Content uploaded by Barbara Rothmüller
Author content
All content in this area was uploaded by Barbara Rothmüller on Nov 04, 2021
Content may be subject to copyright.
Full Terms & Conditions of access and use can be found at
https://www.tandfonline.com/action/journalInformation?journalCode=tchs20
Culture, Health & Sexuality
An International Journal for Research, Intervention and Care
ISSN: (Print) (Online) Journal homepage: https://www.tandfonline.com/loi/tchs20
The grip of pandemic mononormativity in Austria
and Germany
Barbara Rothmüller
To cite this article: Barbara Rothmüller (2021) The grip of pandemic mononormativity
in Austria and Germany, Culture, Health & Sexuality, 23:11, 1573-1590, DOI:
10.1080/13691058.2021.1943534
To link to this article: https://doi.org/10.1080/13691058.2021.1943534
Published online: 27 Jul 2021.
Submit your article to this journal
Article views: 96
View related articles
View Crossmark data
The grip of pandemic mononormativity in Austria
and Germany
Barbara Rothm€
uller
Department of Social Psychology, Sigmund Freud University, Vienna, Austria
ABSTRACT
How distancing requirements in the COVID-19 pandemic trans-
formed intimate relationships is under-researched. Against the
backdrop of research on the HIV pandemic, the paper departs
from the assumption that decreased legitimacy of intimate
arrangements and subjective worry about the likeliness of infec-
tion may reduce the frequency of multiple sexual contact and
intimate well-being during the pandemic. Based on findings from
a quantitative study which included measures of risk perception,
frequency of contact with sexual partners and communities, con-
cealment, as well as relationship quality in Austria and Germany,
this paper examines sexual behaviour in association with relation-
ship status and sexual identity. Analysing data from a conveni-
ence sample of 4,709 respondents, of whom 24 per cent
identified as LGBQAþ, 2 per cent as non-binary, and 6 per cent
as consensually non-monogamous, bivariate analysis found signifi-
cant differences in social distancing, frequency of contact with
sexual communities and satisfaction with current sex life. Text
analysis of the survey’s open-ended responses indicates monog-
amisation due to declined legitimacy of less conventional intimate
arrangements during the pandemic. Findings point to the import-
ance of the sexual morality that defined pandemic experiences in
times of HIV for understanding normative pressure on intimate
life during COVID-19.
ARTICLE HISTORY
Received 18 November 2020
Accepted 11 June 2021
KEYWORDS
Sexualities; COVID-19;
concealment; intimacies;
mononormativity
Introduction
As became clear in the first few weeks of the COVID-19 pandemic, the need for social
distancing significantly affected not only the organisation of public life, but also social
relationships and intimacy. Lockdowns severely restricted collective sexual practices,
spaces and communities. In Austria and Germany, sex work and shared intimacy in
bars, clubs, saunas and sex-positive venues were prohibited during the lockdown.
With significant symbolic power, one of the most famous sex-positive clubs in Berlin,
the Berghain technoclub, had to close in 2020; it has since been transformed into an
art gallery, at least temporarily (Balzer 2020). In the spring of 2020, extensive media
discourse on pandemic sexuality developed in Austria and Germany (D€
oring and
CONTACT Barbara Rothm€
uller Barbara.rothmueller@sfu.ac.at
ß2021 Informa UK Limited, trading as Taylor & Francis Group
CULTURE, HEALTH & SEXUALITY
2021, VOL. 23, NO. 11, 1573–1590
https://doi.org/10.1080/13691058.2021.1943534
Walter 2020). Around the world, several political authorities warned against the dan-
gers of sexual promiscuity and called for the reduction of sexual relationships to
household members—or for solo masturbation as a substitute for partnered sex (e.g.
NYC Health Department 2020; Public Health Agency of Canada 2020). Yet, HIV and
AIDS scholars highlighted the fact that the ‘burden of recommendations not to have
sex with anyone outside of one’s household, and unilateral advice to avoid new part-
ners, are not equally distributed in the context of state-sanctioned heterosexuality and
the rights it confers in many parts of the world’(Newman and Guta 2020, 2260).
Research in the history of medicine has shown that ‘[o]ne dramatic aspect of epi-
demic response is the desire to assign responsibility’(Jones 2020, 2). WHO published a
document on mental health in mid-March 2020 highlighting the need to reduce the
stigma from COVID-19 infections and not to attach the disease to any specific social
or ethnic group (WHO 2020, 1). Stereotyping, stigma and fear of ‘infectious’groups
affect intimacy and dating in the COVID-19 pandemic today, as was the case with the
AIDS pandemic in the 1980s (Watkins-Hayes 2014; Valdiserri and Holtgrave 2020). Both
the HIV pandemic and earlier syphilis pandemics were considered to be the result of
irresponsible sexual behaviour (Roberto, Johnson, and Rauhaus 2020). Since the begin-
ning of the COVID-19 pandemic, the cohabitating monogamous dyad and the trad-
itional family have formed the state-protected legitimate arrangement of pandemic
societies. It is not yet clear to what extent non-traditional arrangements are stigma-
tised due to pandemic risk management. Despite striking transformations in state bio-
politics, there remains a lack of empirical data on the reconfiguration of intimate
relationships in the pandemic.
Based on findings from an online survey on love, intimacy and sexuality in the time
of COVID-19, this paper investigates the complexity of pandemic intimacy under con-
ditions of physical distancing. It asks the following questions: how so people navigate
their intimate arrangements during a lockdown; do sexual and romantic identities dif-
fer in terms of risk perception, concealment and frequency of contact to communities
of care; and how do people make sense of new pandemic normativities? Conceptually,
the paper integrates a concern for intimate citizenship with research on pandemic
normativities and their consequences for sexual well-being. Empirical data are ana-
lysed in respect of (a) changes of intimate life, and (b) accounts of the moralisation of
intimate relationships during the pandemic.
Conceptualising intimacy as a relational practice in the time of
a pandemic
Intimate citizenship
In order to integrate individual practices and societal norms of pandemic risk manage-
ment, I draw on feminist and queer approaches to intimate citizenship (Plummer
2001) because these allow us to contextualise sexual activities by relating individual
arrangements to wider society. Based on earlier conceptualisations of sexual citizen-
ship (Lister 2002; Richardson 2018), the concept of intimate citizenship includes poli-
cies and discourses on private matters such as the body, sexual pleasure, autonomy
and care. From a sociological point of view, intimacies are influenced by legal
1574 B. ROTHMÜLLER
frameworks and inequalities as well as by sociocultural expectations and everyday
moralities (Plummer 2003; Roseneil et al. 2020; Brooks 2017; Jamieson 1999).
