The document discusses COVID-19, including its origins, symptoms, diagnosis, negative consequences such as increased anxiety, depression, and stress among students. It outlines coping strategies like religious coping, social distancing, and protective measures like hand hygiene and mask use that are recommended. Vaccination is discussed though there is currently no vaccine available for COVID-19. The pandemic has disrupted education worldwide and increased psychological distress.

1. COVID-19
Diseases are a part of human civilization, the emergence and re-emergence of infectious diseases
such as HIV/AIDS, SARS, H1N1, and Ebola have various consequences on human civilization.
Physical and mental problems emerge due to lack of knowledge, ignoring pre-cautions, and
insufficient information. Since December 2019, there has been an outbreak of pneumonia of an
unknown etiology that was first reported in Wuhan, Hubei Province, China (WHO, 2020). It is
named coronavirus disease 2019 (COVID-19), which started in China in December 2019, is a
catastrophic calamity that has spread across the entire world at the speed of light (Sundarasen et
al., 2020). Coronavirus disease 2019 (COVID-19) is the latest infectious disease to develop rapidly
worldwide to the extent of a severe global pandemic that possesses potent pathogenicity and
transmissibility (Van Doremalen et al., 2020).
COVID-19 outbreak has affected physical and psychological health and seriously threatened the
lives of many people all over the world. Consequently, people have to suffer fear, anxiety, and
hysteria (Salman et al., 2020). In 1918 after the influenza pandemic, COVID-19 is considered as
a most devastating and challenging pandemic that as of 14th May 2020, more than 4.2 million
people have been infected and 292046 succumbed to it globally (WHO, 2020). It has brought a
great deal of anxiety, fear, and unrest among people of all ages. COVID-19 has been considered a
relative of the severe acute respiratory syndrome (SARS), which has the possibility of transmission
from animals to humans (Taylor et al., 2008). Therefore, coronavirus disease 2019 (COVID-19)
is the latest pandemic with a high rate of morbidity and mortality worldwide that bring crises that
can harm the academic functioning and psychophysical health of individuals throughout the globe.

2. Symptoms of Covid-19
The incubation period is the primer of the virus into the body and the beginning of symptoms,
which is about 4 to 7 days in the majority of cases and can vary from 2 to 14 days when COVID-
19 is concerned (Li, Bai, & Hashikawa, 2020). Symptoms include fever in 80 to 90% of cases,
cough in 60 to 70% of cases, gastrointestinal complaints in 40 to 50%, loss of smell in 30 to 40%,
and shortness of breath in 20% (Li, Bai, & Hashikawa, 2020). In addition, according to the World
Health Organization (2020), the most common symptoms of COVID-19 are
 Fever
 Dry cough
 Fatigue
In addition, other symptoms that are less common and may affect some patients include:
 Loss of taste or smell,
 Nasal congestion,
 Conjunctivitis (also known as red eyes)
 Sore throat,
 Headache,
 Muscle or joint pain,
 Different types of skin rash,

3.  Nausea or vomiting,
 Diarrhea,
 Chills or dizziness.
Symptoms of severe COVID‐19 disease include:
 Shortness of breath,
 Loss of appetite,
 Confusion,
 Persistent pain or pressure in the chest,
 High temperature (above 38 °C).
Other less common symptoms are:
 Irritability,
 Confusion,
 Reduced consciousness (sometimes associated with seizures),
 Anxiety,
 Depression,
 Sleep disorders,

