The Case of the United States

The Impact of the COVID-19 Pandemic on Social Connectedness and Isolation in Low-Income Communities

in The International Journal of Social Quality
Author:
Allison A. ParsonsResearch Scientist, Rescue Agency, USA aparsons@rescueagency.com

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Danielle MaholtzPediatric Critical Care Medicine Fellow, Cincinnati Children's Hospital, USA danielle.maholz@cchmc.org

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Jamaica GilliamDoula, Certified Lactation Counselor, OEI Maternal Neighborhood Navigator jamaica.gilliam@gmail.com

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Haleigh LarsonMedical Student, Yale School of Medicine, USA haleigh.larson@yale.edu

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Dan LiMD/PhD Candidate, Yale School of Medicine and Yale School of Public Health, USA dan.li@yale.edu

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Sophia J. ZhaoUndergraduate, Yale College, USA sophia.j.zhao@yale.edu

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Brita RoyAssistant Professor, Medicine and Epidemiology and Director of Population Health, Yale University, USA brita.roy@yale.edu

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Carley RileyAssistant Professor, Pediatrics, University of Cincinnati College of Medicine, USA carley.riley@cchmc.org

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Abstract

Connectedness is vital for health and well-being. Families with lower socioeconomic status and of racial and ethnic minority groups experience inequities in social connections compared to families with higher income and of White race in the United States. We aimed to understand how families in lower-income neighborhoods experienced social connectedness and isolation during the COVID-19 pandemic and if and how political, economic, and other societal factors influenced social connectedness. We conducted in-depth interviews with nineteen caregivers of young children in Cincinnati, Ohio. Participants had a decreased sense of social connectedness to family and friends but also across all aspects of their lives. The current crisis has exacerbated preexisting societal conditions within the United States. We can learn from these caregivers how best to bolster social connectedness and disrupt social isolation.

According to Debra Umberson and Jennifer Karas Montez (2010), “social connectedness” concerns the number, strength, and types of relationships that people possess and their perceived sense of belonging within their community. It is considered a vital condition for health and well-being (Milstein et al. 2020). However, inequities in social networks exist in the United States, in part due to historical and contemporary practices of socioeconomic and racial segregation (Putnam 2016). Families with lower socioeconomic status and families from racial and ethnic minority groups are less likely to have the number, strength, and variety of social connections as families with higher incomes and White families (De la Haye et al. 2019; Ferguson 2006). Because social isolation undermines health and well-being, these disparities in social networks may underlie and reinforce disparities in health and well-being across socioeconomic and racial groups.

During the COVID-19 pandemic, these societal-based inequities may have contributed to observed race- and ethnicity-based disparities in morbidity and mortality from SARS-CoV-2. In the United States, lower-income and racial and ethnic minority populations have been more likely to be infected with, experience morbidity from, and die from COVID-19 (Mackey et al. 2021; Romano 2021). Adding to this complexity, the physical distancing precautions to prevent spread of COVID-19 likely disrupted existing levels of social connectedness (Smith et al. 2020), further worsening health outcomes.

The research question of our study is this: “how do lower-income groups perceive and interpret changes in their social connectedness as an impact of the COVID-19 pandemic?” We sought to better understand how caregivers in families with young children living in lower-income neighborhoods of one American city have experienced and understood social connectedness, isolation, and loneliness during the time of COVID-19. To do so, we conducted a community-based, phenomenological, qualitative study. In learning from caregivers, we also sought to elucidate if and how processes in the sociopolitical and legal, socioeconomic and financial, and sociocultural and welfare dimensions influenced their social connectedness during the pandemic.

First, we provide a summary of the American epidemic situation and the local, state, and federal public health responses to it. This section provides the societal context in which our interviewees experience the nature of social quality in their daily circumstances. We then describe our research methodology and the findings of our study. In the last section, we interpret these findings and provide conclusions based on the research question.

The Pressing COVID-19 Pandemic Context

The first case of SARS-CoV-2 in the United States was identified in the state of Washington on 20 January 2020 (Omer et al. 2020). Between 21 January and 23 February 2020, fourteen cases of SARS-CoV-2 were diagnosed across six states, including twelve travelers from China (Schuchat and CDC COVID-19 Response Team 2020). By 28 February, thirty-nine more cases were confirmed in people returning from areas outside of the United States where the virus was known to be present (Jernigan and CDC COVID 19 Response Team 2020). In late February, cases were being reported that were not associated with recent travel from affected areas or linked to previously known cases, thus signaling pandemic spread in the United States (Qualls et al. 2017). Two months later, more than 235,000 cases had been officially identified across the United States, though these figures are likely underestimated due to the limited capacity for testing at that time (WHO 2020). By 17 March, there were cases in all fifty states and the District of Columbia. By 2 April, there were at least 5,000 COVID-19-related deaths (Omer et al. 2020). Four main factors contributed to accelerated transmission: continued importation of the virus by travelers; large gatherings including social and professional events; introduction of the virus into settings where it would be easily spread (e.g., long-term care facilities, high-density urban areas); and challenges in early detection and tracking (Schuchat and CDC COVID-19 Response Team 2020).

Infection with SARS-CoV-2 and the development of symptoms occurred after a relatively long incubation period (5.7 days) in comparison to other coronavirus outbreaks such as SARS-CoV (4.0 days) and MERS (4.5–5.2 days) (Lessler et al. 2009; Park et al. 2018; Wassie et al. 2020). As such, there was greater spread of the virus during the asymptomatic or mildly symptomatic phase compared with the prior epidemics. In the United States, this had major implications in the first few months of the pandemic, when testing was not widely available. Because infection with SARS-CoV-2 had a lower mortality rate than infection with SARS-CoV or MERS, more people survived or had mild to moderate disease and infected others (Guarner 2020). The United States was allowing unrestricted travel, and until late March to early April 2020 there were few enforced public health precautions such as masking and distancing. During this time, the disease spread quickly, first through major metropolitan areas with a high population density like New York City and then rapidly to other parts of the country. The number of new cases, hospitalizations, and deaths had started to decline in January 2021, largely as a result of the distribution of several highly effective vaccines. However, the emergence of the SARS-CoV-2 Delta variant has led to an increase in COVID-19 cases, mostly among the unvaccinated, starting in July 2021.

