Social Distancing Behavior Research Articles

The link between anger and admiration toward governmental actions and self-reported preventive behaviour in the context of the COVID-19 pandemic.

In the context of the COVID-19 pandemic, across six correlational studies in four different countries (total N = 4937), we examined the link between citizens' anger with and admiration for the government's actions and decisions (i.e., system-based anger and admiration) and engagement in preventive behaviour. The internal meta-analyses showed that individuals who admired the government's actions were more likely to adopt personal hygiene and social distancing behaviour. Yet, the link between emotions and preventive behaviour differed concerning the target of emotions, especially for anger. Specifically, anger about restrictions imposed by the government was negatively related to preventive behaviours, but this relationship was not significant when the target of anger was the government's overall handling of the pandemic. Our findings emphasise the importance of citizens' emotions and the targets of those emotions during the crisis.

Distinction through distancing: Norm formation and enforcement during the COVID-19 pandemic

The unequal spread of COVID-19 was accompanied by disparities in adherence to social distancing. Research is needed on social processes that facilitated widespread adherence to distancing, how they connected with existing resource access and belief systems, and how they potentially strengthened intergroup boundaries. We integrated insights from research on social norms and cultural capital to analyze early pandemic (April–August 2020) qualitative interviews with parents and their teenage children in two higher-resource communities in the United States. Our findings uncovered four interrelated processes that facilitated the rapid establishment of norms around distancing, concurrently strengthening group boundaries. Community members: 1) drew on existing cultural capital to smooth the establishment of new social norms, 2) associated social distancing with individual moral worth and community identity, 3) applied double standards that granted certain exceptions to ingroup members to maintain social cohesion, and 4) drew strong distinctions between their own and outsiders’ social distancing behaviors and moral worth. Our findings articulate social processes that allowed for rapid cohesion around distancing and show how these mechanisms strengthened existing community social boundaries.

Predicting attitudes toward mitigation interventions and social distancing behaviors at the onset of the COVID-19 pandemic in the United States

ABSTRACT Aim The goal of this research was to assess the influence of adult attachment, personality, and cultural orientation on social distancing and attitudes toward COVID-19 mitigation interventions. Methods Survey data was collected across two samples (NMTurk = 201, Nsnowball = 242) in the US from April 29 to May 11, 2020. Adult attachment was assessed via the Experiences in Close Relationships Scale-Short Form (ECR-S; Wei, M., Russell, D. W., Mallinckrodt, B., & Vogel, D. L. (2007). The experiences in close relationship scale (ECR)-short form: Reliability, validity, and factor structure. Journal of Personality Assessment, 88(2), 187–204), personality was assessed via the Ten Item Personality Inventory (TIPI; Gosling, S. D., Rentfrow, P. J., & Swann, W. B. (2003). A very brief measure of the Big-Five personality domains. Journal of Research in Personality, 37(6), 504–528), cultural orientation was assessed via the Horizontal and Vertical Individualism and Collectivism Scale (Triandis, H. C., & Galfand, M. J. (1998). Converging measurement of horizontal and vertical individualism and collectivism. Journal of Personality and Social Psychology, 74(1), 118–128), and social distancing and attitudes toward mitigation interventions were assessed via self-report measures developed for this assessment. Results In the MTurk sample, agreeableness (β = .19) and conscientiousness (β = .26) predicted positive mitigation intervention attitudes. Agreeableness (β = .24) and vertical collectivism (β = .25) positively predicted social distancing, while attachment anxiety (β = −.32) and vertical individualism (β = −.32) negatively predicted social distancing. In our snowball sample, residing primarily in New York, openness (β = .18) and horizontal collectivism (β = .16) predicted positive intervention attitudes, while horizontal individualism (β = −.20) predicted negative attitudes. Social contact in this sample was low and not associated with predictor variables. In both samples, mitigation attitudes and social distancing were only moderately correlated. Implications Our findings highlight the inherent inconsistency between attitudes and behaviors as well as the potential impact of mandated interventions on both attitudes and behavior.

