Relational and cognitive social capital might have played a key role in preventing higher rates of infection and death from COVID-19 in the U.S., according to a new study, with the strength of social connections remaining important for continued virus control and vaccination rates.

Social capital includes the social relationships people have, as well as the resources and benefits that people acquire through connections with others, such as shared norms and values. Social capital can be defined in terms of a cognitive element, involving the attitudes and dispositions that promote cooperation between individuals; and a relational aspect, which pertains to the strength of social connections present within a community. These relationships are created and reinforced through participation in civic society, community associations and volunteer activities.

The study, published April 20 in Social Science & Medicine, hypothesized that American communities with high levels of relational social capital prior to the COVID-19 outbreak most likely had a dense network of interpersonal relations. These communities would then be at particular risk during the pandemic, as contact across large social networks enabled the swift spread of disease, particularly given the prevalence of asymptomatic infections.

However, following the initial period of the pandemic's outbreak in the U.S., as knowledge about the virus began to improve, researchers found that both cognitive and relational social capital proved helpful for communities and contributed to lower rates of transmission and COVID-19 fatalities. In communities demonstrating high levels of social capital, information about the virus could have circulated faster than in other communities, prompting individuals to alter risky behavior either voluntarily or in response to government requirements and recommendations. As a result, virus transmission would be lower.

Francesca Borgonovi, the study's co-author and a British Academy Global Professor at University College London, said the pandemic drew attention to the important role of social determinants of health, especially given COVID-19's novelty and the absence of effective treatments for the ill. 

"Over the past year, we have witnessed how the burden of the pandemic, whether health or economic, has been very unequal, and I wanted to explore if and how social relations explained such variations," she told The Academic Times.

Using county level data from sources including the Census Bureau and the U.S. Congress Joint Economic Committee, Borgonovi and her colleagues mapped the association between social capital and COVID-19 hospitalizations and deaths from January 2020 to January 2021 in the United States. Social capital was defined using a variety of indicators, such as the number of nonreligious nonprofits per capita, the number of religious congregations per capita, the number of adults who volunteered in the past year and the response rates to the 2010 decennial census.

"A number of papers have examined the association between social capital or civic capital and mobility changes, respect for social distancing, mask-wearing and COVID infections and deaths between spring 2020 and the summer of 2020," Borgonovi said. She added that because the pandemic is still unfolding, the researchers "became increasingly convinced" that it was important to understand how social capital impacted COVID-19 outcomes and why that might have been the case. 

Although both relational and cognitive social capital were associated with lower deaths in the spring of 2020, when COVID-19's serious health risks were first established, cognitive social capital was not significantly associated with a sustained lower death toll beyond that point. The association between cognitive social capital and the number of COVID-19 deaths was largest during the early period of mandatory social distancing in the U.S., after which, no significant relationship was noted. In fact, starting around July, the number of new coronavirus-related deaths was higher in communities with higher levels of cognitive social capital. 

Communities with higher levels of relational social capital, however, experienced lower deaths due to COVID-19 throughout the pandemic. Although researchers found that such a correlation became less pronounced from April to November 2020, a difference of one standard deviation in relational social capital corresponded to a 30% reduction in the number of COVID-19 deaths recorded in March and April 2020.

Borgonovi and her colleagues believe that many of the factors that made relational social capital important in 2020 are likely to make it just as important in 2021. Strong social ties and norms of reciprocity, for example, could continue to facilitate the spread of pandemic information and the need for individuals to be vaccinated against the virus.

"When vaccines [are] scarce, social capital can ensure that communities prioritize those most in need of getting vaccinated, and suppression measures are maintained in the meantime to keep spread low," Borgonovi said. "When vaccines become more available, it can propel individuals to engage in the personal risks that might be associated with getting vaccinated ... to protect not only yourself but also others."

Although vaccinations are now available across the U.S., Borgonovi's and her colleagues' research on interpersonal connections could also still prove helpful in minimizing community spread and preventing deaths in other countries around the world, for which the pandemic is far from over. 

In the future, Borgonovi would like to build upon the findings of this study to investigate long-term consequences of the pandemic as experienced by affected communities. 

"We are very interested in exploring the extent to which communities with high levels of social capital may be better at caring for individuals with long COVID or deal[ing] with secondary effects of the pandemic," she said. "For example, supporting students who are lagging behind compared to what they would have [achieved] had schools operated at normal capacity."

The study, "The evolution of the association between community level social capital and COVID-19 deaths and hospitalizations in the United States," published April 20 in Social Science & Medicine, was authored by Francesca Borgonovi, University College London; Elodie Andrieu, King's College London; and S.V. Subramanian, Harvard University.