In Figures 1 and 2, the course of the epidemic in the United States is pictured in new cases and deaths per 100,000 population. Figure 3 depicts the cumulative vaccination coverage, which is expressed in doses administered per 100,000 population.

Figure 1.
Figure 1.

Daily new confirmed COVID-19 cases.

Citation: The International Journal of Social Quality 11, 1-2; 10.3167/IJSQ.2021.11010214

Figure 2.
Figure 2.

Daily new confirmed COVID-19 deaths.

Citation: The International Journal of Social Quality 11, 1-2; 10.3167/IJSQ.2021.11010214

Figure 3.
Figure 3.

COVID-19 vaccine doses administered.

Citation: The International Journal of Social Quality 11, 1-2; 10.3167/IJSQ.2021.11010214

Public Health Responses

Testing and Diagnostics

The United States had been struggling with testing and diagnostics since the start of the pandemic. One contributing factor was that the Food and Drug Administration (FDA) was not freely allowing academic laboratories and developers to produce tests. Also, the Centers for Disease Control and Prevention (CDC) took control of the development of SARS-CoV-2 testing kits as opposed to engaging private laboratories. As such, when the CDC's single product failed upon distribution, there were no alternate testing strategies (ASM 2021). The shortage of testing in the United States may have limited the ability to understand and contain the spread of the virus. This shortage also limited states’ access to testing kits. Additionally, though people from racial and ethnic minority groups had been particularly hard hit by the coronavirus pandemic, healthcare access—and therefore access to testing—was especially difficult for them. The disparity in access to health insurance increased the likelihood that people from racial and ethnic minority groups would delay testing and care until their symptoms worsened (Lopez et al. 2021).

Essential Equipment

Though the Strategic National Stockpile of personal protective equipment (PPE) was designed to provide support during a pandemic response, it was not intended to support a crisis of the magnitude of the COVID-19 pandemic (Esbitt 2003). Since the 2009 H1N1 influenza pandemic, critical PPE was never replaced in the Strategic National Stockpile. The shortfalls in resourcing PPE and ventilators resulted in underperformance in the early frontline response (Gerstein 2020). Underfunded state governments and local institutions were managing the broken PPE supply chain (Handfield et al. 2020). The lack of these resources disproportionately affected people from racial and ethnic minority groups, as they were more likely to work on the frontlines and in essential services, putting them at higher risk for infection exacerbated by the shortage of PPE (Lopez et al. 2021).

Therapeutics and Vaccines

It was essential to identify or develop highly specific therapies against the virus, as well as to mass produce them. Given the urgency of the situation, the FDA committed to moving medical countermeasures through the regulatory process quickly while maintaining the safety and efficacy of the products (Simpson et al. 2020). The FDA also partnered with the medical countermeasure industry to expedite the development and manufacture of therapeutics (i.e., vaccines, antibodies, drugs) to protect against COVID-19 (March 2021). As a result, the United States during the course of the pandemic became a leader in effective therapeutics and vaccine development.

Government Responses

Federal and Congressional Response

As the biggest public health crisis of the last century, the COVID-19 pandemic had placed all levels of government and institutions under unprecedented strain. At a time of national crisis, citizens and local governments looked to the federal government and the US government health agencies for critical and timely information and guidance. In the initial stages of the pandemic, messaging around the seriousness of COVID-19 as well as what precautions to take was inconsistent, leading to confusion. The lack of clear communication led to poor decisions by the state and local governments and by the general population. For example, the United States was slow to shut down borders and develop necessary restrictions such as screening, quarantine, isolation, contact tracing, and travel bans.

Eventually, Congress enacted laws providing funding to help governments, institutions, and individuals during the pandemic. In response to the pandemic, Congress also passed key legislation, including the Coronavirus Aid, Relief, and Economic Security (CARES) Act (Mountain 2020), the Families First Coronavirus Response Act (FFCRA) (Welton and Meyers 2020), and the Coronavirus Preparedness and Response Supplemental Appropriations Act (Kopp et al. 2020), which addressed several key issues that American people faced during the pandemic, such as financial insecurity, food shortages accompanied by food insecurity, and mental health concerns.

Timely Global Partnership and Communication

The US historically has been a contributor to and supporter of the World Health Organization (WHO); however, when the COVID-19 pandemic hit the United States in March, the United States USA left the WHO (Lovinger and So 2020). This resulted in a delay in the United States receiving available effective testing. Rather than using test kits approved by the WHO, which were being used in other countries at the time, US healthcare agencies developed new test kits.

State Responses

According to the US Supreme Court, state governments have broad authority “to enact quarantine laws and health laws of every description,” and governors have the “supreme executive power of state.” As such, the US national government did not have the authority to mandate public health precautions, such as masking, physical distancing, and quarantine procedures, or to regulate which businesses or institutions could remain open. While the CDC provided recommendations, each state, and sometimes local city governments, independently enacted emergency legislation and declared states of emergency at various times during the pandemic (Berman 2020). These public health precautions included bans on social gatherings; the closing of schools, fitness facilities, bars, and restaurants; and the issuance of “stay at home orders” (Courtemanche et al. 2020).

Socioeconomic Impact

The American economy contracted by 3.5 percent in 2020, the largest decline since 1946, due to decreased spending, closing businesses, and job losses (Furman and Powell III 2021). The effects of such changes most acutely affected poorer Americans, who are more likely to be black or Latinx. In June 2020, 27 percent of Supplemental Nutrition Assistance Program (SNAP) recipients were unemployed or lost income due to reduced working hours during the pandemic (Enriquez and Goldstein 2020). SNAP supplements the food budget of those who are eligible based on income. Around this time, 50 percent of SNAP beneficiaries also reported unstable housing within one month (Enriquez and Goldstein 2020). Lost income was most severe for Black Americans, while housing precarity was most prominent for both Black and Latinx communities (Enriquez and Goldstein 2020). Hospitality and educational industries lost the most jobs in March 2020 (Burns 2020), while the retail, transportation, and entertainment industries additionally faced the highest risk of layoffs (Kochhar and Barroso 2020).

