BULLETIN 157December2020 The Covid-19 pandemic, health and medicine: Sociological investigations and perspectives
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B U L L E T I N 157 December 2020 The Covid-19 pandemic, health and medicine: Sociological investigations and perspectives
Table of Contents Introduction 1 Michael Gemperle and Raphaël Hammer “It is complex”: perception of uncertainty and inequality issues in the COVID-19 crisis. Results from a survey among university students in Switzerland (Research note) 7 Thomas Abel and Richard Benkert The Covid-19 Social Monitor: A panel study providing evidence about the social and public health impact of the pandemic 14 Marc Höglinger and Sarah Heiniger Nurses and healthcare assistants’ views of their institution’s response to first wave of COVID-19 pandemic and their intentions to remain in their current workplace: a first glance at the ProH-COVID project 20 Matteo Antonini, Margaux Perriraz, Philippe Delmas, Claudia Ortoleva Bucher, Tanja Bellier-Teichmann, Isabelle Peytremann Bridevaux, and Ingrid Gilles “The COVID-19 pandemic is illustrating a long-term fight about the very definition of health”. Interview with Claudine Burton-Jeangros 26 Interviewed by Raphaël Hammer Shifting inequalities in student lifestyles during the COVID-19 pandemic 31 Guy Schwegler
Introduction
Michael Gemperle* and Raphaël Hammer**
The SARS-CoV-2 virus, which began to circulate formations and tensions become more apparent
around the world at the end of 2019, has triggered and, at the same time, groups of agents’ beliefs in
a global health crisis. Due to the highly transmis- institutions undergo a change (cf. Bourdieu 1990).
sible and pathogenic nature of the coronavirus, From the point of view of the sociology of health
the measures to contain its spread in Switzerland and medicine, a variety of particularly interesting
and elsewhere relatively soon had an impact upon sociological issues can be identified, of which we
more fields than just health. Even the media cover- are able to highlight only a few in the following (for
age and political discussion leave little doubt that more, see Lupton 2020; Matthewman & Huppatz
the COVID-19 pandemic and its management is 2020; Ward 2020):
a phenomenon worthy of Marcel Mauss’ concept ›› First and foremost, the problem of social
of the “total social phenomenon”, drawing atten- inequalities with regard to health: There is
tion to the interrelation and interaction of different increasing evidence that underprivileged
spheres of society. The social turmoil associated groups are being disproportionately affected
with the health crisis confirms, if it were necessary, by COVID-19 and COVID-19 related deaths
the extent to which illness and both individual (e. g. Azar et al. 2020; Clouston et al. 2021;
and institutional responses to it constitute central Dragano et al. 2020; Brüningk et al. 2020).
categories in the analysis and understanding of a so- Investigations into this phenomenon beyond
ciety, as medical anthropologists long have shown. classical epidemiological indicators are neces-
The Board of the Swiss Sociological Associa- sary to show the social significance of these
tion has kindly charged the Sociology of Health socially determined inequalities (cf. Siff et al.
and Medicine Research Committee with coordi- 2020; Wachter et al. 2020).
nating this issue of the thematic bulletin on the ›› Second, the problem of the social consequences
COVID-19 pandemic. We launched a call for of public health measures: Contrary to the as-
contributions in our network and within the short sumption that public health interventions are
period available (a mere few weeks) received several essentially positive and, at worst, ineffective,
texts. These contributions have in common that the measures to contain the circulation of the
they draw on research activities initiated shortly virus show in an unprecedented way that pub-
after the first cases of COVID-19 were confirmed lic health measures may also cause social and
in Switzerland in February 2020 and aim to inform mental harm. And, it’s again underprivileged
a broader audience rather than specialists about the groups that have been generally most affected
social dimensions of the health crisis. by this (e. g. Hövermann 2020; Kohlrausch
Sociology can understand the current crisis as et al. 2020; Witteveen & Velthorst 2020; cf.
a moment in which structural conditions, trans- the contributions in this issue by Höglinger &
Heiniger and Schwegler). Sociology is well
* Zurich University of Applied Sciences equipped to analyze the social conditions
** University of Applied Sciences and Arts Western
of this suffering and thus to contribute to a
Switzerland
Bulletin 157, SGS/SSS 1sound understanding of the social and mental Switzerland’s (prospective) upper classes show
consequences of health-promoting measures. relatively little awareness of social inequality (cf.
›› Third, the related phenomenon of the disaf- the contribution by Abel and Benkert).
fection of parts of the population with public ›› Another issue the COVID-19 pandemic brings
health measures, as can be observed, for ex- to the center of attention are the working con-
ample, in demonstrations against protective ditions in the health sector, especially those of
measures and negative attitudes toward vacci- the non-medical professional groups, above all
nation. In this regard, the social conditions of nursing (the contribution by Antonini et al.
this shattered belief in public authorities during ties in here). The rich empirical and conceptual
the public intervention against the pandemic heritage of sociology allows us to arrive at a
would merit thorough investigation (also tak- sound understanding of the social and political
ing into account the side effects of health care conditions underlying the working conditions
measures; for a first attempt see: Demertzis & of health professionals.
