Introduction

In late December 2019, an outbreak of a new viral disease belonging to the coronavirus family was reported in Wuhan, the capital of Hubei, China.¹ The new COVID-19 belongs to the same group of coronaviruses as acute respiratory syndrome (SARS) and Middle East Respiratory Syndrome (MERS), which has caused two outbreaks in recent years.² The new virus is mainly transmitted by respiratory droplets and contact³ and affects all age groups.⁴ On December, 2021, due to the rapid spread of the virus and the increase in infections, followed by alarming death tolls from the disease was declared an epidemic by the World Health Organization.⁵ According to the WHO, as of December 6, 2021, 269 559 230 people worldwide have been infected and 530 5337 people have died from the virus. Also in Iran, as of December 6 in 2021, 6 137 821 people have been infected and 130 277 people have died due to this virus.^6,7

The COVID-19 pandemics crisis has caused great unrest in society and unprecedented changes in lifestyle, work and social interactions.⁸ The implementation of policies such as social distancing and the closure of gathering and interaction centers such as parks, cafes, shrines, schools, universities, etc., has had certain social consequences.⁹ Prolonged stay at home, in a society with a patriarchal lifestyle, will increase the pressure for women to do housework. The economic and psychological dimensions of COVID-19 also affect family members. The issue of increasing domestic violence, including child abuse, spousal abuse, elder abuse, and disability abuse following the COVID-19 pandemics crisis, is such that the Secretary-General of the United Nations has also expressed concern.¹⁰ The closure of schools and universities will deprive millions of children, teenagers and young people of social educational activities for a long time, after which it may not be easy to compensate.^11,12 Travel restrictions by different countries have reduced social relations in external areas and led to the isolation of individuals. Because COVID-19 affects all aspects of human life, it has increased divorce and reduced marriage in many countries.¹³ In couples' lives, we have witnessed a decrease in marital relationships due to fear of contracting or transmitting the disease.¹⁴ COVID-19 has also challenged and damaged public transport.^15,16

The COVID-19 greatly affects people's lives. Everyone in the world directly or indirectly faces the severe consequences of this disease. Due to severe isolation and cessation of some social affairs, this disease causes problems such as social anxiety, panic due to insecurity, economic recession and severe psychological stress, which requires coordinated efforts to prevent and control them, and people should follow the advice and the suggestions of government officials and the World Health Organization to make the necessary and at the same time contrary to the internal desire in their daily plan.¹⁷ Given that previous studies have evaluated the psychological and social consequences of other respiratory illnesses; few studies have been performed to evaluate the results of the current epidemic of COVID-19. Therefore, this review study will be conducted with the aim of estimating the social consequences of COVID-19 in order to identify them and take the necessary preventive measures to reduce the problems caused by these consequences. The present study sought to answer the following question: What are the social consequences of COVID-19 disease?

Methods

Search strategy. All stages of this research were performed based on the writing standard of systematic studies, PRISMA meta-analysis. The study population in this study included articles on the social consequences of COVID-19 that were indexed on one of the Internet sites. The Web of Science, Scopus, PubMed, Embase, and Magiran databases were searched as international databases, and the Google Scholar search engine was searched in Persian and English between 2000 and 2020. To find related articles in Persian and English language databases, the words searched in line with the research topic and based on mesh and syntax were the following items that were combined using AND and OR operators. The searching strategy used in Medline was: “(COVID-19[tiab] OR Coronavirus[tiab] OR Coronaviruses[tiab] OR Deltacoronavirus[tiab] OR Deltacoronaviruses[tiab] OR “Munia coronavirus HKU13”[tiab] OR “Coronavirus HKU15”[tiab] OR (Coronavirus[tiab] AND Rabbit[tiab]) OR “Rabbit Coronavirus*” [tiab] OR (Coronaviruses[tiab] AND Rabbit[tiab]) OR “Bulbul coronavirus HKU11”[tiab] OR “Thrush coronavirus HKU12”[tiab] OR (“Coronavirus 229E”[tiab] AND Human[tiab]) OR (“Coronavirus NL63”[tiab] AND Human[tiab]) OR “Middle East Respiratory Syndrome Coronavirus”[tiab] OR “SARS Virus”[tiab]) AND (“Social Behavior”[tiab] OR (Behavior[tiab] AND Social[tiab]) OR (Behaviors[tiab] AND Social[tiab]) OR “Social Behaviors”[tiab] OR “Competitive Behavior”[tiab] OR “Cooperative Behavior”[tiab] OR Self-Control[tiab] OR “Social Adjustment”[tiab] OR “Social Distance”[tiab] OR “Social Isolation”[tiab] OR “Social Skills”[tiab] OR “Social Stigma”[tiab] OR (Psychology[tiab] AND Social[tiab]))”.