Community Responses

In the absence of early and effective national preparedness and responses, many local communities and institutions were handling the crisis on their own. Aside from the high demands on healthcare, society also experienced economic disruption, the disruption of essential services, and shortages of essential commodities. Local community-based organizations and institutions began to take it upon themselves to develop programs to ensure their local communities had access to accurate information, food, water, medications, and essential services. Many community organizations were engaged in strengthening the social services safety net for vulnerable populations (Marston et al. 2020).

Research Question

Theoretical Framework

We sought to better understand how caregivers in families with young children living in lower-income neighborhoods of one city in the United States understood and experienced social connectedness, isolation, and loneliness during the COVID-19 pandemic. This research question also aims to explore how the structural context of the United States (e.g., historical and contemporary practices of socioeconomic and racial segregation) was reflected in the context of families and communities. We conducted a community-based, phenomenological, qualitative study. In learning from caregivers, we also sought to elucidate if and how sociopolitical and legal, socioeconomic and financial, and sociocultural and welfare processes influenced their social connectedness during the pandemic. To organize our findings, we used the analytical framework of social quality theory (SQT) (IASQ 2019). With help of this framework, we were able to understand if and how people were able to meaningfully engage in societal relationships in ways that benefited their “well-being, capacity, and individual potential.” In this framework, a distinction is made between three sets of factors with which to understand the “social quality of daily circumstances at a certain place and time.” One of the three sets concerns the conditional factors of social quality, namely socioeconomic security; social inclusion; social cohesion; and social empowerment (Van der Maesen and Walker 2012). These factors reflect the societal circumstances that are conditional for developing a particular degree of social quality in one's daily life. According to SQT, these conditional factors are in continuous reciprocal interaction with the so-called “constitutional” (subjective) factors expressing characteristics of individual persons. The outcome of these reciprocal processes, constituting the “quality of the social,” can be valued by “normative” (ethical) criteria.

The themes that emerged in the interviews have been grouped by deploying the social quality set of conditional factors (IASQ 2019):

  1. (1)Social cohesion: represents the social cohesion experience in their communities.
    1. (a)Subthemes: freedom and togetherness; family; friends; everyday routines; life events
  2. (2)Social empowerment: represents the extent to which people are able to attain roles of responsibility within society and be involved in societal change.
  3. (3)Subthemes: parental involvement in virtual learning; changes in school environment; mental health
  4. (4)Socioeconomic security: represents the socioeconomic conditions people live in (e.g., employment, finances).
  5. (5)Social inclusion: represents societal conditions that enable a person to realize their civil rights.
    1. (a)Subthemes: safety and security; relationships impacted by racism

Definitions of Social Connectedness, Isolation, Loneliness

Social connectedness has been defined as the opposite of loneliness and as a sense of belonging derived from forming bonds with others (Umberson and Montez 2010). Isolation is often likened to loneliness, whereas loneliness has been defined as an awareness of being apart from others as well as a wish for interaction that currently does not exist. Given the many and varied definitions of these terms, we asked the participants in this study to provide their personal definitions for social connectedness, isolation, and loneliness. Most described social connectedness as the ability to communicate or interact with others in any medium. Most acknowledged better interactions in person compared with the virtual space. Some described social connectedness as having an uninhibited network of friendship and support. The definitions for isolation included “being” alone physically and “feeling” alone emotionally. For those who defined isolation as physically “being” alone, many connected this with the need to isolate from others by staying at home. Some connected isolation with the protection of loved ones. After defining isolation using loneliness, a few participants struggled to provide a different definition for loneliness. Most reported “feeling” alone emotionally as the definition for loneliness, including feelings of being “abandoned” or “deserted.” Some tied their definition of loneliness back to their definition of social connectedness and defined the former as missing as the absence of ties to others.

While almost all participants reported that their definitions for these words had not changed since the pandemic started, most admitted that the words now held more value. Moreover, most participants reported experiencing what they felt those words described for the first time during the pandemic. They also felt that these terms had become more normal to think and talk about. This was expressed by participants who did and did not endorse mental health concerns prior to the pandemic.

Research Methodology

Study Design

We conducted a prospective qualitative study to explore the impact of COVID-19 and its related context on social connectedness, isolation, and loneliness. Our core study team comprised three clinician-scientists (DM, BR, CR), a qualitative researcher (AP), and a community partner (JG). All members worked together to define the research questions, design the study, conduct data collection, analyze the data, and disseminate the findings. Both the qualitative researcher and the community partner, who has training and prior experience conducting qualitative interviews, conducted one-on-one, in-depth qualitative interviews from April to May 2021. The Institutional Review Board at Cincinnati Children's Hospital deemed this study exempt.

Setting

We conducted this study in Cincinnati, Ohio, a city in the Midwestern region of the United States. Cincinnati has a total population of 303,954 people, including around 66,000 children and youth under 18 years of age (US Census Bureau 2020). Approximately 40 percent of children and youth live in poverty as defined by federal guidelines, where a family of four is considered poor if their household income is less than $25,750 per year (May 2019). Approximately 42 percent of the total population self-identifies as black and 48 percent as Hispanic (US Census Bureau 2020). This study was motivated and informed by the families, community partners, and improvement teams of the All Children Thrive Learning Network, a multisector, community-engaged learning network structured to promote communication, collaboration, and learning between the health system, community partners, and families (All Children Thrive 2019; Beck et al. 2019; Kahn et al. 2017).