Eyerman 2020). In addition, the issue of risk ›› Regarding the impact of the health crisis on
perception seems to be a promising avenue, the medical world itself, another interesting
showing that the understanding of the situa- question seems to be the extent to which an
tion and its evolution involves a complex set of event as wide-ranging as a pandemic affects
factors, including personal experience of risk the structure and the functioning of medicine.
and values (Brown 2020; Dryhurst et al. 2020). Medicine is indeed a relatively autonomous
›› Fourth, the problem of the health crisis as a social sphere, but as the policies to manage the
battleground for health care provision renego- health crisis show, political intervention in this
tiation: From the beginning of the pandemic, field may also change (at least temporarily) the
measures to contain the spread of the virus have priority accorded to different specialisms (with
been set in relation to other priorities (economy, virology and critical care medicine coming be-
education, etc.), but at least since the first fore surgery). Here, the concept of the “medical
lockdown, leading politicians’ concerns have field” (cf. Pinell 2005; Pinell 2011) may help
been focused more on the economy and public to identify the struggles over resources and
finances than on consistently containing a virus prestige between the medical specialisms and
that mostly affects underprivileged groups (cf. professional groups.
Lessenich 2020a; Lessenich 2020b). On the The following contributions take up aspects of these
other hand, history shows that major epidem- research perspectives. They provide valuable data
ics that did not stop at class boundaries (pest, and thus both contribute to the understanding of
cholera) promoted the improvement of health the complex phenomenon of the COVID-19 pan-
standards even among the lower classes of so- demic and inspire further research. These contribu-
ciety (cf. Goudsblom 1986). Investigating the tions are conceptually and empirically quite varied,
ongoing struggles for the definition and shaping reflecting the diversity of research perspectives in
of health care provision (cf. the interview with the sociology of health and medicine. This variety
Burton-Jeangros) thus seems to be of prime also reflects the studies’ different institutional ori-
relevance, not least against the backdrop that gins, with the stronger affinity of university output
2 Bulletin 157, SGS/SSSto theoretical issues and the stronger orientation people aged between 18 to 29 who were affected
of the output of universities of applied sciences by high rates of loneliness during these times. It is
to issues of the medical field and public health hoped that thorough and refined analyses will not
not atypical of the field of sociology of health and only provide a sound understanding of the issues
medicine in Switzerland. in question, but also feed into discussions on the
underlying social mechanisms.
The contributions The next contribution is a short interview with
In their contribution, Thomas Abel and Rich- Claudine Burton-Jeangros (Geneva) conducted by
ard Benkert (Bern) analyze how perceptions of Raphaël Hammer (Lausanne). Claudine Burton-
pandemic-related uncertainties and complexity Jeangros was involved in and contributed to the
issues are related to social characteristics. They edited volume COVID-19 – le regard des sciences
surveyed students from four Swiss universities sociales (Gamba et al.) published in June 2020,
in April/May 2020, and the results show that a which was one of the first major attempts to assess
considerable proportion of these students do not the COVID-19 pandemic in sociological terms.
have an accurate perception of the complexity and Burton-Jeangros argues how the current political
uncertainty of prevailing key issues. Of particular management of the pandemic is underpinned
sociological interest is the fact that an inadequate by a medical definition of health which tends to
awareness of social inequality in this pandemic is overlook the importance of a more global or social
most evident among students from less educated definition of health. The interview aptly shows how
family backgrounds, pointing to class-based differ- necessary a sociological perspective is for societal
ences in perceptions of the pandemic. This study reflections and political debates in the current
reflects a line of research in health sociology based crisis. Claudine Burton-Jeangros also highlights
on Pierre Bourdieu’s concept of cultural capital the significance of the opportunity for theoretical
that highlights the importance of class-related discussions on the way our societies have responded
cultural resources for inequalities in health, and to the COVID-19 pandemic in comparison to
complements work on perceptions of economic and previous similar pandemics.
health risks (Holst et al. 2020) and class-dependent The contribution of Matteo Antonini et al.
exposure to the pandemic (see above). (Lausanne) provides insight into nurses’ and health-
The contribution of Marc Höglinger and Sara care assistants’ experiences with and perceptions of
Heiniger (Winterthur) provides insight into the the pandemic. The authors present partial results of
social and public health impact of the pandemic. a study at eleven hospitals in western Switzerland.
Based on data from their Covid-19 Social Monitor The findings indicate that nurses and healthcare
project, they report selected findings about qual- assistants had a fairly positive opinion of the way
ity of life, mental health and social isolation in their respective institutions handled the emergency
Switzerland since April 2020. The findings indicate and generally intended to remain in their current
that the lockdown in spring and the containment workplace, although more than half reported an
measures in November/December led to increased increase in their workload and one third doubted
stress and an increased psychological burden for their institution’s ability to deal with another crisis
the population and that it is especially young of this nature. This not only reflects a pronounced
Bulletin 157, SGS/SSS 3commitment from employees who were very tainty: research pathways, conceptual tools,
stressed during the crisis. It also expresses the fact and some magic from Mary Douglas. In:
that, due to the exceptional nature of the situa- Health, Risk & Society 22(1), pp. 1–14. doi:
tion, workload does not have a 1 : 1 effect on the 10.1080/13698575.2020.1745508.
intention to leave the profession. This contribution Brüningk, Sarah C./Klatt, Juliane/Stange, Mad
needs be understood against the background of the len/Mari, Alfredo/Brunner, Myrta/Roloff,
recent dynamics of the Swiss universities and the Tim-Christoph/…/ Egli, Adrian (2020). De-
academization of the health professions. terminants of SARS-CoV-2 transmission to
Guy Schwegler’s (Lucerne) contribution ex- guide vaccination strategy in a city. MedRxiv,
plores the question of the differential effects that 2020.12.15.20248130. doi:10.1101/2020.12.
the lockdown in spring 2020 had on the everyday 15.20248130.