Selection of studies. In total, in this study, systematic review with the above keywords was initially studied in 912 articles and reports, protocols by reputable health organizations and considering the entry and exit criteria of articles in the relevant databases. After studying the titles and abstracts of articles by the authors of the article and removing similar and unrelated items, the relevant items were selected as research. Due to the widespread and increasing prevalence of the disease and the change in the statistics related to the prevalence, the statistics presented in this study are until July 23, 2020. Criteria for selecting articles are: (i) Descriptive, analytical, interventional and review articles related to the last 5 years; (ii) Persian and English language articles published in scientific research journals inside and outside the country, the full text of which was available; and, (iii) Articles related to the study of the social consequences of COVID-19.

Criteria for deleting articles were: articles that did not have a full text, articles that did not have a clear implementation method, and articles that focused solely on the social consequences of the disease. To review the articles obtained in the search of databases, were evaluated and evaluated according to the inclusion and exit criteria in the working method, four research colleagues participated. After reviewing the inclusion and exclusion criteria of the study, 43 articles and 4 protocols and reports in accordance with the above criteria entered the final quality assessment stage (Figure 1).

Figure 1. The flowchart describing the study design process 

Quality control. The quality of the papers selected by the two individuals was assessed independently using the Newcastle Ottawa Scale (NOS). This scale examines articles in terms of selection process (including four sections: sample expediency and sample size, non-response and measurement tools, comparability (control of confounders and influencing factors) and results (evaluation of results and statistical tests). Based on this scale, articles are rated from zero (weakest study) to 10 (strongest study). In this study, studies that scored above 4 were considered as quality studies. Therefore, according to the quality results of the reviewed articles, all articles selected at this stage had a score higher than 4 (optimal level).

Extracting the data: After evaluating the quality, to extract data from the text of articles eligible to enter to the study of two researchers independently by the researcher form, information about each article by name of authors, year of publication, type of research, place of research, Sample size and specificity of samples, standardization of research tools, main findings were extracted. In case of need for review and doubt in the method of reviewing articles, the help of a third researcher was sought (Table 1).

Results

In late 2019, the world faced a global crisis called COVID-19, which was a threatening epidemic. In addition to increasing the incidence and mortality of this epidemic, it caused significant other economic, social, political, and psychological problems. Social isolation by quarantining billions of people at home to disrupt the virus transmission chain has created many crises in various dimensions,¹⁸ here are some of them:

Scope of knowledge and education. COVID-19 has disrupted students' lives in different ways and it has provided anxious times for students and parents.¹⁹ According to UNESCO, more than 1.5 billion students in about 165 countries have been affected by the restrictions on schools and universities. As a result, schools, colleges and universities were forced to turn to online learning. This has caused students to continue their education at home.²⁰ Closing schools and accepting distance education may negatively affect students' learning through four main channels: spending less time learning, stress symptoms, changes in how students interact, and lack of motivation to learn. Most formal child learning takes place in schools, and closing schools and moving to a distance learning environment may cause children to spend less time learning.²¹ Students who stay home because of COVID-19 are more likely to develop acute stress, maladaptation, and PTSD. The possibility of dropping out of school due to mental health problems also increases.²² Attendance at schools increases the interaction between students and teachers and strengthens social skills and increases self-esteem and other skills necessary for the social environment. However, due to quarantine proceedings and the closure of schools, these social interactions have decreased.²¹ Also, some teachers or students are not familiar enough with the world of the Internet and distance education, and this has disrupted the educational process. On the other hand, due to the lack of access to online education tools for all students such as phones or laptops or the lack of Internet access in less developed areas, problems in distance education have been created for them.²³