Sampling, Recruitment, and Informed Consent

We recruited participants using purposive criterion sampling strategies (Patton 2005). Participants had to be English-speaking caregivers of children under six years of age. We recruited participants through our connections with community organizations that provide social services to families with young children. If the prospective participant was interested in participating, they completed a verbal informed consent process that included information about participation being voluntary, their right to refuse to answer any questions or withdraw from the study at any time without consequences, and confidentiality. Participants received a $20 gift card for participating.

Interviews

Interview protocols were designed to explore the impact of COVID-19 and its related public health precautions on social connectedness, isolation, and loneliness. The initial interview protocol was outlined by two members of the core team (AP, CR) and reviewed by the community partner (JG). Three core team members (AP, DM, JG) piloted the interview guide with a total of five people to identify problems with wording and question order. Interviews were held by phone or video conference, audio-recorded, and lasted thirty to sixty minutes. Interviews were transcribed verbatim using an online application, and one team member (DM) reviewed each transcript and corrected any errors.

Analysis

The qualitative researcher (AP) and another core team member (DM) independently coded the transcribed interviews by reading eight transcripts line by line and recording inductively derived open codes. The open coding process resulted in a codebook including the codes and their definitions and descriptions. The qualitative researcher then applied the codebook to all transcripts, and additional codes were added to the codebook. The qualitative researcher created a table of categories of codes with example quotes and shared this with the core team. The core study team reviewed the categories, codes, and quotes, and developed themes from these categories.

Characteristics of the Sample

We included eighteen mothers and one father, with seventeen of the nineteen total caregivers living in lower-income neighborhoods in Cincinnati, Ohio. Twelve participants self-identified as non-Hispanic Black, six as non-Hispanic White, and one as multiracial. All participants were caregivers in families with at least one child under 6 years of age.

Limitations of the Study

The following limitations should be considered. The participants included in the study were purposively sampled based on particular criteria; therefore, the findings cannot be generalized to the larger population. While these participants and their perspectives are unique, many themes are fundamental and likely relevant to other settings and populations. We sought to increase the likelihood that participants would speak candidly by using snowball sampling and also in working in partnership with a community member; it is possible that participants censored their responses.

Findings: Perceptions of Caregivers Related to Social Connectedness

Our findings are presented according to the four themes listed above and are based on the conditional factors of SQT.

Theme 1: Social Cohesion

State governments across the United States began to issue mandates related to the COVID-19 pandemic in March 2020. This included guidelines for wearing masks, physical distancing, and business closures. In Ohio, the governor was the fifth in the country to declare a state of emergency. He did so on 9 March 2020 and included a “Stay at Home Order” (Patrício Silva et al. 2020). This order stated that only essential workers or people taking care of an essential tasks (e.g., grocery shopping, attending health-related appointments) were to leave home. We asked participants about their lives before the start of the pandemic to understand if and how COVID-19-related changes influenced their sense of connection to the people in their lives.

Freedom and Togetherness

When asked to describe their lives “pre-COVID,” every participant mentioned not having to wear a mask and contend with other restrictions related to the COVID-19 pandemic. One participant summarized it as when “life was normal: when there weren't rules and mandates and curfews and things of that nature.” Though some participants felt that their routines had stayed “the same just with the mask added” because they were essential workers, most participants felt that much of their lives had changed since the start of the COVID-19 pandemic. Participants often used the word “freedom” in describing when things were “normal,” such as:

Like I feel like pre-COVID everything was, that's what you would say normal … you can do what you wanted, you can go where you wanted. It just felt more free and you had more freedom to live your life.

Participants gave examples of places that they could go and the people that they were able to see before the restrictions of the COVID-19 pandemic went into place:

Most days we have a lot of company, as far as family members, friends, we could go to parks, more freely and, you know, just enjoy ourselves a lot more … we'd be able to go out and enjoy gatherings with family or friends.

In addition to being able to go places, see people, and enjoy daily life more, participants also described a sense of togetherness that they experienced before the COVID-19 pandemic. As one participant described:

The togetherness of being with others like whether it's in a store, you see a friend and you run up and give them a hug or, or if it's you know experiencing a concert together, going to church together, like just all those experiences of togetherness is what I think of when I think of pre-COVID.

Family and Friends

Participants differed in their interactions with family. Some said that they continued to see family like they had before. One said:

I know they didn't want us to go places but we kind of only saw the same people anyway. And I know that my family, like the people we were going to see, don't see outside people really. So I think family really hasn't been changed, honestly like we would go see my parents, and then we would go see my son's dad's parents, but that was pretty much normal like that's what we did anyway. So now it's the same, like we still see the same people.

When participants talked about the way interactions remained the same, they provided COVID-19-related context. For instance, they would explain that they understood that the rules said they should be staying at home and limiting their interaction. They also would often explain that they knew the people with whom they were interacting were being safe and limiting their interactions.

Participants who were either limiting how often they were seeing their family members or not seeing their family members at all said that this was challenging from an emotional perspective. As one participant put it: “I'm really close to my mom; she barely came out; she would barely come over. You know … it was miserable to me.” Some said that they did try to maintain their connections through social media, phone calls, and virtual platforms. One participant shared:

And the pandemic has really put a halt in a lot of our usual family activities so you know, staying connected, we use a lot of FaceTime and Zoom applications and mainly try to spend as much time together as we can, even though it's kind of hard right now.

Participants talked about how it was difficult to explain limited contact with family to their children. One participant said: “The kids always ask: ‘Mama is granny coming over or can we go over?’ I'll tell them ‘no,’ and try to explain but they really didn't understand.”

Similarly, participants had differing experiences of staying connected with friends. Some participants said, “I don't really have friends,” and others said the friends that they did have were associated with work. Most participants mentioned that they were “not really seeing too many friends or people that I like to hang out with.” One participant characterized the changes in her interactions with friends like this:

Going to my friend's house for a barbecue and game night that all just came to a screeching halt. At that point, you kind of felt concerned about your safety if you go out the house are you going to contract it, give it to somebody else and everything like that so it's like, even a harmless get together could be life or death, so that was stressful.