lives of university students with and without an Clouston, Sean A. P./Natale, Ginny/Link, Bruce
academic background. He draws on qualitative G. (2021). Socioeconomic Inequalities in
interviews and diary entries from 25 students. The the Spread of Coronavirus-19 in the United
findings indicate that the closure of the universities States: A Examination of the Emergence
particularly limited the opportunities and motiva- of Social Inequalities. In: Social Science &
tion of students without an academic background. Medicine 268: 113554. doi: 10.1016/j.socsci-
From a life course perspective, Schwegler also med.2020.113554.
recognizes possible effects on health that are inde- Demertzis, Nicolas/Eyerman, Ron (2020). Covid-
pendent of the current situation. By highlighting 19 as cultural trauma. In: American Journal
the importance of social origin, Schwegler focuses of Cultural Sociology 8(3), pp. 428–450.
on an aspect that attracted little attention in previ- doi:10.1057/s41290-020-00112-z.
ous studies on the consequences of the lockdown, Dragano, Nico/Rupprecht, Christoph J./ Dort-
which were primarily interested in the effects on mann, Olga/Scheider, Maria/Wahrendorf,
student’s performance (cf. Gonzales et al. 2020; Morten (2020). Higher Risk of COVID-19
Grewenig et al. 2020). Hospitalization for Unemployed: An Analysis
of 1 298 416 Health Insured Individuals in
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6 Bulletin 157, SGS/SSS“It is complex”: perception of uncertainty and inequality
issues in the COVID-19 crisis. Results from a survey among
university students in Switzerland (Research note)
Thomas Abel* and Richard Benkert*
Background Citizens are called upon to accept behavioural
From the beginning, early in 2020, the coronavirus restrictions that often lead to drastic changes in
crisis created enormous societal challenges (Gamba their lives. For most, necessary adaptations in the
et al., 2020). In particular, it has shown how much organization of private and professional patterns
societies depend on their citizens to deal with and are difficult to make. Health messages change
overcome viral pandemic threats. In the absence and individuals are challenged by an overflow of
of medical solutions, governments have to rely on information that is often inconsistent. Complex-
citizens to adjust their behaviours and help mitigate ity inherent in the issues thus challenges not only
the problems. scientists and politicians but also citizens in their
Although major differences exist in national active response to the crisis. Denying or ignoring
conditions, common features of the COVID-19 uncertainty and complexity in public health com-
pandemic pose similar challenges in most coun- munication may lead to reduced trust (van der Bles
tries. Scientific knowledge about the Sars-Cov-2 et al., 2019) and eventually contribute to citizens
virus – its biomedical nature, mutations, and becoming sceptical and not following even the most
distribution patterns, etc. – has needed and still basic behavioural rules.
needs time to emerge; many questions remain un- Thus, beyond being aware of the urgency of
answered at this time (Davey- Smith et al., 2020). the situation and the need to slow and reduce the
This uncertainty in the science is likely to spill spread of the virus, the crisis requires from all
over to the policy arena and add to uncertainty in citizens a recognition and basic understanding
administrative and governmental decision-making. of the complex issues associated with it. But even
Even as scientific knowledge gets stronger over if the uncertainty of slowly emerging scientific
time and governments gather more experience on knowledge and the complexity inherent in political
which to base decisions, the complexity of issues is action challenge everyone, the ability to recognize
not likely to decrease. In fact, new challenges have uncertainty and be aware of complexity may sup-
emerged as social inequalities have become appar- port citizens’ adoption of appropriate measures –
ent (e. g. school closures widening the social gap), even when scientific knowledge is incomplete and
the relevance and effectiveness of interventions political action far from coherent.
has depended upon the contexts in which people From a social science perspective, these condi-
live and work, and the contextual adaptation of tions call for basic research addressing citizens’
mid- and long-term preventive measures by citizens recognition and understanding of the uncertain-
has required their expertise (Cuerdo-Vilches et al., ties and complexities of a pandemic crisis. A focus
2020; Mesa Vieira et al., 2020). on particular population groups may be helpful
for this. Adolescents and young adults have been
* University of Bern identified as problem groups in this crisis (Li et al.,
Bulletin 157, SGS/SSS 72020; Nivette et al., 2021). Initially, both scientific and awareness of such complexity issues among
and public discourse have focussed on young adults highly educated young adults.
as identifiable “carriers of risk”. More recently,
the focus has shifted to recognize the health and Methods
social burdens this age group suffers, which include Development of survey items on complexity
mental health problems, higher unemployment perception
rates, increased stress, and uncertainty in academic Early in the COVID-19 pandemic, an interdisci-
training (OECD, 2020; Sahu, 2020). However, plinary group of public health experts discussed
systematic social science research exploring the relevant themes applicable to university students.
effects of the current pandemic on the lives of Three rounds of expert feedback produced a set
the younger population is only slowly emerging. of five items that were then pretested in German,
More specifically, we know very little about their French, and English among young adults (n = 16).
perceptions and understanding of complexity and Respondents’ feedback focused on phrasing and
uncertainty in a pandemic crisis. wording and informed revisions of the survey ques-
We developed a small number of survey items tions. The final set of five items addressed a range
to explore empirically the distribution and variation of key issues in the pandemic, all which are linked
of the recognition of complex pandemic-related to complexity and the uncertainty of knowledge in
issues among a group of young adults who are uni- public health actions. (see Table 1, page 10).
versity students in Switzerland. Our basic assump-
tion was that, among those with the highest formal The International Student Well-Being Survey
education, appropriate perception of complexity The five new items were included in the COVID-19
and awareness of uncertainty in slowly emerging International Student Well-Being Study (C19
scientific knowledge should be widespread in a ISWS). C19 ISWS is the result of a study design,
pandemic crisis. study protocol, and questionnaire developed by
a team of the University of Antwerp, Belgium
Aims of the study (Van de Velde et al., 2020). Data were collected in
This population-level research explores citizens’ 27 countries across Europe and North America, as
perceptions of pandemic-related uncertainty and well as in South Africa (Van de Velde et al., 2020).