Family scope. With the announcement of the epidemic of COVID-19 and the application of various restrictions in the community, some jobs were closed, which increased the financial and economic burden on the family and increased the couple's dissatisfaction, as well as disputes and even divorce. Also, due to the constraints and economic problems caused by COVID-19, weddings and bonds between people have decreased.^24,25 With the closure of schools and the presence of students in homes and the closure of businesses due to social constraints, it has increased psychological problems in families, abuse and violence between family members.²⁶ This has a very important impact on people's lifestyle, the short-term consequences of which can be seen in health. These restrictions have led to decreased physical activity, weight gain, changes in diet, changes in smoking and alcohol consumption habits, changes in lifestyle, and ultimately quality of life and well-being.^27,28 Also, different degrees of quarantine measures have reduced people's access to healthy food, inequality between communities, increased anxiety and stress, and impaired sleep quality. Some people also used drugs and alcohol to alleviate the fear and anxiety of COVID-19.²⁹

Judicial scope. By imposing social distancing and various restrictions, individuals may resist these commands. The increasing burden of social distance in daily life has led to violence, bad temper, conflict, theft, murder, suicide, sabotage, and disregard for the law.³⁰ Social distance at the court level has also disrupted the proceedings and the presence of parties and witnesses in court.³¹ The sale of illicit drugs, the distribution and consumption of drugs and alcohol, cybercrime, as well as the sale and purchase of firearms are among the crimes that are on the rise during COVID-19.³² The outbreak of COVID-19 and the need for social isolation have also hampered the normal process of prisons. The temporary release of many prisoners in some countries has caused anxiety at the community level, and due to the lack of adequate space for solitary confinement, the possibility of increasing the incidence of COVID-19 among prisoners has become even more significant. Also, in some countries, the possibility of COVID-19 disease is higher among prisoners due to lack of adequate hygiene.³³

Sexual scope. Anxiety about the state of the world, along with constant exposure to images of illness and death, has severely affected everyone's emotional stability. Daily turmoil, restriction of freedom and loss of sense of usefulness in society create a feeling of helplessness and overload in human beings. This has also affected the sexual sphere. Fear of these conditions has reduced physical contact in couples from simple kissing to full sexual intercourse and has weakened the bond between husband and wife.³⁴ Further depression and anxiety can reduce the level of sexual desire. With the closure of schools and the constant presence of children at home, sexual relations between individuals have also been overshadowed.³⁵ With the restrictions imposed, the tendency to have sex online has increased. Fear of infection has led single people to masturbate, have sex on the phone, and use of sexual means, which in turn has increased their desire for pornography and visits to pornographic sites and movies.^22,36

Scope of transportation. Restrictions imposed by the government have halted public transport, restricted travel and activities abroad. The change of direction to personal transportation by individuals has intensified traffic on the roads and reduced the overall air quality in the urban environment. With the application of social distance, we are witnessing an increase in queues at bus and metro stations.^37,38 Air travel has also decreased significantly. COVID-19 has also led to the closure of many transportation agencies around the world due to a sharp drop in demand and a heavy economic burden on the people and the government. Violations and accidents on the road and in the city have also increased due to the use of private vehicles by the people.¹⁶