Conceptualised as an embodied experience of closeness, trust, communication and
care in affective spaces and sexual fields, intimacy is experienced (if at all) in social
groups ranging from family to friends, ‘dates’to communities of care, or within other
structured opportunities for intimate encounters. The social negotiation of intimate
morality leads to feelings of social affinity and closeness, and of social distance and
shame, following different trajectories in specific contexts over time.
Since the beginning of the COVID-19 pandemic, the call to abstain from any
unnecessary social contact has resulted in the emergence of new social norms. In
Austria and Germany, a shift of intimate citizenship has been institutionalised, with
only law-abiding individuals who follow social distancing rules being viewed as valu-
able citizens. Without taking the structural and social barriers to compliant behaviour
into account, good intimate citizenship has become marked by the sanctioning of dis-
tancing as an altruistic act necessary for the common good (De Lagasnerie 2020). The
pandemic has re-institutionalised a traditional model of how people should legitim-
ately form a social unit. The French sociologist Geoffroy De Lagasnerie has asserted
that the ‘authorization of certain contacts and the prohibition of others has produced
a psychic reconfiguration of the links that each of us maintains with others—certain
intimate relations have been defined as strange relationships that we cannot maintain
any more’(De Lagasnerie 2020). Changed distancing requirements have reinforced
traditional norms of cohabitation, commitment and monogamy. In Austria, for
example, pandemic regulations allowed adults dressed as Santa Claus to break the
curfew in order to visit children in December 2020, while at the same time prohibiting
singles from going on Tinder dates. The regulations also specify that online acquain-
tances are not to be considered close relationships.
Intimate morality
Despite the transformation of what counts as legitimate intimacy in the discourse of
sexual liberation in the recent decades, the couple remains a fundamental element in
moral debate over what constitutes intimate citizenship. Historically, monogamy is
linked to the development of bourgeois and heteronormative norms of nuclear family
life, forming the crystal of modern sexuality (Foucault 1980). Throughout the historical
process of monogamisation, ‘mononormativities’(Kean 2015; St. Vil et al. 2020) have
institutionalised a particular yet hegemonic couple norm (Roseneil et al. 2020).
Indispensable for the recognition as a respectable citizen, the performance of monog-
amy is still considered a moral obligation in most social settings, even though multi-
partnering and non-monogamy have gained significant ground in public acceptance
(Klesse 2006).
Despite this, and in the face of the COVID-19 pandemic, monogamy and abstinence
have been promoted as the healthy individual choices made by responsible citizens
(Jones 2020). At the height of the HIV pandemic, the moral pressure to avoid sex
defined public health responses in the USA and many African countries. In addition to
abstinence and the use of condoms, prevention programmes recommended
CULTURE, HEALTH & SEXUALITY 1575
faithfulness to one partner as the main risk avoidance strategy, in contrast to the situ-
ation in Europe, where most countries focused their liberal policies on safer sex (Matic
2006). The association of HIV with promiscuity and homosexuality encouraged many
people to return to monogamy out of fear of infection (Daly 2020). This cultural prob-
lematisation of promiscuity produced shame and concealment in the case of HIV
(Hardon and Posel 2012), yet, sexual minorities also created alternative spaces of rad-
ical democratic citizenship for AIDS care and activism (Brown 1997). Managing the risk
of intimacy within communities of care was a crucial part of navigating the HIV pan-
demic and could be so in the case of COVID-19 as well (Green et al. 2018; Stephenson
et al. 2021).
What have been the consequences of pandemic normativity on intimacy?
Most recent international research suggests that the COVID-19 pandemic is decreasing
the frequency and quality of people’s sex lives, both directly—due to social distancing
requirements—and indirectly, because of (1) stress and depression, and (2) stigma and
sexual stigma (Ko et al. 2020; McKay et al. 2020). One important aspect of the trans-
formation of intimate relations concerns risk perception and anxiety linked to the like-
liness of infection (Ko et al. 2020). Yet, as researchers from the Kinsey Institute in the
USA have shown, some people have also experimented with new sexual practices and
extended their sexual repertoire during lockdown (Lehmiller et al. 2021).
Research on the HIV pandemic has highlighted that concealment and disclosure are
part of the cultural politics of secrecy and truth-telling that are a fundamental to everyday
social life (Hardon and Posel 2012). Conceptualised as a relational practice, concealment
cannot be considered to originate in the individual. Rather, shame, guilt and active silence
are expressions of cultural norms, expectations and the intention to reduce risks and
harm in respect of social relationships. Both disclosure and non-disclosure require agents
to perform emotional and ‘moral labour’(Dong et al. 2020). In a pandemic, concealment
can be seen as a social practice that covers up non-hegemonic (sexual) practices and
intimate arrangements, particularly if people are put at risk of infection.
Method
Between 1–30 April 2020, the Love, Intimacy and Sexuality in the Time of COVID-19 sur-
vey was conducted in Austria and Germany. In collaboration with researchers from the
Kinsey Institute at Indiana University, a German language translation of parts of their
sex and relationship survey was integrated into a larger study of intimacy, sexuality
and social solidarity during the COVID-19 pandemic. The study collected data on sex-
ual behaviour, satisfaction with sex life, and sexual desire, among other variables.
The German language questionnaire included newly items on frequency of contact
with members of sexual communities (e.g. the queer community, LGBTIAþ, sex-posi-
tive community, bodywork, polyamory, BDSM, sex work, etc.), the number of conversa-
tion partners on sexual topics, worries that intimate relationships might fall apart, and
decline of invitations to meet for sex during the pandemic. It also included four new
items that allowed for a theoretical comparison between the COVID-19 and HIV
1576 B. ROTHMÜLLER
pandemics. Two questions were included that focused on anxiety about infection as a
result of sexual behaviour in the case of respondents who engaged in partnered sex
or group sex or anonymous sex in public spaces. Two further questions addressed the
concealment of sexual contacts, needs and practices from friends and partners during
the pandemic (for details, see online supplemental appendix).