Though participants mentioned staying in contact through text, phone calls, and virtual chats, opinions varied about the effectiveness of these options. One person felt that “we've learned to, I guess, communicate better with each other since we talked on the phone more.” Another participant said: “You didn't really get to stay in contact, social media and like the phones and everything was very helpful, but it wasn't the same.”

Participants also talked about having to limit the interactions of their children with friends. One participant said: “The kids have to stay distanced from their friends. So that's hard because they're, like, ‘I want to play with my friend’, ‘I want my friend to come over’, and like ‘no we can't have that happen’.”

Everyday Routines

In addition to changes in interactions with family members and friends, participants felt that their everyday interactions decreased. Many said they were no longer talking to other caregivers when they took their children to activities, or having casual conversations with people at places like the park or grocery store. Some felt that this limited their ability to support others. As one participant stated:

I still try to be kind … I'll try to say hello and it's just, you still want to keep your distance … it's hard to want to go nearby and offer your help because you don't know how that person would feel about it regardless of you having a mask on … other people might be worried about getting close to you or getting help from you because they don't really know you, they don't know what you're doing on a daily basis.

Another participant felt disconnected from her community because it had become “insular,” stating:

Black folks are, like, we are rooted in connection and, like, village and taking care, and to see this like insular way of living so fast and so ugly and so firm really rocked me; it has me looking at people very different.

Those participants who were working at this time mentioned that their interactions with coworkers were different due to either working from home or COVID-19 public health precautions in the workplace. While many participants who worked from home appreciated the flexibility that virtual platforms provided, they also felt that they changed the work environment. One participant said: “Everything is through Zoom, Skype, or you're typing to one another or sending emails, so we don't really have the same vibe.”

Participants who were going in person to work noted that their work environment had changed “drastically.” One participant explained:

I don't really join others for lunch like in the break room now, I usually just kind of go off by myself because we're still trying to social distance the best we can and keep ourselves, you know, as far away as possible without masks while eating, but you know that's not typical all the time.

Both groups mentioned that they missed “seeing faces,” getting to be “sociable,” “making personal connections,” and “bounc[ing] ideas off of [others].”

Life Events

Several participants gave birth during the pandemic. These participants discussed how they had imagined this time in their lives as one filled with joy, changes, and connection to family and their community. Instead, they found that public health precautions limited contact with their support network and isolated them from family and friends. One participant mentioned that they felt it was “unfair that [my] significant other or the baby's dad cannot go to appointments with [me] and share that special moment … but yet bars are open, restaurants are open.” Another echoed this, saying this was “depressing” to her. She went on to say:

I felt really lonely. When I went to have the baby at the hospital … my mom couldn't be there. And then, like their dad he still worked so if he came in the morning, couldn't nobody come other but him. So basically … about time he got off of work the visiting hours were off. I was basically in the hospital by myself.

Participants mentioned that because they were following the COVID-19-related public health precautions, they were unable to introduce their babies to the rest of their family. One participant said: “A lot of people in our family don't really know my son like that; it's sad. [They] haven't really interacted with him.” One of the first-time mothers talked about the differences in how she had imagined life with a new baby and what it was actually like:

I was romanticizing what life with a kid was going to look like with my community and now the memories that I have don't exist, but I'm looking at everybody who's kind of interfering with the new normal … and I just can't help to be like … you literally won't meet this child until she's 8.

Only one participant spoke specifically about their experience with a death in the family during the COVID-19 pandemic:

My grandfather passed away during COVID, and we couldn't visit him due to the whole restrictions thing. So, I just really felt like he got lonely and that's kind of the reason he ended up passing away so soon, because like we could only see him through the glass and he didn't understand why we couldn't come in.

Theme 2: Social Empowerment

In this section, participants describe how school and work as well as life events such as birth and death were changed. They discuss the emotional toll this took as well as how these changes related to their sense of isolation and ability to connect with others.

Parental Involvement in Virtual Learning

In Cincinnati, the school year runs from August to May. In 2020, students were sent home on 16 March. There was no school or any school-related activities for three weeks until schools developed a plan for virtual learning programs (Patrício Silva et al. 2020). The schools in Cincinnati remained closed for the remainder of the school year, and school was entirely online (ABC 6 News 2020). In August 2020, some schools began trialing optional in-person days in addition to virtual learning, and in 2021 most schools resumed full-time in-person learning.

The majority of participants in this study said they were worried about “how am I gonna manage my kids” when childcare and schools closed. When describing this time, participants used words like “frenzy,” “stressful,” “overwhelming,” and “crazy.” Participants were “unsure … how everything was going to work being at home with all my kids.” Once virtual learning began, participants “had more jobs” because they had to ensure their kids were “doing what they needed to do” for school. One participant described it like this:

A lot of us … [were] all over the place with the emotions … overwhelmed trying to … manage all of our different roles because … I went from a working mom to being a working mom, teacher, [and] principal.

To fill the role of the school and teachers, caregivers had to “cut their hours at work to stay home with their children, to make sure that their children was [sic] starting at school.” This was not possible for everyone due to differing family structures, access to financial resources, and work situations, particularly those who were essential workers. Also, people from racial and ethnic minority groups were more likely to work in essential services (Lopez et al. 2021). As one participant said:

The belief that every parent has the fucking power … That parents have the actual time to stay up and like do school with their kids … even if you have a two-parent home, you don't know those parents’ [work] hours, like parents gonna go to work. But like, Oh, you're not rich to be there and sit around and do school with your kids and not work.

In this virtual school setting, caregivers also had concerns about their children's development and their academic achievement. One caregiver who was also a childcare worker said:

I do see a lot with my younger children that I care for. I see a lot of a lot more behavior issues, a lot more. They're falling behind academically, just because they're not getting the interpersonal connection with people like their peers or people in general.