complexity issues. Because we found no survey A comprehensive questionnaire was developed to
measures available on this topic, the first study assess the impact of COVID-19 on the university
aim was to develop an initial set of survey items to student population. The five new items presented
measure knowledge and awareness about key issues here were included towards the end of questionnaire
in dealing with complexity-related challenges in and distributed to students in Switzerland and Ger-
the current crisis. many. In Switzerland, versions of the questionnaire
The second aim was to apply these measures were provided in German, French, and English.
in a population group of major significance in the The survey was distributed using the online
current pandemic crisis (young adults) and obtain survey-tool Qualtrics. For Switzerland, the online
insight into the social distribution of knowledge survey was open from 28 April through 27 May
2020. Participants were recruited at four universi-
8 Bulletin 157, SGS/SSSties in Switzerland: the University of Bern, Bern of dichotomization of response options for each
University of Applied Sciences, University of Fri- item is described in the following chapter. Results
bourg, and the University of Geneva. Recruitment were considered significant when p < 0.05. Stata 14
was conducted via email sent by the university software was used for the analyses.
administration to all students enrolled at the four
universities. Participation in the study was vol- Measures of complexity perception
untary and all data were collected anonymously. The following five items were used to assess stu-
dents’ perception of key issues linked to complex-
Sociodemographic characteristics ity and knowledge uncertainty in the current
Sociodemographic characteristics including gen- pandemic.
der (male, female, diverse), study level (bachelors,
masters, PhD), and affiliation (University of Bern, Distribution of complexity perception
Bern University of Applied Sciences, University of The basic distribution of item responses in our
Fribourg, and University of Geneva) were gathered sample is displayed in Table 2 (see next page). As
by the questionnaire. Due to the low number of expected with a highly educated population group,
responses for the diverse gender option (n = 57), we for most items the answers are not normally dis-
concentrated only on males and females. Univer- tributed; most students were aware of complexity
sities were categorized into the German language and uncertainty issues.
region, including University of Bern and Bern The five items address different issues that all
University of Applied Sciences, and into French contribute to the complexity that is challenging
language region, including University of Fribourg public health, political action, and individual citi-
and University of Geneva. Parental education was zens. For a meaningful analysis, we dichotomized
assessed by asking about the highest educational the response options with answer categories in
degree obtained by respondents’ parents. This infor- bold indicating low complexity perception (see
mation was used to categorize parental education Table 2). This is based on plausibility as follows.
as low (both had less than secondary education), At the time of the survey (May 2020) scientific
middle (at least one parent with secondary educa- knowledge about the Sars-Cov-2 virus and the
tion), and high (at least one parent with a university disease COVID-19 was only emerging; many ques-
degree) education. tions relevant to the planning and implementation
of health measures were not answered. The scien-
Statistical procedures tific knowledge for political decision-making was
We employed basic descriptive statistics to examine neither “very strong” nor was it “very weak”. For
the distribution of complexity perception, and odds this analysis, we coded item 1 as follows: response
ratio analysis. We calculated odds ratios in single options 1 and 5 (very strong/very weak) were com-
(dichotomized) item analysis to measure bivariate bined to “low complexity perception”. Item 2 ad-
associations between low complexity perception dresses the degree of complexity in a reverse manner
and selected sociodemographic (gender, parental (simple, straightforward); we coded the response
education) and academic characteristics (study options 1 and 2 (fully agree and rather agree) as
level, language region of university). The procedure low perception of complexity. The importance of
Bulletin 157, SGS/SSS 9Table 1 Indicators of complexity perception; item definiton and 5-point sets of Likert Response options
Item response options
1 How would you rate the current scientific knowledge on COVID-19 available very strong; rather strong;
to guide political decisions in Switzerland? neutral; rather weak;
very weak
2 Please, indicate how much you agree or disagree with the following fully agree; rather agree; neutral,
statement: Overall, the challenges in this COVID-19 crisis are simple and rather disagree; fully disagree
decision-making is fairly straightforward.
3 There are many organizations involved in the management of this crisis. very important;
How important is it for you to understand the often-different interests and rather important, neutral;
motivations among the key players in this crisis (e. g. the government, rather not important;
political parties, employer organizations, unions, health authorities, etc.)? not important
4 Please indicate how much you agree or disagree with the following fully agree; rather agree;
statement: The biggest problem in this pandemic is with the high-risk neutral, rather disagree; fully
groups (e. g. 65+; people with chronic health problems) – consequently disagree
the behavioral restrictions should apply only to them.
5 Please, indicate how much you agree or disagree with the following fully agree; rather agree;
statement: Independent of their social class or status, individuals are neutral; rather disagree; fully
equally affected by the current pandemic. disagree
Table 2 Relative frequency distribution (%) of answers
Response option Item number
1 2 3 4 5
“quality of sci. “decisions simple” “varying “solidarity” “inequality”
knowledge” Interests”
1 4.3 1.3 34.2 2.7 16.0
2 33.9 8.3 46.5 11.8 14.9
3 31.9 12.0 14.6 9.4 5.7
4 25.4 38.7 4.0 34.1 28.6
5 4.5 39.7 0.7 42.0 34.8
Item definition and response options, see table 1. N = 3 616.
understanding the complexity of issues related to a 1 and 2). The understanding or awareness of social
multitude of interests at play is addressed in item 3 class differences in the pandemic crisis is addressed
and coded as “low” when it is rather unimportant or in item 5 and the corresponding response options 1
not important to the respondent (response options and 2 (fully agree/rather agree) were coded as “low”.