Comparing COVID-19 Response Behaviors between a Cancer Patient Sample and a Population-Based Cancer-Free Sample in a Rural Midwestern State

Introduction: The COVID-19 pandemic caused an increase in fear, anxiety, and depressive symptoms globally. For populations at increased risk for adverse outcomes due to illness, such as cancer patients, these worries may have been exacerbated. Understanding how the pandemic impacted cancer patients will inform better preparation for future events that cause disturbances to cancer care delivery. Methods: This study analyzed data from two surveys to determine whether cancer patients’ responses differed from a cancer-free population-based sample in terms of concerns, preventive behaviors, and thoughts on their healthcare provider’s communication regarding COVID-19 in a US Midwestern state. In August 2020, a survey was sent to 10,009 Iowans aged 18 and older, randomly selected from the 2018 Iowa voter registration file. In September 2020, a survey was emailed to 2,954 cancer patients aged 18 and older who opted into the University of Iowa Holden Comprehensive Cancer Center’s Patients Enhancing Research Collaborations at Holden program. Previously validated and pretested Likert-type and multiple-choice items assessed concern regarding COVID-19, social distancing perception and behaviors, and demographic characteristics of respondents. We used χ2 tests and logistic regression to examine differences between the cancer patient and general population survey responses. Results: We included 3,622 responses from the general population survey and 780 responses from the cancer patient survey in this analysis. Cancer patient survey respondents were more frequently older, lived in urban areas, had Medicare insurance coverage, had a college degree or higher, and were married. Cancer patients were more likely to report engaging in social distancing behaviors and greater concern regarding the pandemic. Conclusion: This study suggests differences in the impact of the COVID-19 pandemic on cancer patients compared to cancer-free members of the general population. These results indicate the need for consideration of cancer patients’ physical and mental health during large-scale disruptions to cancer care.

Temporal variations of vaccine hesitancy amid the COVID-19 outbreaks in Hong Kong.

To inform the dynamic adjustments of vaccination campaigns, this study examined the transitions among vaccine hesitancy profiles over the COVID-19 pandemic progression and their predictors and outcomes. The transition patterns among hesitancy profiles over three periods were identified using a latent transition analysis with individuals from a longitudinal cohort study since the emergence of COVID-19 in Hong Kong. Four profiles (i.e., skeptics, apathetics, fence-sitters, and believers) emerged consistently over time. From Period 1 (third and fourth pandemic waves) to Period 2 (dormant period, vaccine rollout), 14.17% of believers became fence-sitters (ambivalization), and 12.11% of fence-sitters became apathetics (apathetization). From Period 2 to Period 3 (omicron surge and vaccine mandates), 20.21% of believers became fence-sitters. Lower trust in government predicted a transition to skepticism, whereas higher trust predicted the opposite. Staying as believers was associated with decreased hygienic and social distancing behavior. The stable hesitancy profiles amid the rapid vaccine uptake suggest that structural factors rather than personal agency may drive the surge. Ambivalization and apathetization may signal disengagement in preventive behaviors. Trust in the government is crucial in the pandemic response. Public health interventions may improve compliance with guidelines and prevent skepticism and apathy.

Assessing Adherence to Vaccination, Social Distancing and Other Preventive Behaviors by Patients With Mental Disorders in the Context Of Covid-19 Pandemic: A Scoping Review Protocol.

The COVID-19 pandemic has emerged as a worldwide public health crisis, leading to significant disruptions in societal behaviors and norms. Within the affected population, individuals with mental health disorders are considered a vulnerable group, experiencing higher infection rates and poorer outcomes. These adverse outcomes can be attributed to various factors, including inadequate adherence to vaccination and other preventive measures. To address this issue, this study aims to present the research protocol for a scoping review that will comprehensively examine the literature on the adherence of individuals with mental disorders to preventive behaviors during the COVID-19 pandemic. The scoping review will adhere to the methodological guidelines outlined by the Joanna Briggs Institute and will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. A comprehensive search for published literature containing original data will be conducted in the Embase, MEDLINE, PsycINFO, and Web of Science databases. The search strategy will be developed based on the Population, Concept, and Context inclusion criteria. Two authors will independently screen titles, abstracts, and full texts for inclusion and extract relevant data. The findings of the review will be presented using descriptive statistics, including tables, charts, and flow diagrams, to elucidate the key concepts of interest.