Other caregivers echoed this opinion, feeling that the option to continue with virtual learning was not viable, as their children “were not learning anything … not retaining any information” so they were sending their children back to in-person school despite concerns about the pandemic.

Changes in the School Environment

Caregivers and teachers talked about the changes in interactions in the childcare and school setting for the caregivers and the children. One teacher said that her classroom included a diverse group of students including mostly Latino/a and African immigrant children. She said that she “miss[ed] the times where I can just smile at my children and they'll know I'm proud of them, I'm smiling at them, I'm happy.” She felt that the mask made it hard for her to communicate her feelings to the children in her classroom, especially when there was a language barrier.

Caregivers and teachers also said the school environment was “different for them … it's not as free as before.” A caregiver talked about what her children's school used to be like in this way:

My kids were able to go to school and stand next to their friends and play with their friends before going into the school building; they were able to sit together at lunch and recess to play; they were able to sit together in class and play.

The participants recognized that these changes had taken a “toll” on their children. They mentioned that restricted access to the school building meant that they themselves were unable to interact with teachers. One participant said that she used to be able to “go and talk to the teachers and ask [about their] progress and what they were doing.”

Mental Health

During these interviews, every participant mentioned some level of worry or concern associated with changes arising as a result of the pandemic. In addition, many participants were worried about passing COVID-19 to family members and friends, and their children getting COVID-19; a couple expressed a concern that they themselves would get COVID-19. This worry impacted both their social behaviors and their mental health. One participant said:

I was like paralyzed by the fear of COVID. I was scared, and then you started to see people's parents die, their cousins or you just seeing death, or people in hospitals and I got COVID and, and I'm like, “Oh, this is the end”; I was just waiting for those traumatic moments. So to be honest, I didn't think we're going to get this far.

In response to these concerns, many participants developed their own informal safety protocols. Many mentioned that they were avoiding people, saying, “I'm finding myself literally staying away from people as much as possible. Like, going to the store I literally am more than six feet If I can.” Others talked about how they used to ask people about their weekend “to make sure they had a good weekend,” and now they are asking: “What did y'all do this weekend, who were y'all around, do they have any symptoms?” One participant characterized it this way:

When COVID hit, I felt like I was doing interviews before people could even talk to me. I'm like: “What are you doing, where was you at, did you wear your mask?” “I saw you on Facebook, stop lying to me.”

Anxiety, panic, and depression were mentioned many times by the participants. Several also spoke about how “the quarantine took a toll on a lot of people” who had preexisting mental health issues. One mom said:

I think I started being depressed. I started being mad and angry, you know, yelling at the kids … I wasn't being the best of who I am and who I love to be … But because I was told to do something that I didn't want to do, that brought back up my trauma.

Theme 3: Socioeconomic Security

Changes in childcare and school had implications for participants’ work situations with school personnel out of work and caregivers quitting jobs or reducing hours to supervise their children. Additionally, many participants were suddenly out of work or furloughed. One participant described the situation:

My husband still is unemployed; our cars are broke down; we can't afford to have them repaired. We're strictly living off our savings. We don't have enough money to pay our bills; if we didn't have a savings, we wouldn't be able to pay our bills.

Other participants who were able to maintain their jobs were in and out of work because of COVID-19-related public health precautions. One participant said: “This is why I'm out of work right now. Someone at my job had COVID so we had to close down.” Another person who tested positive for SARS-CoV-2 said: “I was out of work for five weeks with no type of benefits [e.g., health insurance] because I was not at my job 90 days yet.” Of the participants who lost their jobs, one mentioned that unemployment benefits “helped a lot” and another said that federal business loans helped “people … get back on their feet.” Generally, participants mentioned “being frightened” and “anxious” about the future due to the uncertainty of their jobs and lack of consistency in income.

Theme 4: Social Inclusion

We asked participants about the racial justice movement, concurrent with the second wave of the COVID-19 pandemic in the United States, that was triggered by the murder of a Black man by a White police officer. Several participants talked about the fact that though racism has “been going on since before we've been born,” the pandemic “gives you no choice because you're not really doing anything so it's not like you can … keep your mind off of things,” in reference to racism. Many participants echoed the following sentiment

White people … I've seen … Since Trump has [sic] shown their true colors against Black people even though it's always been there but like in my time, I'm only 26, I've never seen that is such as that as this, like, in my face. And that's scary though.

Safety and Security

Many participants, when talking about racism during the pandemic, mentioned they were scared for themselves or their family and friends. Most who expressed concern for themselves were Black, while both White and Black participants expressed concerns for Black and/or multiracial family and friends. One Black participant who identified as a man said,

being more aware of the fuckery that goes on in this country, so already being aware of it as a Black man, I had to be like, I don't really want to be outside too much, it's not safe out there.

Participants were encouraging their Black family members and friends to “stay in the house” to avoid experiencing race-related violence. Stories of race-related violence were not limited to interactions with the police. One Black participant who identified as a woman shared a story that she had been told by friends in her neighborhood:

I was scared to go outside certain days. Just because of certain stuff like that. There was actually someone over in Avondale, I guess, walking around with a sign saying “Trump supporter.” And every time he would see like a black person, he would cuss us out and stuff.

The fear and trauma that Black people in particular were experiencing exacerbated the impact of COVID-19-related anxiety. One participant said:

I don't know how much more we can take; visually, I can't keep watching us die. I can't keep sharing it on social media, I'm tired of hearing of it but yeah, it's impacted me. It's traumatic as ever, and we started off this year with a big bang with people … at the capital. So, it's been a rough year for everybody and COVID doesn't make it better.

Relationships Impacted by Racism

When we asked participants about whether these national events that highlighted racism impacted their connection to others, most participants said “yes” but for varying reasons. Many participants mentioned that they had lost or ended connections with people because of what they had learned about them. One participant shared:

I kind of learned a lot about people. During that time, a lot of people that I thought were my folks were not because I don't understand how you can support someone who is against my very presence on this earth, you know, against people of color. So, it really did affect me, and some of the relationships that I have.