4.  More severe and rare neurological complications such as strokes, brain inflammation,
delirium, and nerve damage.
Causes
The core cause of the Covid-19 pandemic is unknown, but according to the present literature,
China 31 December alerted the WHO to cases of unusual pneumonia in Wuhan (Aljazeera, 2020).
According to Aljazeera (2020), COVID-19 is thought to have originated in a seafood market where
wildlife was sold illegally. On February 7, Chinese researchers said the virus could have spread
from an infected animal to humans through illegally trafficked pangolins, prized in Asia for food
and medicine (Aljazeera, 2020). Scientists have pointed to either bats or snakes as possible sources,
but the research has been ongoing for further investigation (Aljazeera, 2020).
Diagnosis
Diagnosis is the first step for people who are at risk of being affected or who had symptoms. The
diagnosis process is conducted to demonstrate the virus in the secretions from the nose, throat, or
lower respiratory tract (RT-PCR test) of people (Li, Bai, & Hashikawa, 2020). The sensitivity of
this test may drop to 70% in the early stages of the disease and may not give positive results for
all patients (Woelfel et al., 2020) It is required to evaluate the chest x-ray or CT scan images of
patients who are more practically suspected (Woelfel et al., 2020). Although the definitive
diagnosis cannot be made according to the results of the x-ray, it can demonstrate a high match
with the RT-PCR test and thus indicate possible disease earlier during the pandemic (Li, Bai, &
Hashikawa, 2020) Serological tests for the investigation of early specific antibodies (IgM)
generated by our virus defense system are also in question and can turn positive on day 3 to 5
following the onset of symptoms (Woelfel et al., 2020). Making a retrospective diagnosis

5. following the recovery of patients is also possible following research on late specific antibodies
(IgG) (Li, Bai, & Hashikawa, 2020).
Negative Consequences of Covid-19
The outbreak of COVID-19 has affected physical and psychological health, and cause threatened
the lives of many people all over the world. The continuous spread of the disease, conspiracy
theories, myths, and blame games, sensational media reporting of COVID-19, frustration and
boredom, family financial loss due to lockdown are some of the main risk factors significantly
influencing the mental health of university student (Salman et al., 2020). The populations may
have experienced some known risk factors for depression and anxiety including high mortality
rate, resource and food insecurity, discrimination, and experience with infected and sick
individuals, which can lead to some adverse mental health outcomes during these epidemics [8]
Since the pandemic is not over yet and there is a further spread of the pandemic
to other countries. The COVID-19 pandemic may cause excessive panic
and anxiety because of the increasing number of COVID-19 cases worldwide. WHO (2020) has
also raised this concern in these words:
“The impact of the pandemic on people’s mental health is already extremely concerning.
Social isolation, fear of contagion, and loss of family members is compounded by the distress
caused by loss of income and often employment.”
Students mental health and the COVID-19 Pandemic
In Pakistan, the first case of COVID-19 appeared on 26th February 2020. After the closure of the
educational institution, most of the authorities have been discussing academic, but there have been
fewer discussions on how to support children who rely on schools for behavioral and mental health

6. supports (Phelps & Sperry, 2020). UNESCO emphasis that the pandemic has interrupted the
learning of more than one billion students in 129 countries around the world (UNESCO). Many
universities worldwide have moved to emergency remote teaching (ERT) via online platforms,
which cause further inducing anxiety among the students. In this process, all the educational
institutes were also locked down all of a sudden and the students were in different phases of their
academic year. Students experience lots of stress especially before and during the examinations.
The examinations were postponed due to the lockdown effect and the actual date of the exam is
awaited. All these students are in high stress because their pre-examination period will continue
till they complete the examination. Though many of the educational institutes have launched online
classes, an adaptation of the student to the sudden transition from the routine teaching method is
stressful. This is true especially in case of the slow learners.
According to Salman et al., (2020), the prevalence of anxiety and depression among students
during the COVID-19 pandemic was between 34% to 24%. In addition, Females generally express
emotions to a greater extent than males do, and the recent pandemic may have exacerbated this
situation. Studies indicate that females’ uncertainty tolerance threshold is lower than that of males,
and crossing that threshold triggers undue stress and anxiety. Female students may further be
subject to lesser coping strategies in times of uncertainty and stressful situations (Sundarasen et
al., 2020).
Trauma
According to Blaustein, (2013)trauma has been defined as
“Events that overwhelm a person’s ability to adapt to life, leading to strong negative
emotions that are associated with the degree of experienced or witnessed threat to self”