Calculation Method and Application of Time-Varying Transmission Rate via Data-Driven Approach

Most research about compartmental models of infection disease often consider the transmission rate as a constant, which is not ideal for the dynamic surveillance of infectious diseases. This study fully utilized continuously updated real-time epidemiological data and proposed a SEAIUHR model incorporating asymptomatic and symptomatic infectiousness, reported and unreported cases, inpatient and non-inpatient cases, and vaccine inoculation. This study proposed a novel approach based on our model to calculate the time-varying transmission rate with an under-report rate, vaccination efficiency, and relaxation of social distancing behavior. The proposed method was evaluated based on epidemiological data from the United States. The results suggest that using this approach to combine epidemiological data can provide a clearer understanding of the spread rule of epidemic, offering data support for subsequent related research.

GAMBARAN PERILAKU MASYARAKAT DALAM PELAKSANAAN PROTOKOL KESEHATAN SEBAGAI UPAYA PENCEGAHAN COVID-19 DI WILAYAH KERJA PUSKESMAS WAJO

Efforts prevent spread Covid-19 can be carried out with strict health protocols and carried out by all levels society. Data from Wajo Health Center showed many as 202 cases Covid-19 and there are 2 cases death in 2021. Increase in cases Covid-19 is caused not complying with health protocols recommended by government. Purpose study was to find out description behavior in form washing hands, wearing masks, maintaining distance, staying away from crowds, and reducing mobility in implementation health protocols effort to prevent Covid-19. Type of research used is descriptive observational. Research population is entire community totaling 18,532, sample amounting to 391 and side method used is cluster sampling. Research data collection consisted primary data obtained by questionnaire and secondary data obtained from report notes Wajo Health Center. Data processing is done computerized using SPSS program. Analysis used is univariate analysis, namely to see appearance frequency distribution each variable studied. Results univariate analysis showed that 59.6% had poor hand washing behavior, 59.6% had less mask wearing behavior, 55.8% had less social distancing behavior, 55.5% avoided crowd behavior who are lacking, and 57.5% have behavior of reducing mobility that is lacking in implementation health protocols as an effort to prevent Covid-19. Conclusion shows that there is still a lack community behavior in implementing health protocols effort to prevent Covid-19 in work area Wajo Health Center, Baubau City. Suggestions for need to increase awareness, willingness and behavior from the community to implement health protocols effort to prevent Covid-19.

Behind closed doors: Protective social behavior during the COVID-19 pandemic.

The success of personal non-pharmaceutical interventions as a public health strategy requires a high level of compliance from individuals in private social settings. Strategies to increase compliance in these hard-to-reach settings depend upon a comprehensive understanding of the patterns and predictors of protective social behavior. Social cognitive models of protective behavior emphasize the contribution of individual-level factors while social-ecological models emphasize the contribution of environmental factors. This study draws on 28 waves of survey data from the Understanding Coronavirus in America survey to measure patterns of adherence to two protective social behaviors-private social-distancing behavior and private masking behavior-during the COVID-19 pandemic and to assess the role individual and environmental factors play in predicting adherence. Results show that patterns of adherence fall into three categories marked by high, moderate, and low levels of adherence, with just under half of respondents exhibiting a high level of adherence. Health beliefs emerge as the single strongest predictor of adherence. All other environmental and individual-level predictors have relatively poor predictive power or primarily indirect effects.

Toward a causal link between attachment styles and mental health during the COVID-19 pandemic.

Recent research has shown that insecure attachment, especially attachment anxiety, is associated with poor mental health outcomes, especially during the COVID-19 pandemic. Other research suggests that insecure attachment may be linked to nonadherence to social distancing behaviours during the pandemic. The present study aims to examine the causal links between attachment styles (secure, anxious, avoidant), mental health outcomes (depression, anxiety, loneliness) and adherence to social distancing behaviours during the first several months of the UK lockdown (between April and August 2020). We used a nationally representative UK sample (cross-sectional n = 1325; longitudinal n = 950). The data were analysed using state-of-the-art causal discovery and targeted learning algorithms to identify causal processes. The results showed that insecure attachment styles were causally linked to poorer mental health outcomes, mediated by loneliness. Only attachment avoidance was causally linked to nonadherence to social distancing guidelines. Future interventions to improve mental health outcomes should focus on mitigating feelings of loneliness. Limitations include no access to pre-pandemic data and the use of categorical attachment measure. Insecure attachment is a risk factor for poorer mental health outcomes.

Media Consumption and COVID-19-Related Precautionary Behaviors During the Early Pandemic: Survey Study of Older Adults.