Some participants who were White said that they “had always been taught to love everyone” but that during this time they learned that “they had to take a different approach to try to learn to see.” One participant shared:

People say, like, all lives matter. Yes, that's true. But we're not all struggling to live our lives or stay alive, I should say so, you know it did open my eyes to a lot of connections that I thought I had with people and … it kind of opened my eyes to who I could associate, um associate myself with, or not. Because, you know, I obviously feel stronger about the situation, having a fiancé who is African American and my children who are half African American, and I feel like these things need to be heard more, and we do need to press these issues, you know, and so yes [I] definitely distanced myself from a lot of people.

Another participant, who was White, worried that her family's connection within the neighborhood would be impacted because of her race and her political views. She said: “I don't want people thinking ‘oh okay, she's White, she likes Trump, she's racist,’ and she felt that “it's just as hard for the people who are being portrayed as the ones who are racist because not everybody is.”

Some participants expressed concern about how to educate children about race-related violence that they were seeing on the news and social media. One participant talked about her experience from her perspective as both a teacher and a caregiver, saying:

So, it's not necessarily part of my subject matter, but it really affected my students, and so therefore it really affected me. And then I also have a 13-year-old who's kind of learning to navigate the world and so when [concurrent] events happen, you know you have to explain that to your kids in a way that they understand, and so that really affects me.

Discussion

In this qualitative study conducted in Cincinnati, Ohio, caregivers with young children revealed the broad and deep impact of the COVID-19 pandemic on their experience of social connectedness and isolation. These personal experiences were reflections of the preexisting societal conditions of their daily lives in the United States, exacerbated by the pandemic, which SQT organizes into social cohesion, social empowerment, socioeconomic security, and social inclusion.

The pandemic had its own sociopolitical, socioeconomic, and sociocultural ramifications, and created a societal context in which many caregivers became truly aware of social connectedness and isolation for the first time in their lives. Many described gaining an appreciation for these aspects of their lives during the pandemic, and noted that social connectedness and isolation had now become something normal to think and talk about. Notably though, their appreciation was largely born out of the disruption of their prior social connectedness and the emergence or exacerbation of social isolation.

The COVID-19 pandemic and the public policies and practices put in place to limit the effects of the pandemic took a toll on the sense of togetherness experienced by the caregivers of young children. This toll in the early stages of the pandemic was exacerbated by the political divisiveness, economic uncertainty, and societal tensions that existed in the United States. The COVID-19 pandemic revealed and amplified existing shared grievances and highlighted between-group differences (Grant and Smith 2021). At-home confinement associated with the COVID-19 pandemic led to increases in media and social media consumption, resulting in more focused attention on racism across systems (Marshburn et al. 2021). Many participants said that they had “learned a lot about people” during this time, which led them to disconnect from certain people in their lives. Historical and contemporary injustices led to widespread protests and intensified the negative emotional climate associated with the COVID-19 pandemic (Grant and Smith 2021).

The social isolation and longing for better social connectedness described by the caregivers in this study demands attention and action. In recent years, a growing body of research has shown how social connectedness, isolation, and loneliness influence our health and well-being (Delhey and Dragolov 2016; Han et al. 2013; Nieminen et al. 2010; Portela et al. 2013; Yamaoka 2008). This link is particularly true for already marginalized communities, which are now experiencing significant worsening of mental health effects due to disproportionate stresses of financial insecurity and community mortality during the COVID-19 pandemic (Purtle 2020). Consistent with this literature, the caregivers in this study spoke to the deleterious effects of lesser connectedness and greater isolation on their mental health and perceived quality of life. Many participants who identified as Black spoke about their increased anxiety associated with the current state and future uncertainty related to the COVID-19 pandemic as well as the fear associated with the upsurge of racial violence. Through their words, we can understand that the trauma experienced over this last year is expansive and that the need for mental health supports and rebuilding the social fabric of US communities, moving forward, is essential to healing.

As they reflected on the year behind them, some participants mentioned that being at home helped them to “slow down” and take a break from all the things that pulled them in different directions. By doing so, they were able to focus on things that were important to them, enjoy time with the people they lived with, and learn new ways of connecting and communicating with others. They hoped that they would continue this more intentional approach in their choices moving forward. Consistent with their words, in the spring of 2021, more than one year after the start of the COVID-19 pandemic, articles in the mainstream press reflected on the experience of languishing endorsed by many (Grant 2021) and the actions that individuals could take to improve their well-being (Blum 2021). Across the United States, prior to and during the pandemic, whole communities strove to find ways to foster social connectedness and disrupt isolation and loneliness. The report Thriving Together: A Springboard for Equitable Recovery and Resilience in Communities across America captures some of these ways, elevating population and community interventions such as intentionally shaping the public narrative (i.e., “tell a new story in which human differences are a collective strength, not a cause to separate from or destroy each other”), create public spaces for connection (i.e., “reshape neighborhoods, organizations, and public spaces to be open, inviting, exciting, and also free from segregation, violence, or neglect”), foster a culture that supports inclusion (i.e., “uphold, enforce, and expand both social norms and legal safeguards against discrimination in all forms”), and allocate resources to promote belonging (i.e., make investment more fair through targeted universalism), among others (Milstein et al. 2020).

Conclusion

As we navigate the current crisis in the United States—recognizing that it has been exacerbated through political indecisiveness and chaos, as well as preexisting societal conditions—and work to emerge better in its aftermath, we can learn from the insights of these caregivers and the efforts of others to bolster social connectedness and disrupt social isolation. In talking about living through the pandemic, participants in general made remarks such as “I would like not to have done it.” With the increased awareness of societal-based political strife in the United States came an increased sense of social empowerment, as well as social inclusion. Ultimately, navigating the pandemic taught them not only how capable and resilient they are but also how much social connectedness means to them and isolation affects them. On reflection, some participants noted that “tomorrow isn't granted” and that they hope this experience “would have woke[n] us up” to how necessary kindness, compassion, and empathy are for the future.