7. In an urban study of children age 10 to 18 years old, a study explicit that 92.5% of the youth had
experienced one or more lifetime traumatic events (Abram et al., 2004). Low socioeconomic status
is one of the factors, that cause trauma in children. Research has indicated that these childhood
experiences can have adverse long-lasting biopsychosocial consequences such as disrupted
neurodevelopment, social, emotional, and cognitive impairment, adoption of health-risk behaviors,
disease, disability, and social problems; and early death (Ports, Ford, & Merrick, 2016).
Stress
Lazarus et al (1984) defined stress as “a particular relationship between the person and
the environment that the person considers to be taxing or exceeding his or her resources and putting
his or her well-being at risk.” (p. 19)
Stress is an emotional feeling that comes from a sudden event or thought that causes frustration,
aggression, and makes a person nervous (Weiller et al., 2020). Stress impacts the body, and the
human body is designed to experience stress and react to it. Stress can be positive, keeping us alert,
motivated, and ready to avoid danger. Stress becomes negative when a person faces continuous
challenges without relief or relaxation between stressors (Weiller et al., 2020). As a result, the
person becomes overworked, and stress-related tension builds. The body's autonomic nervous
system has a built-in stress response that causes physiological changes to allow the body to combat
stressful situations. This stress response, also known as the "fight or flight response", is activated
in case of an emergency. However, this response can become chronically activated during
prolonged periods of stress. Prolonged activation of the stress response causes wears and tear on

8. the body – both physical and emotional (Weiller et al., 2020). According to Weiller et al., (2020)
stress can be diagnosed with the indication of the following symptoms:
 Dizziness
 General aches and pains.
 Grinding teeth, clenched jaw.
 Headaches.
 Indigestion or acid reflux symptoms.
 Increase in or loss of appetite.
 Muscle tension in neck, face, or shoulders.
 Problems sleeping.
 Racing heart.
 Cold and sweaty palms.
 Tiredness, exhaustion.
 Trembling/shaking.
 Weight gain or loss.
 Diarrhea.
Anxiety
The outbreak of the COVID-19 pandemic causes anxiety widespread and it conceivably as
crippling as depression (Weiller et al., 2020). Anxiety can be fueled by uncertainty and by fears of
the risk of harm to self or others. Anxiety is still undiagnosed and under-treated in the global
context. In addition to intense feelings of fear or panic, anxiety patients may also experience other
physiological symptoms, such as feeling weak, fainting, pain or nausea, shivers, rapid breathing,

9. etc. (Testa et al., 2013). Anxiety impairs focus and concentration, memory, and visual-motor skills
(Moran, 2016).
In addition, the negative influence of pandemics on students’ psychological well-being has led to
acute depression and anxiety. Cao et al. [11] investigated the psychological impact on university
students in China during the COVID-19 pandemic. Out of 7143 students studied, 0.9% had severe
anxiety, 2.7% had moderate anxiety, and 21.3% had mild anxiety. The study by [12] on 1210
students from 194 cities in China, found 53.8% of respondents having severe to moderate
psychological impact, with female students being associated with greater psychological impacts.
Several stressors have been identified as key factors affecting the students’ anxiety and
psychological well-being: a parent or associate being infected by COVID-19; monetary issues and
their effects on daily life; educational disruptions effects of the disease on education and potential
jobs and sensational broadcasts and inaccurate news reports (Cornine, 2020). Other stressors
include students’ place of residence, family income stability, parents’ psychological status,
reduced social interactions, increased number of new cases, affected provinces and the imposition
of travel bans affecting daily life (Tang et al., 2020), and fear of their family members and friends
getting infected (Salman et al., 2020)
Depression
The outbreak of the COVID-19 pandemic has also brought an increase in the depression rate. In
China, 16.5% of respondents reported moderate to severe symptoms of depression (Lei et al.,
2020).In addition, another study reveals that The majority of participants (53.3%) of participants
felt horrified and apprehensive due to the pandemic (Zhang & Ma, 2020). In Italy, the rate of
depression was 17.3% (Rossi et al., 2020). In Nepal, the rate of depression was reported to be