4 and 5). Item 4 alludes to an understanding of the Table 3 displays the proportion of respondents
need for preventive behaviours to help protect oth- with low pandemic complexity perception or basic
ers and is coded as “low” when the respondent fully knowledge for each item. The distributions across
or rather agrees with the statement (response option all items and cofactors indicate a gender difference:
10 Bulletin 157, SGS/SSSTable 3 Frequency distribution of low perception of complexity in items 1 to 5) and odds ratios
for bivariate associations
Variable Proportion of low perception of complexity ( %) and odds ratios (OR) in item number
1 2 3 4 5
“quality of decisions “decisions simple” “varying interests” “solidarity” “inequality”
simple knowledge”
% OR % OR % OR % OR % OR
Gender
male 11.9 1.64* 13.5 1.75* 4.8 1.07 19.4 1.62* 30.8 0.99
female (Ref.) 7.6 8.2 4.5 12.9 31.0
Parental Education
low 10.2 1.30 10.9 1.22 5.9 1.30 16.4 1.78 37.0 1.45*
middle 10.2 1.31 10.5 1.18 2.5 0.53* 13.1 0.90 31.8 1.15
high (Ref.) 8 9.1 4.6 14.2 28.8
Study level
bachelor 8.3 1.09 10.2 1.19 4.6 1.43 15.2 1.19 32.5 2.68*
master 9.9 1.33 8.1 0.92 5.1 1.59 12.2 0.92 28.9 2.27*
PhD (Ref.) 7.6 8.7 3.3 13.0 15.2
Language Region
german 9.5 1.22 10.3 1.21 5.1 1.22 17.2 1.50* 34.0 1.33*
french (Ref.) 7.9 8.7 4.0 12.1 28.0
*significant at p < 0.05.
in 3 out of 5 items there are fewer female students the German-speaking than the French-speaking
with low perceptions than male students. Among universities (OR = 1.33; 95 % CI = 1.15–1.54).
students from German-speaking universities, the Study-level differences indicate that the perception
proportion showing low complexity perception of class differences in disease burden may increase
tends to be higher compared to their French-speak- with exposure to advanced science as indicated by
ing fellows (although only 2 out 5 are statistically the gradual increase from BA (OR = 2.68, 95 %
significant). For all but one item, PhD students CI = 1.50–5.16) to MA (OR = 2.27, 95 % CI = 1.25–
have a lower chance of low complexity perception 4.41) to PhD level.
compared to BA or MA students. Differences in From a sociological perspective, perhaps even
the distribution according to education level in the more interesting is the gradient effect of parental
family do not show a clear trend. education on the awareness of social class differ-
ences in the coronavirus crisis (see Fig. 1). Students
Perception of social inequality coming from low-education families show the
The item on social inequality in the burden of largest proportion of not being aware of social
the pandemic (item 5) reveals interesting associa- class differences in the pandemic (OR = 1.45; 95 %
tions with the selected cofactors. The proportion CI = 1.18–1.78). This finding is in line with earlier
of students unaware of social class differences in studies that found recognition of social health
the impact of the coronavirus crisis is higher in inequalities more pronounced among the middle
Bulletin 157, SGS/SSS 11class compared to working class women (Calnan, pandemic. As a case in point, we found insufficient
1987). This preliminary finding and the other awareness of social inequality in this pandemic,
results above await confirmation in further studies. especially among students from families with
lower educational background. Earlier studies in
Figure 1 Social inequality perception by medical sociology found that lay theories of health
parents’ education inequalities differ across social classes and have
40
Parental education: offered potential explanations (Blaxter, 1997). The
high (N=2285)
30 middle (N=598) preliminary results presented here indicate that
relative frequency f / %
low (N=543)
perceptions of pandemic burdens are likely to also
20 vary by social class and deserve special attention.
The findings and suggestions of this study
10
await critical consideration and confirmation. Since
more pandemics are likely to emerge, and the cur-
0
fully
agree
rather
agree
neutral rather
disagree
fully
disagree
rent crisis will remain with us for some time, the
Item 5: Individuals are equally affected independent of their social status conditions for citizen engagement in preventing
Item 5: Individuals are equally affected independent of their
social status. and successfully handling such crises need to be
better understood. The field is now open for social
Discussion science research to pay more attention to the per-
Pandemics such as this COVID-19 crisis cause ception of complex, pandemic-related uncertainty
huge damage to individuals and societies. The and inequality.
challenges are complex for citizens who are asked
to follow strict behavioural rules often based on sci- Acknowledgements
entific knowledge that slowly emerges yet is subject This study is part of the COVID-19 International
to revision within rather short periods. A surfeit Student Well-Being Study (C19 ISWS). C19 ISWS
of information, and misinformation, and politi- is the result of a study design, study protocol, and
cal failure in public communication make it even questionnaire developed by a team at the University
more difficult for citizens to deal with pandemic of Antwerp, Belgium (Van de Velde et al., 2020).
challenges. However, even if communication with We thank Carina Nigg for literature support
the public was perfect citizens would still need to and Christopher Ritter for editorial assistance.
find ways to deal with the complexities and uncer-
tainties of pandemics (Abel and McQueen, 2020). References
This study’s five survey items assess proxies Abel, T., & McQueen, D. 2020 (in press). Critical
for young adults’ perceptions of complexity and health literacy in pandemics: the special case of
the uncertainty of knowledge during the current COVID-19. Health Promotion International.