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  • Wassie, G. T., A. G. Azene, G. M. Bantie, G. Dessie, and A. M. Aragaw. 2020. “Incubation Period of Severe Acute Respiratory Syndrome Novel Coronavirus 2 that Causes Coronavirus Disease 2019: A Systematic Review and Meta-Analysis.” Current Therapeutic Research, Clinical and Experimental 93: 100607. doi:10.1016/j.curtheres.2020.100607.

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  • Welton, C. R., and M. Meyers. 2020. “The# RealCollege Student Implications of The Families First Coronavirus Response Act (FFCRA).” The Hope Center, 27 March. https://hope4college.com/wp-content/uploads/2020/03/RealCollege_PolicyBriefs_FFCRA_v1.pdf.

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  • WHO (World Health Organization). 2020. Coronavirus Disease 2019 (COVID-19): Situation Report, 39. 28 February. Geneva: World Health Organization. https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200228-sitrep-39-covid-19.pdf.

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  • Yamaoka, K. 2008. “Social Capital and Health and Well-Being in East Asia: A Population-Based Study.” Social Science & Medicine 66 (4): 885899. doi:10.1016/j.socscimed.2007.10.024.

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Contributor Notes

Allison A. Parsons, PhD, is a Research Scientist at Rescue Agency who has expertise in public health research with a focus on the impacts of structural racism. She received her Bachelor of Arts in economics from Texas A&M University, Master of Allied Health Sciences from East Carolina University, and PhD in public health from the University of South Carolina. She was a National Research Service Award Fellow at Cincinnati Children's Hospital. Her work focuses on the impact of structural racism on child and family health outcomes. Email: aparsons@rescueagency.com

Danielle Maholtz, DO, is a Second-Year Pediatric Critical Care Medicine Fellow at Cincinnati Children's Hospital. She is a pediatric clinician-investigator with the goal of advocating systems-based changes to target the social needs of critically ill pediatric patients. In her research, she focuses on social and environmental factors that promote optimal health for children. She is currently working to design and test approaches to identify health disparities in critically ill pediatric patients as well as hospital and community-based interventions to improve child well-being and mitigate related disparities. Email: danielle.maholz@cchmc.org

Jamaica Gilliam, DO, is a Doula, Certified Lactation Counselor, and an OEI Maternal Neighborhood Navigator. She is the Executive Director of Blaq Birth Circle, Cincinnati's largest collective of birthworkers, and the owner of LATCH'D LIFE. She sits on many maternal and infant health advocacy boards and teams. She is a mother of three and a Cincinnati native. She is passionate about closing health gaps and tackling racial disparities in creative ways. Email: jamaica.gilliam@gmail.com

Haleigh Larson is a Medical Student at the Yale School of Medicine, where she is pursuing an interest in medical genetics, surgery, and medico-legal topics. She is also the Co-Founder of S-PHASEC (Students Promoting Health Advocacy and Synchronized Engagement with Communities for Crisis Response), which was created out of a need to utilize health professions students to aid health campaigns, shape policies in response to the COVID-19 pandemic, help ensure vaccine equity, and relay accessible information to the general public on vaccine development. Email: haleigh.larson@yale.edu

Dan Li is a Fourth-Year MD/PhD Candidate at the Yale School of Medicine and the Yale School of Public Health studying the epidemiology of microbial diseases. Her focus is on maternal and child health and healthcare access, implementation, and education. She currently studies child safety during the COVID-19 pandemic. Dan graduated from Harvard College with a BA with High Honors in chemical and physical biology and a minor in mathematical sciences in 2015. She has played a vital role in guiding the Connecticut Public School System and the Connecticut Association of Independent Schools through the school reopening process. Email: dan.li@yale.edu

Sophia J. Zhao is in her second year majoring in molecular biophysics and biochemistry and the history of science, medicine, and public health at Yale College. She is interested in neuroscience research as well as studying how narratives persist throughout medical history and manifest themselves in contemporary health systems. Email: sophia.j.zhao@yale.edu

Brita Roy, MD, MPH, MHS, is Assistant Professor of Medicine and Epidemiology, and Director of Population Health at Yale University. Her research focuses on exploring the contribution of positive psychosocial and environmental factors to population health outcomes. She co-leads the Yale-Gallup Well-Being Research Team and the 100 Million Healthier Lives measurement team. Dr. Roy enjoys caring for patients and teaching medical students and residents as an academic hospitalist. She received a BE from Vanderbilt University and a combined MD/MPH at the University of Michigan. She was also a Robert Wood Johnson Foundation Clinical Scholar at Yale University. Email: brita.roy@yale.edu

Carley Riley, MD, MPP, MHS, is Assistant Professor in Pediatrics at University of Cincinnati College of Medicine, Attending Physician in Critical Care and Co-Faculty Lead for Population and Community Health at Cincinnati Children's Hospital, and Associate Director of Integrating Special Populations of the Center for Clinical and Translational Science and Training. She received a Bachelor of Arts and Medical Doctorate from Northwestern University, a Master of Public Policy from UCLA, and a Master of Health Science from Yale University. She was a Robert Wood Johnson Foundation Clinical Scholar at Yale (2013–2015) and is a Fellow with The Institute for Integrative Health. Email: carley.riley@cchmc.org

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  • Welton, C. R., and M. Meyers. 2020. “The# RealCollege Student Implications of The Families First Coronavirus Response Act (FFCRA).” The Hope Center, 27 March. https://hope4college.com/wp-content/uploads/2020/03/RealCollege_PolicyBriefs_FFCRA_v1.pdf.

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    • Export Citation
  • Yamaoka, K. 2008. “Social Capital and Health and Well-Being in East Asia: A Population-Based Study.” Social Science & Medicine 66 (4): 885899. doi:10.1016/j.socscimed.2007.10.024.

    • Crossref
    • Search Google Scholar
    • Export Citation

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