10. 34.1% (Sigdel et al., 2020). In Malaysia Out of the 983 respondents, 20.4%, 6.6%, and 2.8%
experienced minimal to moderate, marked to severe, and most extreme levels of anxiety
(Sundarasen et al., 2020). In turkey, the rate of depression was found to be higher in females,
university students, high school, and lower graduates, with mental health problems (Karasar &
Canlı, 2020). Moreover, the cut-off point for the depression score was set to be 17 and the rate of
the people having 17 points, or higher scores were found to be 16.6% (Karasar & Canlı, 2020).
Coping strategies
The individual's reactions to negative situations, stressful life events, or strategies to deal
with these situations are different. While it may take a long time for some people to get back to
their normal life by getting rid of the effects of these negative situations or stressful events (Dogan,
2015). According to Salman et al., (2020), educational institutions need to work collaboratively
with government authorities to promote measures suggested by the World Health Organization to
improve the mental health of their students. In addition, a complete and smart lockdown needs to
be implemented to quickly escalated from this situation. Salman et al., (2020), study reveals that
students in Pakistan are mostly following self-distraction, planning, acceptance, and “religious
coping” to cope with this situation. Kaleem (2020), educational institutions, and public places,
and open markets directed to remain closed. Researchers have found that evidence-based services
can improve children’s overall mental health (Bartlett et al., 2016).
Protection
Protection from Covid-19 pandemic can ensure my collective measure, but some individual
measure need to be taken under consideration to protect oneself and others form this disease.
Infected people need to be isolated from others. If you find symptoms go for a test as soon as

11. possible. If the test results are negative, isolation is ended. The isolation period must be at least 14
days due to the incubation period. Therefore, as individual members of society, we all need to do:
Hand hygiene, clean hands and cover the face with a mask, and act responsibly and support this
goal together.
Vaccination
According to Shet, Ray, Malavige, Santosham, & Bar-Zeev, (2020) vaccination for the Coivid-19
at moment is not present, but data obtained from 178 countries in the world indicated that the
incidence rate of COVID-19 is lower in countries where the TB vaccine (BCG) is commonly
applied compared to other countries (Shet, Ray, Malavige, Santosham, & Bar-Zeev, 2020). In
addition, it is reported that mortality rates are 10 times lower thanks to early-age BCG
vaccination. This study suggests that the immune system (immunity) can grow stronger following
BCG vaccination in childhood and thus COVID-19 may at least be milder in persons vaccinated
this way (Shet, Ray, Malavige, Santosham, & Bar-Zeev, 2020)
Social Distancing
Social distancing needs to be maintained between a sick person and when an individual is in public.
There should be a minimum of 1.5 – 2 meters especially indoors, and When going out in public, it
is important to stay at least 6 feet away from other people and wear a mask to slow the spread
of COVID-19 (WH0, 2020)

12. Mask Selection
Mask is important ant fabrics use to cover the face. It prevents prevent the spread of the infection
to a great extent when used by sick people. There is a variety of masks, and an individual can
choose as per their requirement and resources, but they need to be replaced after use, and in the
case of cloth reusable mask, wash them regularly. Mask needs t to be wear both indoor and outdoor.
In addition, specialty, masks can be used in severe cases such as N95 (FFP1), N97 (FFP2), and
N99 (FPP3), which can filter out coronavirus by 95%, 97%, and 99% respectively (Lowe et al.,
2020). It is necessary for healthcare professionals to use FFP2 or FFP3 masks (Lowe et al., 2020).
They can work effectively for approximately 8 hours. At the end of this period, they need to be
replaced. Some studies suggest that it is appropriate to reuse such masks once or twice after
sterilizing them for about 15 to 30 minutes with UV rays since they cost more and are not very
easy to procure (Lowe et al., 2020).
Hand Washing
Hands are used mostly, as without hand daily rituals are not possible, but due to Covid-19 hand
need to be sanitized before touching our mouth, nose, and eyes. It is recommended to wear gloves,
and regularly sanitize hands. A 20 to 30-second hand watch with soap or detergent can minimize
the ability of the virus to spread (Weiller et al., 2020). Apart from washing our hands with soap,
alcohol-based hand disinfectants are also known to disrupt the envelope structure of the virus and
eliminate its ability to infect (Weiller et al., 2020).