The questionnaire was developed in SoSci and distributed via major daily newspa-
pers, radio and queer networks. Based on a final sample size of 4,709 German and
Austrian adults who completed the survey (for demographic characteristics, see Table
1), data analysis was performed using SPSS. One-way ANOVA and non-parametric tests
in the case of non-normally distributed data were conducted, and effect sizes were
used to identify statistically significant differences in concealment, risk perception and
frequency of contact by gender, age, sexual identity and relationship status. A signifi-
cance level of 0.01 was used for all analyses due to the large sample size.
Additionally, 4,140 respondents answered a question on positive and negative
changes in their intimate relationships. These open-ended responses filled 458 pages
in total and allowed for an analysis of subjective experiences of the pandemic’s effects
on social relationships. 1,169 people further elaborated on reasons for dissatisfaction
with their current romantic and sex life via two additional open-ended questions.
Open-ended responses were not analysed in respect of frequency of occurrence.
Rather, themes were identified that represented response patterns of shared meaning,
providing additional insight into different perspectives on sexual norms and morality.
After generating descriptive themes and refining initial codes related to the research
Table 1. Demographic characteristics of participants.
Country (N, %)
Austria 3123 66.4
Germany 1583 33.6
Gender (N, %)
Female 3174 67.5
Male 1311 27.9
Non-binary 115 2.4
Other 104 2.2
Age (M, SD) 35.2 11.9
Education (N, %)
Compulsory/Secondary School 411 8.7
Gymnasium/High School 1318 28.0
University 2971 63.2
Sexual identity (N, %)
Asexual 100 2.1
Bisexual 371 7.9
Pansexual 120 2.6
Queer 178 3.8
Lesbian or gay 285 6.1
Heterosexual 3460 73.5
Kinky 63 1.3
Not sure 100 2.1
Relationship status (N, %)
No romantic or sexual relationship 677 14.4
Casual sexual relationship(s) 272 5.8
At the beginning of a new relationship 330 7.0
Committed couple (marriage or partnership) 2711 57.6
Open or polyamorous relationships 292 6.2
Unclear ‘complicated’relationship(s) 240 5.1
At the end of a relationship/in separation 70 1.5
CULTURE, HEALTH & SEXUALITY 1577
questions, content analysis was conducted on the subthemes of moral pressure, anx-
iety, concealment and responses relevant to the earlier HIV pandemic. Compelling
examples were selected for inclusion in the final analysis.
In terms of ethics, respondents were alerted to the aims of the study and assured
of anonymity of participation and data protection. Respondents were able to skip
questions; age was the only mandatory question of the survey. No IP address, referral
site or any other potentially identifying personal information was collected.
Quantitative findings
Frequency of contact with sexual partners and communities
How did the pandemic affect community involvement and frequency of contact with
current intimate partners? In April 2020, one quarter of all respondents reported being
less frequently in contact (online or offline) with their current sexual partner(s) than
before the pandemic. Almost half of participants had less contact with former sexual
or romantic partners.
Statistically significant changes in frequency were observed across different relation-
ship arrangements (see Table 3). While people in committed couple relationships often
intensified contact with their partner (Mdn ¼3), respondents with casual sexual partners
restricted their contact (Mdn ¼2), U¼216,703.50, z¼10.22, p<.001, r¼0.19. Half
of sexually active singles met their current sex partners less frequently or not at all dur-
ing contact restrictions in April 2020. This self-restriction was also reflected in the fact
that 36 per cent of participants pursuing casual sex and 21 per cent of people in non-
monogamous relationships turned down an invitation to have sex during the lockdown.
Changes in the frequency of sexual contact significantly differed according to sexual
identification H(8)¼50.10, p<.001, age, H(5) ¼62.52, p<.001 and gender, H(2) ¼
24.40, p<.001. Stable levels of contact were most often reported by asexual and les-
bian participants. Among the group of heterosexual participants, 23 per cent had less
and 38 per cent more frequent contact with their current sexual partner(s) in April
2020. Gay men reduced their sexual contact more than heterosexual men: 55 per cent
had less contact with sex partners than before the lockdown (Mdn ¼2), while the fig-
ure among heterosexual men was 26 per cent (Mdn ¼3), U¼33,856.00, z¼5.83, p
<.001, r¼0.19. In addition, 47 per cent of the respondents who identified as kinky
reported a reduction in partner contact.
The frequency of community contact varied greatly according to sexual identity
(Figure 1 and Table 2), H(8) ¼1,129.56, p<.001. Two thirds of heterosexual respondents
generally had no contact with people from sexual communities. Among respondents
identifying as LGBPQKþ, the percentage of people having no contact with sexual com-
munities was 16 per cent before the pandemic but rose to 29 per cent in April 2020.
Lockdown thus increased the isolation of sexual minorities from their communities
of affinity and care. Asexual and queer people were interesting exceptions to that
community transformation. Their community involvement was not significantly
affected by the pandemic, although in different ways. Before the pandemic, many
asexual respondents were not in contact with any community members and remained
distant from sexual communities throughout the pandemic. At the other end of the
1578 B. ROTHMÜLLER
spectrum of community involvement, queer participants remained in contact with
their peers at a relatively high level both before and during lockdown.
Intimate relationship quality
How did distancing measures affect intimacy? The reduction in sexual contacts was
not without consequences for intimate relationship quality. The distancing or deepen-
ing of intimate relationships was related to relationship status during the lockdown
(Figure 2 and Table 3), F(7, 4,653) ¼53.77, p<.001. Singles, people in separation,
those with unclear relationship status, that is, in ‘complicated’relationships with one
or more persons, and respondents with casual sexual partners, experienced a loss of
closeness in their intimate relationships compared to the start of the pandemic.
Gay men most frequently reported that their intimate relationship(s) had become
more distant: this was the case for one in four respondents. Almost half of the
respondents who had casual sex (43%) or were in unclear ‘complicated’relationships
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
asexual bisexual pansexual queer lesbian, gay heterosexual kinky not sure
Sexual identy
not at all less frequent once a week several mes a week daily
Figure 1. Frequency of community contact, by sexual identity in April 2020. In the last two weeks,
how often have you had contact with people from a sexual or gender diverse community (e.g.
queer community, LGBTIAþ, sex-positive community, bodywork, polyamory, BDSM, sex work,
or similar)?
Table 2. Changes in frequency of community contact during the lockdown in April 2020 and
before the pandemic.