During the COVID-19 pandemic, media sources dedicated significant time and resources to improve knowledge of COVID-19 precautionary behaviors (eg, wearing a mask). Many older adults report using the television, radio, print newspapers, or web-based sources to get information on political news, yet little is known about whether consuming news in the early phase of the pandemic led to behavior change, particularly in older adults. The goals of this study were to determine (1) whether dosage of news consumption on the COVID-19 pandemic was associated with COVID-19 precautionary behaviors; (2) whether being an ever-user of social media was associated with engagement in COVID-19 precautionary behaviors; and (3) among social media users, whether change in social media use during the early stages of the pandemic was associated with engagement in COVID-19 precautionary behaviors. Data were obtained from a University of Florida-administered study conducted in May and June of 2020. Linear regression models were used to assess the association between traditional news and social media use on COVID-19 precautionary behaviors (eg, mask wearing, hand washing, and social distancing behaviors). Analyses were adjusted for demographic characteristics, including age, sex, marital status, and education level. In a sample of 1082 older adults (mean age 73, IQR 68-78 years; 615/1082, 56.8% female), reporting 0 and <1 hour per day of media consumption, relative to >3 hours per day, was associated with lower engagement in COVID-19 precautionary behaviors in models adjusted for demographic characteristics (β=-2.00; P<.001 and β=-.41; P=.01, respectively). In addition, increasing social media use (relative to unchanged use) was associated with engagement in more COVID-19 precautionary behaviors (β=.70, P<.001). No associations were found between being an ever-user of social media and engaging in COVID-19 precautionary behaviors. The results demonstrated an association between higher media consumption and greater engagement in COVID-19 precautionary behaviors in older adults. These findings suggest that media can be effectively used as a public health tool for communication of prevention strategies and best practices during future health threats, even among populations who are historically less engaged in certain types of media.

Learning from the COVID-19 pandemic: health care disturbances and telemedicine as an alternative rheumatology practice in Indonesia

BackgroundCoronavirus disease 2019 (COVID-19) affects health care services. Our aim was to assess health care disruptions, treatment interruptions, and telemedicine reception regarding autoimmune rheumatic diseases (ARDs) in Indonesia.MethodA cross-sectional population online-based questionnaire was conducted in Indonesia from September to December 2021.ResultsA total of 311 ARD patients were included, of whom 81 (26.0%) underwent consultations via telemedicine during the COVID-19 pandemic. The respondents showed increased concern about their susceptibility to COVID-19 (score of 3.9/5). Approximately 81 (26.0%) avoided hospital visits, and 76 (24.4%) stopped taking the medication without medical advice. Respondents’ concerns correlated with their social distancing behaviors (p value 0.000, r 0.458). Respondent concerns, behaviors, and blocked access to the hospital during the pandemic were associated with avoiding hospital visits (p value 0.014; 0.001; 0.045; 0.008). Sex was associated with stopping medication (p value 0.005). In multivariate analysis, blocked access and sex remained significant. Approximately 81 (26%) respondents who used telemedicine services during the COVID-19 pandemic as an alternative medical consultation method showed high satisfaction (3.8/5).ConclusionHealth care disruptions and treatment interruptions were affected by patients’ internal and external factors during the COVID-19 pandemic. Telemedicine may be the best option to address barriers to health care access in Indonesia’s rheumatology practice during and after the pandemic situation.

Social distancing and mental health among pregnant women during the coronavirus pandemic

BackgroundThe effect of social distancing due to the COVID-19 pandemic on the mental health of pregnant women is of particular concern, given potential effects on physical health, family functioning, and child development.MethodsPregnant women were recruited for the “Implications of and Experiences Surrounding being Pregnant during the COVID-19 Pandemic” study at Woman’s Hospital in Baton Rouge, Louisiana. Participants enrolled at any point during their pregnancy and surveys were delivered weekly until the participant indicated that she had delivered her baby; a postpartum survey followed four weeks after delivery. This analysis includes 1037 participants with baseline, 596 with follow-up, and 302 with postpartum surveys. Questions on social distancing behaviors were asked at baseline and grouped based on whether they involved social distancing from work, friends and family, or public places. Symptoms of anxiety, stress, depression, and pregnancy-related anxiety were measured. Each type of social distancing was examined as a predictor of mental health using linear model with control for confounders.ResultsThe study population was largely white (84.1%), married (81.8%), and educated (76.2% with a bachelor’s or higher degree). Women who were younger, Black, unmarried, or had less education or income reported fewer social distancing behaviors. Mean anxiety score in the highest quartile of overall social distancing was 8.3 (SD 5.6), while in the lowest quartile it was 6.0 (SD 5.0) (p < 0.01), while perceived stress postpartum and pregnancy-related stress were not associated with social distancing. Associations were substantially diminished when controlled for baseline levels of anxiety symptoms.ConclusionsGreater social distancing was associated with more anxiety symptoms, but worse mental health, particularly anxiety, may also have contributed to greater social distancing behaviors.