13. Surface cleaning
Viruses can remain on the infected surfaces for days at a quality and quantity that can maintain
their infectivity.3 In a study on SARS-CoV2, it is found that the virus can survive up to 3 days on
plastic and steel surfaces, up to 24 hours on cardboard, and up to 4 hours on copper (Van
Doremalen et al., 2020). The infectious potential is approximately 60-70 minutes suspended in
the air, 45-50 minutes on copper, 3-4 hours on cardboard, 5-6 hours on steel, and 6-7 hours on
plastic (Van Doremalen et al., 2020). Therefore, it is scientifically considered sufficient to use
soap, detergents, and diluted bleach for surface cleaning.
In addition, viruses can be transported from infected surfaces by contact, but the duration of contact
and the humidity of such surfaces also matter (Van Doremalen et al., 2020). It takes about 10
seconds of contact time to become infected by touching a dry surface with our dry hands (Van
Doremalen et al., 2020). Furthermore, the virus loses its infectiousness when exposed to direct
sunlight for more than 30 minutes (Van Doremalen et al., 2020).
Nutrition
Nutrition is the major source of energy against the virus and can be beneficial within the diet.
According to Shet, Ray, Malavige, Santosham, and Bar-Zeev, 2020 it is reported that the IV
administration of vitamin C as an antioxidant, especially in high doses, will be beneficial in severe
cases. Based on this, researchers suggest that dietary supplements such as vitamin C and D can be
effective in preventing disease. In addition, further studies suggesting that eating bitter vegetables
or drinking the likes of coffee and tea, which can all be defined as bitter by taste receptors on our
tongue, may be useful in preventing COVID-19 (Shet, Ray, Malavige, Santosham, & Bar-Zeev,
2020)

14. Role of Educational Institutions
Educational institutions can play a vital role in assisting students to cope with mental issues during
a pandemic. Institutions should set priorities in developing digital psychological interventions,
such as apps and online programs, alongside other services such as text messages, chatlines,
forums, and phone calls (Holme et al., 2020). Awareness of the presence of such interventions
should be communicated to the student population. Universities should also provide psychological
services, either face to face or remotely, as they will mitigate the emotional and mental impacts on
students. It is crucial to be constantly in touch with the students. Universities ought to embark on
structured programs to reduce anxiety, such as life skills training and mindfulness therapy, which
have been validated to reduce anxiety levels (Holme et al., 2020). Equally important is for
universities to re-examine their curricula, learning outcomes, and assessment methods for the
courses and programs taught online as they should be distinguished from those meant for face-to-
face teaching mode (Holme et al., 2020).
Boycott Unreliable Sources
Control (CDC), has proposed some guidelines—minimize repeatedly watching, reading, and
listening to new stories on COVID-19, specifically from unreliable sources of social media(Holme
et al., 2020). Instead maintain a healthy diet, exercise, adequate hours of sleep; and keep the mind
stress free by virtually connecting with friends and family members; and finally, take time to
unwind and indulge in activities one enjoys (Sundarasen et al., 2020)

15. lockdowns or quarantines
Lockdowns or quarantines are necessary as protective measures for physical health. Quarantining
of infected people and social distancing were implemented to restrict the virus’ spread and reduce
interactions with individuals infected with COVID-19 (Sundarasen et al., 2020)
General Strategies
WHO, (2020) recommend some cautions that need to be followed in order to stop the prevalence,
and chances of being infected:
• Listen to advice and recommendations from the authorities.
• Have a healthy daily routine (wake up and go to sleep at similar times every day, keep up
with personal hygiene, eat healthily, exercise regularly, Allocate time for working and time
for resting, and make time for doing things you enjoy)
 Try to minimize how much you watch, read, or listen to news that makes you feel anxious
or distressed. Seek the latest information at specific times of the day, once or twice a day
if needed.
• As social contact is important to reduce stress, stay connected with people close to you by
telephone and online channels.
• Avoid using alcohol and drugs as a way of dealing with fear, anxiety, boredom and
frustration, and social isolation.
• Try to maintain a balance with on-screen and off-line activities in your daily routine.

16. • Use social media to promote positive and hopeful stories. Notably, correct misinformation
related to COVID-19 wherever you see it.
• Offer support to others who may need it.
• Regularly wash hands with soap and water.
• Covering your mouth with your elbow when sneezing or coughing.
• Maintain “physical distancing” – keeping at least 1 meter (three feet) between yourself and
others
• Avoid touching your face, eyes, and mouth with unwashed hands.
• Avoid unnecessary, unprotected contact with animals, and be sure to thoroughly wash
hands after contact.

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