a stop gap, absorbing the additional housework and care the pandemic necessitated.”
They also worried more—about their children’s education, their family’s well-being, and many other facets. “The worrying job is very feminized,” says Gonalons-Pons. “It’s not just feeding the kids or paying attention to them, but also the weight of worry that’s part of the hidden labor that falls mostly on mothers. That’s been hypothesized as a reason why we see greater declines in mental health and well-being for this group.”
In her own research in collaboration with Penn graduate student Yasmin Mertehikian, Gonalons-Pons studied how parents in the labor market managed during the pandemic. She found that this group fell the farthest behind, employment-wise, from where they’d been before COVID-19, and mothers fared worst.
“Some employment for parents has recovered, but it’s the employment recovering the slowest compared to single people and those without kids,” she says. “That’s a very clear pattern. There’s also a gender imbalance in the new jobs being added to the economy, with reports from recent months showing a larger share of jobs going to men than women.”
These factors all decrease well-being and increase stress and the need to multitask. And despite what seems like movement toward fewer pandemic-related restrictions and fears, parents are still facing instability and a lack of predictability around their children, particularly for those in the still-vaccine-ineligible under-5 group.
“When a child has been exposed to COVID in the classroom, somebody still has to stay home and look after the child, find a COVID test. We know from research prior to the pandemic that when kids get sick, when schools close, it’s mostly mothers who step in as the emergency care,” Dunatchik says. “I expect that is likely the case in the pandemic too, even in this new phase. Parents still must juggle all these responsibilities, and that has implications for their well-being.”
What comes next
So many other groups felt the psychological weight of the pandemic: people whose jobs didn’t allow them to work from home; health care workers who daily put themselves at risk and who experienced clinical trauma seeing so much death all around them; every person anxious or scared before COVID-19 who suddenly had to figure out a new routine in a world with a strange and unknown virus floating around.
“I know the term is thrown around way too often, but the situation was unprecedented,” says Turk-Karan. “We don’t have anything to compare this to. I can tell you what I’ve seen but I can’t predict with any amount of certainty the future toll of this pandemic. That’s the truth.”
And now, even as daily U.S. case counts of COVID-19 still top tens of thousands and as more than 1,000 people die in this country each day, another new phase—learning how to live with this virus for good—is poking its head around the corner.
Though it’s once again an unfamiliar situation to navigate, experts say we are moving in a positive direction. Scientists now know where to look for the information they’ll need when the next variant emerges, and other viruses offer a partial playbook for forging ahead. “People really want to feel like there’s no risk, like what happened with polio,” Turk-Karan says. “We’re not there yet, but we’re still much better than we were a year or a year-and-a-half ago.”
Michele W. Berger