Sexual identity
Frequency in
April 2020 (Mdn)
Frequency before
the pandemic (Mdn) Wilcoxon test
Asexual 5.0 5.0 Z¼2.08, p¼.038
Bisexual 4.0 3.0 Z¼7.08, p<.001
Pansexual 3.0 2.0 Z ¼4.89, p<.001
Queer 2.0 2.0 Z ¼5.44, p<.001
Lesbian and Gay 4.0 3.0 Z ¼7.68, p<.001
Heterosexual 5.0 5.0 Z ¼14.99, p<.001
Kinky 3.0 2.0 Z ¼2.57, p¼.010
Not sure 4.0 4.0 Z ¼1.59, p¼.112
Frequency: 1 ¼daily, 2 ¼several times a week, 3 ¼once a week, 4 ¼less frequent, 5 ¼not at all.
CULTURE, HEALTH & SEXUALITY 1579
(49%), were concerned that their intimate relationships might break up during the
pandemic (Mdn ¼4). Among committed couples, only 16 per cent were affected by
this concern (Mdn ¼2), U¼220,514.50, z¼11.54, p<.001, r¼0.21.
Furthermore, relationship status was also associated with a currently satisfying sex
life (Table 3), H(7) ¼543.08, p<.001. Particularly, singles and people in separation
reported low satisfaction. Interestingly, and despite their overall dissatisfaction with
their current sex life, survey data showed that many asexual respondents and singles
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Relaonship status
strongly deepened
somewhat deepened
stayed the same
somewhat distant
very distant
Figure 2. Distancing or deepening of intimate relationships, by relationship status. Would you say
that your intimate relationships have deepened overall in the last two weeks, have they stayed the
same, or have they become more distant?
Table 3. Change in contact frequency and distancing of intimate relationships.
Relationship status
Change of frequency
of contact with
current sexual
partners (Mdn)
Satisfaction with
current
sex life (Mdn)
Deepening of
intimate
relationships
(M, SD)
Worries that
intimate
relationships will
break apart (Mdn)
No romantic or sexual
relationship
–2.0 3.5 (1.1) 3.0
Casual sexual partner(s) 2.0 3.0 3.3 (1.3) 4.0
Committed couple
(marriage/partnership)
3.0 5.0 2.7 (1.1) 2.0
At the beginning of a new
relationship
3.0 5.0 2.6 (1.3) 3.0
Open or polyamorous
relationships
3.0 4.0 2.8 (1.1) 3.0
Unclear ‘complicated’
relationship(s)
3.0 3.0 3.2 (1.2) 4.0
At the end of a
relationship/
in separation
2.0 2.0 4.0 (1.2) 5.0
Frequency:1 ¼less often, 3 ¼stayed the same, 5 ¼more often.
Satisfaction:1 ¼not at all satisfied, 7 ¼very satisfied.
Deepening:1 ¼strongly deepened, 3 ¼stayed the same, 5 ¼very distant.
Worries:1 ¼no, not at all, 7 ¼yes, very much.
1580 B. ROTHMÜLLER
without sexual relationships felt they profited from the lockdown: at last, no-one
expected them to have an active sex life. One third of the respondents without a sex-
ual or romantic relationship, and half of asexual people, felt relieved of stressful sexual
expectations due to the contact restrictions.
Concealment from friends and partners
To what extend did respondents experience concealment pressure during the pan-
demic? In respect of current sexual activities, practices and needs, non-disclosure to
friends was relatively frequent—more frequent than secrecy in intimate partnerships.
One third (33%) of respondents frequently kept their close friends in the dark about
their pandemic sexual activities, and a quarter (28%) did so sometimes. 13 per cent of
participants often did not disclose their activities to partner(s), with an additional 23
per cent of respondents sometimes concealing their sexual life or aspects thereof.
Concealment was related to respondents’relationship status at the time of the lock-
down (concealment from partners: H(7) ¼80.23, p<.001, friends: H(7) ¼105.97, p<
.001), but not related to sexual identity, gender or age.
Only 4 per cent of participants in an open or polyamorous relationship said that
they kept their current sexual practices secret from partners, an additional 15 per cent
said they did so sometimes. In contrast to this low level of secrecy in non-monogam-
ous relationships, one third of committed couples and as many as half of interviewees
who had casual sex were hiding parts of their sexuality from their partner(s). Similarly,
people in polyamorous arrangements reported the lowest frequency of friendship
non-disclosure (Mdn ¼3, other respondents: Mdn ¼2). Survey findings showed that
concealment from friends during the pandemic also correlated with the sexual open-
ness of a person’s social network (Figure 3). The lower the frequency of contact with
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
daily several mes a
week
once a week less frequent not at all
Frequency of pandemic community contact
yes oen
somemes
infrequent
never
Figure 3. Concealment of pandemic sexuality from friends, by frequency of community contact
during the pandemic. Do you keep close friends in the dark about your current sexual contacts,
needs and practices?
CULTURE, HEALTH & SEXUALITY 1581
members of particular sexual community before and during the pandemic, the higher
the secrecy among respondents, r¼.14, p<.001.
The most substantive finding relating to concealment concerned the number of
people that respondents had been talking to openly about their sexuality in the
12 months prior to the survey participation (see Table 3), r¼.34, p<.001. The num-
ber of available and trusted persons with whom respondents were able to be open
about their sexualities differed between sexual identity categories, H(8) ¼404.36, p<
.001. Asexual interviewees reported having the fewest conversation partners in the
year prior to their survey participation, with half of them having had only one person
to talk to about their sexuality (Mdn ¼1). Most of the heterosexual respondents had
two persons (Mdn ¼2), lesbian and gay respondents reported 3, bisexual people
reported 4, and queer, kinky and pansexual people reported 5 persons with whom
they could share sexual experiences.
Risk perception and anxiety
Overall, 83 per cent of participants who had sex with a partner, a stranger, group sex
or anonymous sex in public during the lockdown were not at all afraid of contracting
COVID-19 through their sexual activities. 76 per cent considered their sexual risk to be
very low. Only two per cent of the respondents worried about risk of infection and 3.5
per cent perceived a genuine risk of infection. Worries about infection risks were
related to sexual identity, H(8) ¼47.62, p<.001, and were not related to age, H(5) ¼
8.79, p¼.117 or gender, H(2) ¼1.43, p¼.490.
Gay, bisexual, pansexual and queer men reported significantly higher concern about
infection and showed higher risk assessment than heterosexual men (Figures 4 and 5),
U¼24,767.50, z¼5.64, p<.001, d¼0.32.