pandemic crisis. The survey suggests that even Blaxter, Mildred (1997). Whose fault is it? People’s
among Switzerland’s educational elite a consider- own conceptions of the reasons for health
able proportion of young people do not seem to inequalities. Soc. Sci. Med. Vol. 44, No. 6,
be sufficiently cognizant of prevailing complexi- pp. 747–756.
ties and uncertainties in key issues caused by this
12 Bulletin 157, SGS/SSSCalnan, Michael (1987). Health and lllness – The Nivette, A., Ribeaud, D., Murray, A., Steinhoff, A.,
Lay Perspective. Tavistock, London. Bechtiger, L., Hepp, U., Shanahan, L., & Eis-
Cuerdo-Vilches et al., A Mixed Approach on Re- ner, M. (2021). Non-compliance with COVID-
silience of Spanish Dwellings and Households 19 -related public health measures among
during COVID-19 Lockdown. 2020. young adults in Switzerland: Insights from
Davey Smith, George; Blastland Michael; Munaf, a longitudinal cohort study. Social Science
Marcus (2020). Covid-19’s known unknowns. and Medicine, 268. https://doi.org/10.1016/j.
The more certain someone is about covid-19, socscimed.2020.113370.
the less you should trust them. BMJ; Published: OECD. (2020). OECD Employment Outlook
19 October 2020. http://dx.doi.org/10.1136/ 2020: Worker Security and the COVID-19
bmj.m3979. Crisis. OECD Publishing. https://doi.org/
Gamba, Fiorenza; Nardone, Marco; Ricciardi; https://doi.org/10.1787/1686c758-en.
Toni und Cattacin, Sandro (Hrsg.) (2020). Sahu, P. (2020). Closure of Universities Due
COVID-19. Eine sozialwissenschaftliche Per- to Coronavirus Disease 2019 (COVID-19):
spektive. Zürich und Genf: Seismo Verlag. Impact on Education and Mental Health of
Li, S., Feng, B., Liao, W., & Pan, W. (2020). In- Students and Academic Staff. Cureus. https://
ternet Use, Risk Awareness, and Demographic doi.org/10.7759/cureus.7541.
Characteristics Associated With Engagement Van de Velde, S., Buffel, V., Bracke, P., Van Hal,
in Preventive Behaviors and Testing: Cross- G., Somogyi, N., Willems, B., et al. (2020). The
Sectional Survey on COVID-19 in the United COVID-19 International Student Well-being
States. Journal of Medical Internet Research, Study. Scandinavian Journal of Public Health.
22(6), e19782. https://doi.org/10.2196/19782. van der Bles AM, van der Linden S, Freeman ALJ,
Mesa Vieira, C., Franco, O. H., Gómez Restrepo, Mitchell J, Galvao AB, Zaval L, Spiegelhalter
C., & Abel, T. (2020). COVID-19: The for- DJ. 2019. Communicating uncertainty about
gotten priorities of the pandemic. Maturitas, facts, numbers and science. R. Soc. open sci. 6:
136:38–41. 181870. http://dx.doi.org/10.1098/rsos.181870.
Bulletin 157, SGS/SSS 13The Covid-19 Social Monitor: A panel study providing evidence
about the social and public health impact of the pandemic
Marc Höglinger* and Sarah Heiniger*
Introduction Shortly after the national lockdown and the
Since the end of 2019, the SARS-CoV-2 virus has introduction of social distancing measures, con-
been spreading worldwide. By the end of December cerns arose about the social consequences of these
2020, there were 452,296 confirmed infections, measures, in particular on psychological well-being
18,630 hospitalizations and 7,082 deaths associated and mental health. Research about coronavirus
with Covid-19 in Switzerland.1 The rapid spreading outbreaks prior to Covid-19 has established that,
during the first epidemic wave in spring and the for instance, quarantine measures have negative
second in autumn/winter has challenged society consequences for mental health (Röhr et al., 2020)
and the healthcare system. Various public health and are associated with anxiety, loneliness, insomnia
measures have been implemented to mitigate the and increased stress. Also, the economic impact of
spread of the virus and to reduce the pressure on the pandemic could lead to a deterioration in mental
the health care system. In the first wave, the Swiss health similar to recessions, which are known to
government announced a national lockdown on impair mental health (e. g. Frasquilho et al., 2016).
March 16. National borders, schools and shops
were closed. People were asked to stay at home, The Covid-19 social monitor:
to work from home if possible and to reduce their Aims and design
physical contacts with others. In the second wave To gather systematic evidence about the social and
beginning in October, the Swiss government ab- public health consequences of the pandemic, we
stained from a strict lockdown. Measures taken started on March 30 an online-panel and surveyed
at national level included compulsory wearing of respondents repeatedly covering various domains
masks in public places, restrictions on the number such as individual well-being, quality of life, psy-
of people attending events and meetings in public chological distress, social and physical activities,
places and in private, the introduction of curfew health and health services use, work and adherence
hours (and thus the closure of dance clubs and to protective measures. Our aim was to monitor
discos), the switch to distance learning at universi- health and behavioral changes over time on an in-
ties and a “recommendation” to work from home. dividual level, to provide timely information about
Shortly before the Christmas holidays, restaurants relevant social and public health aspects of the Swiss
were closed. Stricter measures were implemented population during the COVID-19 pandemic, and
in a few heavily affected cantons. to create a rich data source for studies on a broad
range of aspects of the COVID-19 pandemic and
1 Federal Office of Public Health FOPH, https://www.
its impact on society.