Cyberspace scope. This epidemic has played an important role in disseminating information in a news cycle.³⁹ The COVID-19 epidemic has not only posed significant challenges to the health care system worldwide, but has also played an important role in increasing rumors, deception and misinformation about the disease, its consequences, prevention and treatment. With so much news coming from different sources, there are many concerns about fake news. People are constantly following the news of COVID-19 and may experience high anxiety while doing things.⁴⁰ Comprehensive media exposure during the 24-hour news cycle can also lead the viewer to inaccurate and threatening information. These stress reactions may also have long-term consequences for physical and mental health.⁴¹ It may even reduce the function of the immune system and upset the balance of their natural physiological mechanisms.⁴²

Discussion

The social effects of the changes resulting from the COVID-19 pandemic crisis are not yet well known. We know that due to the implementation of social distance policy, many of the usual activities of society in the economic, social and political spheres have been closed or suspended.⁴³ As a result, many people in areas such as business, family relationships, and education have experienced the changes and effects of this policy. Many sectors were forced to adjust their workforce and increase the number of unemployed to reduce costs.⁴⁴ The heavy economic burden and unemployment caused by the COVID-19 epidemic have caused anxiety thoughts, anxiety, and ultimately an increase in crimes such as theft, strife, domestic disputes, fraud, and etc. To prevent such crimes, the government can adopt policies that can include livelihood support, management and organization of Internet businesses, and low-interest lending.⁴⁵ In the policy of social distancing, the situation of certain social groups such as immigrants, refugees and addicts has been ignored and the problems of this group of people have intensified.⁴⁶ Civil society and voluntary groups of people are full of initiatives, innovations and resources that can be used in times of crisis. Internet infrastructures and modern communication tools have transcended the physical limitations of communication and enabled virtual social interactions that can be used to maintain connections.⁴⁷

It should be noted that the lack of management and monitoring of the virtual world can impose irreparable damage on society in the long time.³ Social distancing, despite its problems, has a significant impact on reduction of casualties from the disease and reducing its negative consequences, but ultimately it is the level of public trust in the government that ensures the success of policies and measures. It is necessary to provide more freedom of action for the media to provide accurate, transparent information in this regard. The development of information infrastructure, especially in the less developed regions of the country, must be seriously on the agenda. Necessary requirements for equipping students in need of teaching aids such as tablets.^11,48 The need for public transportation in any society is an indisputable need. Therefore, the government should take action to provide the desired service in accordance with social distance.⁴⁹ Increasing the number of public vehicles, regular disinfection and the use of social distance labels can revitalize this vital sector and meet the needs of the community and prevent pollution. Also, providing brochures and educational materials in public transportation can help reduce anxiety and increase public literacy.^16,50

One must be careful about the social consequences of COVID-19 for certain groups. Ignoring this issue can cause COVID-19 to exacerbate the unfavorable situation of these groups. Groups such as addicts in crisis situations should be given more attention and clear and precise policies and programs should be developed to support this group. Immigrants and refugees also have their own circumstances, and their fate in the context of the COVID-19 pandemic crisis cannot be ignored. Doing all of the above means that a small part of the social issues created by the COVID-19 pandemic crisis require capacities of trust, cross-sectoral cooperation, coordination, transparency and joint action. Capacities that many of them may not have looked good under normal circumstances.^51,52

Limitations of the study: In this study, due to the lack of proficiency of researchers in languages other than English and Persian, articles in other languages were excluded from the study, which can be a limitation of the study.

Conclusion: In this review study, the effect of coronavirus on some aspects of people's lives was briefly discussed. Unfortunately, in the current epidemic and control of the corona virus, while becoming a crisis of health in the world, it is considered as such that it still has various aspects. In recent months, the world has been going through one of the most severe crises in the field of health and without a doubt one of the most important consequences of its epidemic and social ills. In fact, anxiety factors related to the risk of contracting the disease, future employment status, and sources of income for individuals and families, as well as long-term quarantine, can be kept at home for a long time.

Implications of the results for nursing practice. Considering the psychological consequences of the COVID-19 outbreak, the design and planning of intervention and supportive strategies to reduce the negative effects are suggested. In fact, it is necessary to identify the factors that cause the danger to the psychological health of different people in the society in order to use appropriate treatment methods.