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Men who have sex
with men
Heterosexual men
very low
..
...
....
.....
......
very high
Figure 4. Worries about infection. You have indicated that you have had intimate or sexual con-
tacts since the beginning of the pandemic. How great is your concern that you have been infected
with the new Corona virus? (n1 ¼138, n2 ¼458; only men who had sexual contacts; MSM ¼gay,
bisexual, pansexual and queer men).
1582 B. ROTHMÜLLER
Only 59 per cent of gay, bisexual, pansexual and queer men assessed their infection risk
asverylow.Theanxietyofthesemenmightpartlybeexplainedbythefactthattheirsexual
practices differed from heterosexual participants. Gay, bisexual, pansexual and queer men
relatively often reported cruising activities during the lockdown: 6 per cent reported looking
for sex in public places, and 10 per cent had sex with a stranger during lockdown—activities
that were of much less relevance to heterosexual men (0.7 and 2.4 per cent).
Respondents who had sex with a stranger were then more worried than other respond-
ents that their sexual practices had put them at a greater risk of COVID-19, U¼74,726.00,
z¼6.30, p<.001, r ¼0.13. Similarly, respondents reporting cruising showed greater
concern that they might have caught the virus while doing so. Collective sexualities such
as group sex were also a source of concealment and caused worries about increased risks
of COVID-19 among participants who were navigating multiple partners during the lock-
down. More than 40 per cent of participants with multiple partners reported social distanc-
ing from partners who were not living in the same household.
Navigating intimate arrangements during a pandemic: open-ended
responses
Participants’text-based answers provide insight into changes in intimacy and relationships
during the pandemic. How then did people navigate their intimate arrangements during a
lockdown? In general, they did so in a very reflexive manner.
Mononormativities
Many respondents who navigated complex arrangements before the pandemic
reduced the number of partners to one person during lockdown in April 2020—a
transformation that several respondents described as ‘enforced monogamy’
1
(woman,
38, heterosexual, at the beginning of a committed relationship), ‘state imposed
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Men who have sex
with men
Heterosexual men
very low
..
...
....
.....
......
very high
Figure 5. Risk assessment. How high do you estimate the risk that you have been infected with
the new Corona virus during your sexual activities? (n1 ¼138, n2 ¼457; only men who had sexual
contacts; MSM ¼gay, bisexual, pansexual and queer men).
CULTURE, HEALTH & SEXUALITY 1583
monogamy’(nonbinary, 39, bisexual, open or polyamourous relationships) or
‘coronamonogamy’, that is, ‘no Tinder anymore, sexual contact limited to 1 person’
(woman, 38, not sure, open or polyamorous relationships).
My intimacy and physical needs were spread over a number of people before the
pandemic. These included casual sexual contacts, sexual friendship, rope partners, play
partners, but also asexual cuddling-closeness. Due to the pandemic, this relationship
complexity was reduced to one person (even if it is not a romantic relationship). (Non-
binary, 36, queer, casual sexual partners)
People in open relationships explained that they stopped seeing sexual partners.
Instead of group sex or swinging, some respondents now chose to live in a ‘purely monog-
amous relationship’. People who had sex with a stranger were often afraid that they had
done something against the law yet reported having a strong sexual desire and the inabil-
ity to live a ‘celibate’life. Several respondents described it as a loss that they were forced
to distance themselves from intimate partners and choose one exclusive partner. This left
abandoned respondents who had previously thought they were in a relationship, lonely
and deprived of touch at a time of crisis when they felt particularly vulnerable.
What becomes clear from many comments was the reduction in sexual routines
and practices ‘to traditional models of closeness and intimacy’(man, 49, pansexual,
casual sex) and the perception of queer respondents that ‘Corona [has] destroyed the
complexity of (psycho)sexual relationships and intimate relations’(non-binary, 36,
queer, casual sex). Respondents limited their intimate life to only a few people and
actively perceived that transformation as a process of monogamisation:
Although my partners still have sexual contact with others, I am currently switching to
mono. ( …) Dating is something I have let go. (I had a slip a week ago, but I’ll let that go
now) Meetings are cancelled. (I’m in certain groups.). (No information on gender, 27,
kinky, open or polyamorous relationships)
Queer and polyamorous people, in particular, commented on what they saw as a
new mononormativity, reflecting on their needs and choices regarding intimate rela-
tionships with loved ones.
For 5 weeks, I was only with my first partner. It also offered new moments of encounter
and intimacy. It was restful because I did not see my lover. But I also had a lot of longing
for them. I did not want to live monogamously anymore. Anyway, it is not an easy way to
feel polyamorous. Now, I have to be monogamous and I feel more clearly that this is not
what I want. I feel set back. But it is also interesting to feel that so clearly. I talk a lot with
my intimate partners about these feelings and thoughts. (Woman, 48, heterosexual, open
marriage with lover)
Complaining that the pandemic measures only suited traditional, cohabiting nuclear
families and disadvantage patchwork families, poly-relationships, or long-distance rela-
tionships, respondents living in unconventional arrangements suffered a great deal
from social distancing policies.
Moralisation and moral conflict
Respondents sensed ‘a conservative backlash caused by the pandemic’and that
‘relationships that are not “sanctioned”by living together or by a registered partnership/
1584 B. ROTHMÜLLER
marriage are (again) increasingly seen as “not a real relationship,”even in progressive
circles’(non-binary queer respondent, age 39, open or polyamorous relationship).
Participants described of moral pressure to avoid, and barriers to, ‘meeting other people’,
in the case of unconventional arrangements or even separate households:
On the one hand, there is a tendency among female friends to look after each other and
ask how they are doing. On the other hand, I also have the feeling that the moral cudgel
is sometimes being thrown around. ( …) With regard to my relationship, it has become
strange that I suddenly have to discuss with my flatmates whether I can see my girlfriend.
(Woman, 31, lesbian, committed relationship with one person)
Single respondents in particular perceived a new moralisation of sexual relationships:
‘Maintaining intimate relationships is currently not possible as a single person, or if so,
only to a very limited extent. You would also probably be given stern looks’, wrote a 32-
year-old respondent without relationship. Another man pointed out that ‘the feeling that
you’re doing something morally wrong hinders active dating—everything is much more
complicated and seriously moralising than before’(man, 33, gay, casual sexual partners).