bag.admin.ch/dam/bag/de/dokumente/mt/k-und-i/
aktuelle-ausbrueche-pandemien/2019-nCoV/co- Survey participants were randomly selected
vid-19-datengrundlage-lagebericht.xlsx.download. from an existing online access panel of a renowned
xlsx/200325_Datengrundlage_Grafiken_COVID- Swiss panel provider (“LINK”). The sample was stra
19-Bericht.xlsx (31 December 2020).
tified along age, gender and language regions and the
* Zurich University of Applied Sciences, Winterthur
Institute of Health Economics
questionnaire was available in German, French, and
14 Bulletin 157, SGS/SSSItalian. Out of 8 ,174 individuals contacted for the analyses with the Social Monitor data include the
first survey round 2,026 completed the question- non-use of health services during the lockdown
naire (response rate: 24.8 %). Between 1,500 and (Höglinger, 2020), patterns of adherence to social
1,700 responses were collected in the follow-up distancing measures of the elderly (Haag et al.,
rounds. The first survey period lasted from March 2020), the impact of the lockdown on work pro-
30 to April 6, 2020 (3rd week of lockdown). Until ductivity (Höglinger et al., 2020), or acceptance
the end of 2020, 12 survey waves were carried out. of Covid-19 proximity tracing apps (von Wyl
A refreshment sample of N = 1,356 was included in et al., 2020).
wave 12 to maintain a sufficiently large sample size General Quality of life has not changed much
and to mitigate panel selectivity. Further monthly over the course of the pandemic. The share of re-
survey waves will be carried out until at least May spondents reporting a good or very good general
2021. The collected data allows for a representative quality of life always remained at 81 % or higher
analysis of the Swiss population regarding age, (not reported). Also, the share of respondents re-
gender, language region, canton, and education, porting a low or very low quality of life was always
using sampling and calibration weights that adjust very small at about 2 % – and only increased re-
for non-response. Of course, as respondents were cently to 4 % in December 2020 (Figure 1). To what
sampled from an existing online panel (albeit ac- extent this is due to the tightening of the public
tively and offline recruited), there is some selectivity health measures in late 2020 or whether this is a
regarding, for instance, online affinity. Also, vul- typical pattern for winter and/or end of year (some
nerable groups such as persons with serious health sort of “Christmas Blues” …) cannot be answered
conditions, the socially marginalized or the very based on our analysis.
old are certainly underrepresented. This is a limi- Looking at elevated psychological distress, an
tation of almost any population survey that does indicator for increased risk of mental disorders,
not specifically target these groups. Furthermore, we see a prevalence rate of 19 % and more which
self-reported outcomes are prone to misdiagnosis of is rather high compared to results from the Swiss
health conditions. Details about the study design Health Survey 2017 with 15 %. But the difference
are published elsewhere (Moser et al., 2020) and is less accentuated when comparing Swiss Health
can be found on the project webpage.2 Descriptive Survey results from 2012 (18 %) or 2007 (17 %)
results of the main indicators are published online (Schuler et al., 2020). The pattern with a higher
shortly after each data collection. prevalence rate in weeks 14 and 51 seems to support
the hypothesis that the spring-lockdown and the
Selected results: Quality of life, intensified measures in November/December led
mental health and social isolation to an increase in stress and psychological burden
In order to highlight the potential and the possibili- for the population. However, the possibility that
ties of the Covid-19 Social Monitor, we report in other factors caused this pattern cannot be ex-
the following some selected findings about quality cluded. Different age groups show different levels
of life, mental health and social isolation in the of distress, with the younger suffering more, but
course of the pandemic. Other examples of first the shape of the trajectory over time is very similar
for all age groups (Figure 2). The same holds when
2 https://www.zhaw.ch/wig/covid-social-monitor.
Bulletin 157, SGS/SSS 15comparing persons living alone with those not during the spring lockdown and in December 2020
living alone: higher levels of psychological distress (week 51). But again, this might well be to some
for those living alone, but no different trajectory extent a seasonal pattern. Interestingly, we see that
over time (Figure 3). the widespread belief that the elderly have suffered
Turning to loneliness, we see in the beginning in particular from social isolation due to social
of the spring lockdown (weeks 15 and 16) a small distancing measures is not supported by our data.
but substantial share of 3 % of the population It is especially the young aged 18 to 29 that have
that never left their home during the last 7 days. been affected by increased rates of loneliness during
Unsurprisingly, this share was, with 7 %, consider- the time of the spring lockdown and – again – in
ably higher for the elderly aged 60 to 79. During autumn/winter. Finally, those living alone generally
summer, this share dropped to nearly zero percent show about three to four times higher rates of feel-
for all age groups. ings of loneliness – but there is only little evidence
Loneliness, e. g. (very) often feeling lonely, that this group has been more strongly affected by
is more prevalent in spring and autumn/winter the lockdown.
