Preparing for future public health emergencies through elevating the voices of those who lived alone during the pandemic

Single-person households comprise a significant proportion of the population and their experiences during the restrictions associated with the COVID-19 pandemic are critical to improving practices for future public health emergencies. This study assessed the experience of living alone, perceptions of the public health guidance, and recommendations based on the lived experience of participants. Eight focus groups were conducted with participants (n=37) of all ages across the United States during the later stages of the pandemic (November 2021-April 2022). Thematic analysis was used to identify codes and themes. Interrater reliability (85%) was strong, and consensus coding was used to resolve discrepancies. The analysis team, including principal investigators with lived experience of living alone during the pandemic, developed themes from the codes. Participants noted the extreme degree of isolation they experienced during the pandemic restrictions compared to those in multi-person households, but also noted benefits to living alone. They noted a lack of specific guidance, or even acknowledgement of, people of all ages living alone during the pandemic or found that the guidance was unhelpful. When tailored guidance was provided, it was perceived well. Recommendations center on providing guidance for those that live alone, what supports are needed, which mainly involved increasing accessibility of mental healthcare, and considerations for future public health emergencies, such as improved science communication. Being inclusive of all household types in forming policy and health recommendations may be a step in improving public messaging, gaining more public compliance with recommendations, and improving consumer satisfaction with health guidance. • This qualitative study provides the perspective of a geographically diverse group of people of all ages in the United States on the experience of living alone during the COVID-19 pandemic. • Participants noted costs and benefits to living alone compare to living with others. • Participants noted a lack of specific guidance for people living alone but wanted public acknowledgement and guidance. • Participants wanted increased transparency in science communication about the pandemic. • Increased access to mental health services was a common recommendation.