The mitigation of the pandemic also led to inner conflict and emotional contradic-
tions, to ‘moral obstacles’or ‘a moral dilemma, since on the one hand there is respon-
sibility towards society and on the other hand there is an individual need for physical
and emotional closeness’(woman, 25, heterosexual, casual sex). Similarly, another
woman reported, ‘Less contact. Fear of contact vs. desire for closeness. Daily negoti-
ation between one’s own needs and “morality”/society’(woman, 28 years old, hetero-
sexual, no romantic or sexual relationship).
Loneliness and sexual desire came into conflict with both the fears of infection and social
distancing norms. Physical closeness was perceived as taboo, being ‘equated to a violation
of the law’which led to people questioning their previous sexual routines and preferences.
Casual sex is entirely impossible. Old contacts are renewed with the aim of being able to
meet after the ban on contact. Values are reconsidered. Is a permanent relationship the
better choice after all? Is my lifestyle too promiscuous? (Man, 45, gay, casual sex)
Negotiating intimate arrangements proved especially difficult in co-living commun-
ities. Following the need to justify their intimate contacts to other people living in
their shared flat, respondents reported feelings of guilt, remorse and social pressure
with comments such as ‘friends make me feel bad’. Even when some casual sex part-
ners decided on exclusivity, ‘it will always be discussed within the shared flat whether
it is still ok or not’to meet.
The flat-sharing community with my friends has become more intensive, (…), everybody is
suspicious and wants to interfere in others’affairs. ( …) I am forbidden to do anything all the
time and I have to ask for all social contacts I plan (to be at a safe distance and all). I have the
feeling that the couples feel morally superior and believe they are in the only ones in
honourable and exemplary situation and singles are automatically worse people. That was
partly true also before the lockdown. (No gender information, 23, bisexual, no relationship)
Anxiety and concealment
Anxieties were widespread among respondents and affected dating and partners alike.
Some people began to meet their partners in secret: ‘I asked someone for a private
CULTURE, HEALTH & SEXUALITY 1585
meeting for the first time. I was so insecure to ask for a meeting at all because of
Corona that I felt the need to keep it a “secret”that we are meeting now’(no informa-
tion on gender, 27, not sure, at beginning of a committed relationship). Respondents
described how they were afraid to do something punishable and felt guilty: ‘I feel bad
when I visit people who don’t live in my household, that is why I limit myself, but it is
not entirely possible’(woman, 24, heterosexual, open or polyamorous relationships).
Respondents were also uncertain if they were allowed to see their partners in a differ-
ent household—and what would happen if they did do so: ‘Do I have to pay a fine if
the police stops us together in the car and finds out that we do not live in the same
household?’(woman, 23, heterosexual, casual sex). Responses also make visible anxi-
eties based on sexual identity and race:
As a homosexual (sic), the police often do not understand that you hold hands with your
partner and that you are not a friend, and that you live together with her or him (which
is even more difficult to explain with a different skin colour). what often already leads to
looks in everyday life is aggravated by Corona, because you have to explain it three
times, maybe you are even married and have the same name, but you absolutely have to
show your passport. (Non-binary, 34, lesbian/gay, no relationship)
Some participants perceived intimate relationships as taboo and secretive—‘a little
bit like in adolescence’, wrote one respondent, with others highlighting the fact that
the prohibition of intimate contact to strangers makes the thought even more exciting
to them.
Haunting memories of HIV and AIDS
Health risks and management have been omnipresent in the COVID-19 pandemic, trig-
gering a risk awareness that some respondents remembered from the earlier HIV pan-
demic. One respondent noted, ‘The question: Are you healthy? is being asked again’.
Memories of HIV and AIDS remain present in perceptions of the COVID-19 pandemic,
being particularly burdensome for those who suffered from the social distancing and
isolation caused by the HIV pandemic:
Prohibition to meet, to visit (e.g. long-distance relationships/friends with benefits), or
danger of social ostracism if people meet. Physical contact becomes ‘dangerous’again,
now that the threat of HIV due to antiretroviral therapy and PrEP has finally receded in
recent years (through PrEP especially within the last 2 years). Now there is a new
epidemic, which makes touch/physical and intimate proximity taboo or fearful. For people
living with HIV or people who are living together or having sex with people living with
HIV, this is a new collapse of the recently and slowly built up feeling of freedom. (Man,
38, gay, unclear ‘complicated’relationship)
The freedom to decide individually about responsible risk management was a com-
mon topic of discussion. Criticism was directed against organisations such as the AIDS
Hilfe support service due to their advocacy for online sex over sex dating. In the view
of one gay man, 49, this was a form of ‘health fascism’. Another gay man
stressed that,
Compared to dealing with the risk of infection with HIV, the current risk regarding sex
with other people is much less life-threatening for myself than in the past. Out of
solidarity and consideration for the current capacities of the health care system, I also do
1586 B. ROTHMÜLLER
not want to contribute to the spread at the current time and put other people in danger.
(Man, 47, gay, open or polyamorous relationships)
Highlighting solidarity in risk management, respondents worried about the impossi-
bility of safer sex during COVID-19 and anticipated social cleavages.
…there is no safe sex anymore—there is no intimate relationship at the moment; the
reality between singles and people in fixed relationships is drifting apart, which creates
tension in the circle of friends; I am thinking again about the AIDS crisis of the 80 s and
what it means to protect not yourself but others. (Woman, 40, queer, unclear
‘complicated’relationship)
Discussion
How then according to this survey did people navigate their intimate arrangements
during lockdown? Findings support the claim that the pandemic re-institutionalised
traditional modes of intimate citizenship. Empirical data indicate significant transfor-
mations in intimate arrangements and their legitimacy in Austria and Germany in April
2020—both at the political level, by creating lockdown conditions that prioritised and
protected romantic couples living in the same household; and at the social level, by
moralising and anticipating the negative moral evaluation of non-dyadic intimate
arrangements. Even though results from this non-representative survey sample cannot
be generalised, some of the findings reveal insight into new forms of intimacy arising
during the COVID-19 pandemic.
As was already the case at the height of the HIV pandemic, gay, bisexual and other
men who have sex with men appear to be one of the groups most affected by the
COVID-19 pandemic. They reported greater health concerns as well as higher levels of
risk assessment in respect of their sexual activities during lockdown than heterosexual
men. They were also more likely to reduce the frequency of sexual contact, with the
result that they were more anxious that their sexual relationships might be on the
edge of breaking apart. Findings from the analysis of text-based responses show how
the memory of HIV informed some of these respondents’accounts of intimacy, abstin-
ence and pandemic morality in the context of the COVID-19 pandemic.