with up to 10 % affected, whereas in summer the
prevalence drops to 5 %. The Swiss Health Survey Conclusions
2017 showed a prevalence of 5 %, suggesting that The Covid-19 Social Monitor provides rich data
feelings of loneliness were indeed above normal about a series of relevant social and public health
Figure 1 Quality of life, mental health and social isolation over time. Prevalence estimates
and 95%-CI. N between 1492 (week 14) and 2803 (week 51) per survey wave
(Very) Low quality of life Elevated psychological distress
50
30
26 25
21 20 21 21 21 20 20 20
19
% of respondents
3 4
2 2 2 2 2 2 2 1 2 2
0 total
Never left home (last 7 days) (Very) Often feeling lonely
50
9 8 8 8 7
7 6 5 5 6
3 2 2 1
0 1 0 0 1
0
14 15 16 18 20 22 25 29 34 40 46 51 14 15 16 18 20 22 25 29 34 40 46 51
re-opening schools/ intensified re-opening schools/ intensified
shops may 11 measures, oct 29 shops may 11 measures, oct 29
Calendar week 2020
16 Bulletin 157, SGS/SSSFigure 2 Quality of life, mental health and social isolation over time by age. Prevalence estimates
and 95%-CI. N between 1492 (week 14) and 2803 (week 51) per survey wave
(Very) Low quality of life Elevated psychological distress
60
45
41
40 36
33
31 31 32 32 32
31 30 29 30 30
28 29 28
24 26
25 26 26
23 23 23 24 24 24
21 22 22 22 22 22 21
21 21 21
20 19 19
15 15
14
17 18
16
19
15
49 19 20
14
19
16 16
% of respondents
13
11
4
32
5
3221 3 21
43
210 232 32 321
43
21 32 4
34
56
3 18 to 29 years
1 0 1 0 1 0 1
0 30 to 39 years
Never left home (last 7 days) (Very) Often feeling lonely 40 to 49 years
60 50 to 59 years
60 to 79 years
40
20 16 15 16
12 13 13
10 10 11
10
10
9 8 910 87
9
8
10
7 776 76 7
5 5 7 76 6 547 76 6
43
64 65 5 6
3 3 4 3 3
120 10 10 110 21
10 1 01 1 21
0
14 15 16 18 20 22 25 29 34 40 46 51 14 15 16 18 20 22 25 29 34 40 46 51
re-opening schools/ intensified re-opening schools/ intensified
shops, may 11 measures, oct 29 shops, may 11 measures, oct 29
Calendar week 2020
Figure 3 Quality of life, mental health and social isolation over time by living alone/not living alone.
Prevalence estimates and 95%-CI. N between 1492 (week 14) and 2803 (week 51) per survey wave
(Very) Low quality of life Elevated psychological distress
60
40 35
31
28 28
26 26 26 25 25 26
24 24
22 21
20 19 19 19 20 19
17 18 19 19
% of respondents
3 32 3 31 2 3 4
5
2
6
4 living alone
12 1 2 21 1 2 2
0 not living alone
Never left home (last 7 days) (Very) Often feeling lonely
60
40
22
20 20
18 18
15 15 15 14
19
13
11 11
5 5 5 6
5 5 5 4 4 3
2 23 21 1 1 21 21 2 3 3
0 01 0 10
0
14 15 16 18 20 22 25 29 34 40 46 51 14 15 16 18 20 22 25 29 34 40 46 51
re-opening schools/ intensified re-opening schools/ intensified
shops, may 11 measures, oct 29 shops, may 11 measures, oct 29
Calendar week 2020
Bulletin 157, SGS/SSS 17indicators in the domains of well-being, social re- Cattiva / Molto cattiva (vs. Molto buo-
lations and loneliness, mental and somatic health, na / Buona (vs. Né buona, né cattiva)
health services use, work and employment. It allows
for a test of various hypotheses regarding changes Elevated psychological distress
in these outcomes: for instance, a hypothesized Medium and strongly elevated psycho-
decrease in quality of life during the lockdown, logical distress according to Mental Health
deteriorations in mental health, the spread of Inventory (MHI-5). Medium elevated
loneliness etc. Also, it allows for many relevant psychological distress corresponds to in-
subgroup-analyses: by age, education, income, creased risk of mental disorder; a strong to
migration background, etc. very high likelihood of mental disorders
However, changes in these outcomes can- (see BfS Bundesamt für Statistik, 2019).
not simply be attributed to the pandemic and
the concurrent public health measures (e. g. the Never left home (last 7 days)
lockdown), because seasonal variations and other «Wofür haben Sie Ihr Zuhause in den letzten
factors also play an important role and are hard to 7 Tagen verlassen?» / « Pourquoi avez-vous quitté
control for. Still, the monitoring of these outcomes votre appartement/maison au cours des 7 der
allows for an evidence-based judgement of the niers jours ? » / «Perché è uscito dal suo apparta-
psychological state and well-being of the general mento / da casa sua durante gli ultimi 7 giorni?»
population and of various subgroups of interest. Response Option:
Also, it allows us to identify groups at risk of po- «Habe mein Zuhause nicht verlassen»
tentially harmful outcomes such as increased de- « Je n’ai pas quitté mon appartement / ma
pressive symptoms, strong feelings of loneliness or maison »
social isolation. In the future, more sophisticated «Non sono uscito / a di casa»
analyses might facilitate the identification of the
impact of the pandemic or particular events or (Very) Often feeling lonely
measures on these outcomes. «Wie häufig kommt es momentan vor, dass Sie
sich einsam fühlen?» / « A quelle fréquence vous
Measures arrive-t-il de vous sentir seul(e) actuellement » /
(Very) Low quality of life «Con quale frequenza le succede di sentirsi
«Wie schätzen Sie Ihre Lebensqualität im All solo(a) in questo periodo?»
gemeinen im Moment ein?» / « Comment consi Response Options:
dérez-vous votre qualité de vie en général ? » / Häufig / Sehr oft (vs. Nie/ Selten/ Manchmal)
«Come trova, in generale, la Sua qualità di vita?» Assez souvent / Très souvent (vs. Jamais / Presque
Response Options: jamais / De temps en temps)
Schlecht / Sehr schlecht (vs. Sehr gut / Gut / Spesso / Molto spesso (vs. Mai /Quasi mai /
Weder gut noch schlecht) A volte)
Mauvaise / Très mauvaise (vs. Très bonne /
Bonne/ Ni bonne ni mauvaise)
18 Bulletin 157, SGS/SSSReferences Moser, A., Carlander, M., Wieser, S., Hämmig, O.,
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