Persistence of the Omicron variant of SARS-CoV-2 in Australia: The impact of fluctuating social distancing.

We modelled emergence and spread of the Omicron variant of SARS-CoV-2 in Australia between December 2021 and June 2022. This pandemic stage exhibited a diverse epidemiological profile with emergence of co-circulating sub-lineages of Omicron, further complicated by differences in social distancing behaviour which varied over time. Our study delineated distinct phases of the Omicron-associated pandemic stage, and retrospectively quantified the adoption of social distancing measures, fluctuating over different time periods in response to the observable incidence dynamics. We also modelled the corresponding disease burden, in terms of hospitalisations, intensive care unit occupancy, and mortality. Supported by good agreement between simulated and actual health data, our study revealed that the nonlinear dynamics observed in the daily incidence and disease burden were determined not only by introduction of sub-lineages of Omicron, but also by the fluctuating adoption of social distancing measures. Our high-resolution model can be used in design and evaluation of public health interventions during future crises.

A longitudinal study of COVID-19 preventive behavior fatigue in Hong Kong: a city with previous pandemic experience

BackgroundIn addition to high vaccination levels, COVID-19 control requires uptake and continued adherence to personal hygiene and social distancing behaviors. It is unclear whether residents of a city with successive experience in worldwide pandemics such as SARS, would quickly adopt and maintain preventive behaviors.MethodsA population-based, longitudinal telephone survey was conducted between in first local wave of the COVID-19 pandemic (April 2020) and third local wave (December 2020) (n = 403). The study examined factors associated with personal hygiene and social distancing behavior fatigue, as measured by reduced adherence.ResultsOver 9 months, face mask use increased (96.5–100%, p < 0.001). Although habitual hand hygiene remained unchanged (92.0%), blue collar workers and non-working individuals showed higher risk of hand hygiene fatigue. There was a decline (p < 0.05) in avoidance of social gatherings (81.1 to 70.7%), avoidance of public places (52.9–27.5%) and avoidance of international travel (81.9–77.4%) even with rising caseloads. Lowered perception of COVID-19 disease severity was associated with decreased avoidance of social gatherings and public places while lower education was associated with decline in avoidance of social gatherings.ConclusionEven in regions with past pandemic experience, maintaining social distancing behaviors during a protracted pandemic remains a major public health challenge.

New observation of perceptive mechanism behind the long-lasting change of people's community mobility: evidence from COVID-19 in China

COVID-19 pandemic provides an opportunity to investigate how a new and long-lasting threat affects public risk perception and social distancing behavior, which is important for pandemic risk management and recovery of the tertiary industry. We have found that the mechanism that perception decides behavior changes over time. At the beginning of the pandemic, risk directly shapes people’s willingness of going out. But under a persistent threat, perception no longer plays the direct role of shape people’s willingness. Instead, perception indirectly influences the willingness by shaping people’s judgment about the necessity of traveling. Switching from direct to indirect influence, perception’s effect is enlarged, which partially prevents people from returning to normal life even if the governmental ban is removed in a zero-COVID community.

Does pre-COVID impulsive behaviour predict adherence to hygiene and social distancing measures in youths following the COVID-19 pandemic onset? Evidence from a South African longitudinal study.