Yet, as the results also show, these men were not the only group to have signifi-
cantly transformed their intimate life due to pandemic risks. People in non-monogam-
ous relationships were also under pressure to alter their sexual practices. Those
participating in specific cultures of intimacy such as anonymous sex, and sex with sev-
eral partners experienced higher viral risk perception, as well as greater social and
moral pressure, than monogamous dyadic arrangements.
Findings illustrate the various ways in which people process pandemic mononorma-
tivities, ranging from resisting or questioning them, to accepting them as a temporary
phenomenon, or welcoming permission to refrain from exhausting relationship com-
plexities. The fact that the lockdown provided relief for so many asexual people and
singles provides an impressive illustration of the pressure to find a partner and have
partnered sex in Austrian and German society today (cf. Roseneil et al. 2020, 227f). The
emerging shift in social norms towards sexual restraint, however, has a flip side. As
much as diminishing expectations of an exciting sex life felt liberating to happily
CULTURE, HEALTH & SEXUALITY 1587
autonomous singles, conversely, those respondents who would have liked to live
unconventional forms of intimacy with their partner(s) now experienced deeply trou-
bling and sometimes intrusive expectations of monogamy, commitment and stable
cohabitation. Evidence from the survey research supports the thesis that the shift from
the legally sanctioned couple norm towards more liberal and pluralistic norms of
intimate life in the past may have come to an—at least temporary—end during the
COVID-19 pandemic. The governance of the pandemic is intensifying the moral weight
of the couple norm, linking non-traditional alternatives to public health threat and
death. The ‘grip’of the couple norm has not been loosened (Roseneil et al. 2020, 216);
instead, we register the rise of a renewed culture of mononormativity, sexual exclusiv-
ity and cohabitation in viral times.
The COVID-19 pandemic has pressured people to turn to monogamy due to fear of
infection. Bad conscience and the monogamisation of sexual relationships may trans-
form queer and non-monogamous sexualities, particularly due to the loss of commu-
nity contact throughout the pandemic. A follow-up study conducted in Austria and
Germany in November and December 2020 (Rothm€
uller 2021) found additional evi-
dence of the increased isolation of sexual minorities as well as stigmatisation due to
their relationship status in the course of the pandemic: fully 21 per cent of consensu-
ally non-monogamous respondents reported experiencing social exclusion due to their
polyamorous relationships during the pandemic, with 40 per cent of non-monogam-
ous respondents remaining in contact with their primary partner only.
At the beginning of the pandemic, and in a time of increased moral pressure on
minoritised forms of sexuality, community contact provides some relief from conceal-
ment and the effects of a limiting sexual morality. The results indicate that communi-
cation and trust within sexual communities reduces concealment pressure. Contrary to
public discourse that regards non-hegemonic sexuality as a driver of the pandemic,
this study identified moral conflict and careful consideration of pandemic risks among
sexual minority participants.
Instead of stigmatising non-hegemonic forms of sexuality, a comprehensive
approach to the structural, emotional and social aspects of risk reduction is key to
supporting people’s sexual and mental health during the COVID-19 pandemic (Eaton
and Kalichman 2020). Pandemic mitigation strategies can learn from the HIV crisis by
taking the psychosocial dimensions and consequences of distancing into account,
instead of using moral persuasion to encourage people to make responsible decisions
(Eaton and Kalichman 2020). Non-stigmatising mitigation strategies rely on community
mobilisation and collective practices of care (Logie and Turan 2020). Yet, unlike the
HIV pandemic when communities of care were important providers of social support,
the COVID-19 pandemic separation of individuals from communities prevented stigma-
tised people from accessing support at a time when they were most targeted for their
sexual and romantic arrangements.
Note
1. All answers were translated from German to English by the author. Use of small letters as in
the original.
1588 B. ROTHMÜLLER
Acknowledgements
Thanks go to Nora Ruck, Emelie Rack, Sophie K€
onig, Anna Maria Diem and David Seistock from
the Sigmund Freud University in Vienna for their support with the COVID-19 research project. I
also thank Amanda Gesselman and the Kinsey Institute, Indiana University, for their co-operation
in a pilot study in the spring 2020.
Disclosure statement
No potential conflict of interest was reported by the author.
References
Balzer, J. 2020.“Berghain: Jetzt kann nur mehr Kunst helfen.”Die Zeit, September 8. https://
www.zeit.de/kultur/kunst/2020-09/berghain-ausstellungshalle-berlin-schliessung-techno-club-
coronavirus
Brooks, A. 2017.Genealogies of Emotions, Intimacies, and Desire. Theories of Changes in Emotional
Regimes from Medieval Society to Late Modernity. New York: Routledge.
Brown, M. 1997.RePlacing Citizenship: AIDS Activism and Radical Democracy. New York: Guilford
Press.
Daly, S. J. 2020.“Bisexual Women and Monogamy.”In Bisexuality in Europe: Sexual Citizenship,
Romantic Relationships, and Bi þIdentities, edited by E. Maliepaard and R. Baumgartner,
11–114. Abingdon: Routledge.
De Lagasnerie, G. 2020.“Clapping for Anti-Modernism and Nationalist Submission.”Accessed
April 2, 2020. https://www.opendemocracy.net/en/can-europe-make-it/clapping-anti-modern-
ism-and-nationalist-submission
Dong, W., K. E. Muessig, K. A. Knudtson, A. Gilbertson, S. Rennie, K. Soni, and L. B. Hightow-
Weidman. 2020.“Moral Practices Shaping HIV Disclosure among Young Gay and Bisexual Men
Living with HIV in the Context of Biomedical Advance.”Culture, Health & Sexuality. doi:10.
1080/13691058.2020.1790039
D€
oring, N., and R. Walter. 2020.“Wie ver€
andert die COVID-19-Pandemie unsere Sexualit€
aten?
Eine €
Ubersicht medialer Narrative im Fr€
uhjahr 2020.”Zeitschrift F€
ur Sexualforschung 33 (02):
65–75.
Eaton, L. A., and S. C. Kalichman. 2020.“Social and Behavioral Health Responses to COVID-19:
Lessons Learned from Four Decades of an HIV Pandemic.”Journal of Behavioral Medicine 43
(3): 341–345.
Foucault, M. 1980. The History of Sexuality. Vol. 1: An Introduction. New York: Vintage Books.
Green, H. D., M. R. Weeks, M. Berman, H. I. Mosher, M. Abbott, and N. Garcia. 2018.“Managing
the Risk of Intimacy: Accounts of Disclosure and Responsiveness among People with HIV and
Intimate Partners of People with HIV.”Culture, Health & Sexuality 20 (10): 1117–1129.
Hardon, A., and D. Posel. 2012.“Secrecy as Embodied Practice: Beyond the Confessional
Imperative.”Culture, Health & Sexuality 14 (Sup 1): S1–S13.
Jamieson, L. 1999.“Intimacy Transformed? A Critical Look at the ‘Pure Relationship.”Sociology
33 (3): 477–494.
Jones, D. S. 2020.“History in a Crisis - Lessons for Covid-19.”The New England Journal of
Medicine 382 (18): 1681–1683.
Kean, J. 2015.“A Stunning Plurality: Unravelling Hetero- and Mononormativities through HBO’s
Big Love.”Sexualities 18 (5–6): 698–713.
Klesse, C. 2006.“Polyamory and its ‘Others’: Contesting the Terms of Non-Monogamy.”
Sexualities 9 (5): 565–583.
Ko, N.-Y., W.-H. Lu, Y.-L. Chen, D.-J. Li, Y.-P. Chang, C.-F. Wu, P. W. Wang, and C.-F. Yen. 2020.
“Changes in Sex Life among People in Taiwan during the COVID-19 Pandemic: The Roles of
CULTURE, HEALTH & SEXUALITY 1589
Risk Perception, General Anxiety, and Demographic Characteristics.”International Journal of
Environmental Research and Public Health 17 (16): 5822.
Lehmiller, J., J. Garcia, A. Gesselman, and K. P. Mark. 2021.“Less Sex, but More Sexual Diversity:
Changes in Sexual Behavior during the COVID-19 Coronavirus Pandemic.”Leisure Sciences 43
(1–2): 295–304.
Lister, R. 2002.“Sexual Citizenship.”In Handbook of Citizenship Studies, edited by Engin Isin and
Bryan Turner, 191–208. London: SAGE.
Logie, C. H., and J. M. Turan. 2020.“How Do We Balance Tensions Between COVID-19 Public
Health Responses and Stigma Mitigation? Learning from HIV Research.”AIDS Behavior 24 (7):
2003–2006.
Matic, S. 2006.“Twenty-five Years of HIV/AIDS in Europe.”In HIV/AIDS in Europe, edited by S.
Matic, J. Lazarus, and M. Donoghoe, 1–15. Copenhagen: WHO.
McKay, T., J. Henne, G. Gonzales, R. Quarles, K. A. Gavulic, and S. G. Gallegos. 2020.“The COVID-
19 Pandemic and Sexual Behavior among Gay and Bisexual Men in the United States.”
Working Paper, SocArXiv. doi:10.31235/osf.io/8fzay
New York City Health Department. 2020.“Safer Sex and COVID-19”. Fact sheet. Accessed
February 16, 2021. https://www1.nyc.gov/assets/doh/downloads/pdf/imm/covid-sex-guidance.
pdf
Newman, P. A., and A. Guta. 2020.“How to Have Sex in an Epidemic Redux: Reinforcing HIV
Prevention in the COVID-19 Pandemic.”AIDS & Behavior 24 (8): 2260–2264.
Plummer, K. 2001.“The Square of Intimate Citizenship: Some Preliminary Proposals.”Citizenship
Studies 5 (3): 237–253.
Plummer, K. 2003.Intimate Citizenship: Private Decisions and Public Dialogues. Seattle and
London: University of Washington Press.
Public Health Agency of Canada. 2020. Statement from the Chief Public Health Officer of
Canada on 2 September 2020, Dr Theresa Tam. X Monat Jahr. https://www.canada.ca/en/pub-
lic-health/news/2020/09/statement-from-the-chief-publichealth-officer-of-canada-on-septem-
ber-2-2020.html
Richardson, D. 2018.Sexuality and Citizenship. Cambridge, UK: Polity Press.
Roberto, K. J., A. F. Johnson, and B. M. Rauhaus. 2020.“Stigmatization and Prejudice during the
COVID-19 Pandemic.”Administrative Theory & Praxis 42 (3): 364–378.
Roseneil, S., I. Crowhurst, T. Hellesund, A. C. Santos, and M. Stoilove. 2020.“The Tenacity of the
Couple-Norm.”In Intimate Citizenship Regimes in a Changing Europe. London: UCL Press.
Rothm€
uller, B., ed. 2021.Liebe, Sexualit€
at und Solidarit€
at in der COVID-19-Pandemie. Erste
Ergebnisse der Pilotstudie und Folgeerhebung 2020. Vienna: Sigmund Freud University Press.
St. Vil, N. M., L. Y. Bay-Cheng, H. G. Ginn, and Z. Chen. 2020.“Perceptions of Monogamy,
Nonconsensual Nonmonogamy and Consensual Nonmonogamy at the Intersections of Race
and Gender.”Culture, Health & Sexuality. doi:10.1080/13691058.2020.1817561
Stephenson, R., T. M. D. Chavanduka, M. T. Rosso, S. P. Sullivan, R. A. Pitter, A. S. Hunter, and E.
Rogers. 2021.“Sex in the Time of COVID-19: Results of an Online Survey of Gay, Bisexual and
Other Men Who Have Sex with Men’s Experience of Sex and HIV Prevention During the US
COVID-19 Epidemic.”AIDS & Behavior 25 (1): 40–48.
Valdiserri, R. O., and D. Holtgrave. 2020.“Responding to Pandemics: What We’ve Learned from
HIV/AIDS.”AIDS Behavior 24 (7): 1980–1982.
Watkins-Hayes, C. 2014.“Intersectionality and the Sociology of HIV/AIDS: Past, Present, and
Future Research Directions.”Annual Review of Sociology 40 (1): 431–457.
WHO. 2020.“Mental Health and Psychosocial Considerations during the COVID-19 Outbreak.”
Accessed March 18, 2020. https://www.who.int/docs/default-source/coronaviruse/mental-
health-considerations.pdf
1590 B. ROTHMÜLLER