BackgroundEngagement in protective behaviours relating to the COVID-19 pandemic has been proposed to be key to infection control. This is particularly the case for youths as key drivers of infections. A range of factors influencing adherence have been identified, including impulsivity and risk taking. We assessed the association between pre-COVID impulsivity levels and engagement in preventative measures during the COVID-19 pandemic in a longitudinal South African sample, in order to inform future pandemic planning.MethodsData were collected from N = 214 youths (mean age at baseline: M = 17.81 (SD = .71), 55.6% female) living in a South African peri-urban settlement characterised by high poverty and deprivation. Baseline assessments were taken in 2018/19 and the COVID follow-up was conducted in June–October 2020 via remote data collection. Impulsivity was assessed using the Balloon Analogue Task (BART), while hygiene and social distancing behaviours were captured through self-report. Stepwise hierarchical regression analyses were performed to estimate effects of impulsivity on measure adherence.ResultsSelf-rated engagement in hygiene behaviours was high (67.1–86.1% “most of the time”, except for “coughing/sneezing into one’s elbow” at 33.3%), while engagement in social distancing behaviours varied (22.4–57.8% “most of the time”). Higher impulsivity predicted lower levels of hygiene (β = .14, p = .041) but not social distancing behaviours (β = −.02, p = .82). This association was retained when controlling for a range of demographic and COVID-related factors (β = .14, p = .047) and was slightly reduced when including the effects of a life-skills interventions on hygiene behaviour (β = −.13, p = .073).ConclusionsOur data indicate that impulsivity may predict adolescent engagement in hygiene behaviours post COVID-19 pandemic onset in a high risk, sub-Saharan African setting, albeit with a small effect size. For future pandemics, it is important to understand predictors of engagement, particularly in the context of adversity, where adherence may be challenging. Limitations include a small sample size and potential measure shortcomings.

Financial constraint and perceptions of COVID-19

In early March 2020, two crises emerged: the COVID-19 public health crisis and a corresponding economic crisis resulting from business closures and skyrocketing job losses. While the link between socioeconomic status and infectious disease is well-documented, the psychological relationships among economic considerations, such as financial constraint and economic anxiety, and health considerations, such as perceptions of disease spread and preventative actions, is not well understood. Despite past research illustrating the strong link between financial fragility and a wide range of behaviors, surprisingly little research has examined the psychological relationship between the economic crisis and beliefs and behaviors related to the co-occurring health crisis. We show that financial constraint predicts people’s beliefs about both their personal risk of infection and the national spread of the virus as well as their social distancing behavior. In addition, we compare the predictive utility of financial constraint to two other commonly studied factors: political partisanship and local disease severity. We also show that negative affect partially mediates the relationship between financial constraint and COVID-19 beliefs and social distancing behaviors. These results suggest the economic crisis created by COVID-19 spilled over into people’s beliefs about the health crisis and their behaviors.

The effects of emergency government cash transfers on beliefs and behaviours during the COVID pandemic: Evidence from Brazil

This paper examines the impacts of emergency cash-transfers on individuals’ social distancing behaviour and beliefs about COVID-19. We focus on the impacts of “Auxilio Emergencial” (AE): a large-scale cash-transfer in Brazil targeting low-income individuals who were unemployed or informally employed during the pandemic. To identify causal effects we exploit exogenous variation, arising from the AE design, in individuals’ access to the cash-transfer programme. Using data from an online survey, our results suggest that eligibility to the emergency cash transfer led to a reduced likelihood of individuals contracting COVID-19, likely to have been driven by a reduction in working hours. Moreover, the cash transfer seems to have increased perceptions about the seriousness of coronavirus, while also exacerbating misconceptions about the pandemic. These findings indicate effects of emergency cash-transfers in determining individuals’ narratives about a pandemic, in enabling social distancing and potentially in reducing the spread of the disease.

Understanding Covid-19 Mobility Through Human Capital: A Unified Causal Framework.

This paper seeks to identify the causal impact of educational human capital on social distancing behavior at workplace in Turkey using district-level data for the period of April 2020 - February 2021. We adopt a unified causal framework, predicated on domain knowledge, theory-justified constraints anda data-driven causal structure discovery using causal graphs. We answer our causal query by employing machine learning prediction algorithms; instrumental variables in the presence of latent confounding and Heckman's model in the presence of selection bias. Results show that educated regions are able to distance-work and educational human capital is a key factor in reducing workplace mobility, possibly through its impact on employment. This pattern leads to higher workplace mobility for less educated regions and translates into higher Covid-19 infection rates. The future of the pandemic lies in less educated segments of developing countries and calls for public health action to decrease its unequal and pervasive impact.