key: cord-0285803-r10b6bv8 authors: Khadka, S.; Usman, M.; Saleem, M.; Ali, M.; Rasheed, H.; Giri, S.; Saeed, H. A.; Gupta, R. P.; Bajgain, Y.; Shahi, J. title: A qualitative exploration of the perspectives of international medical students residing in university hostels amid COVID-19 pandemic lockdown date: 2021-08-05 journal: nan DOI: 10.1101/2021.08.02.21261480 sha: 10c34e658093a340bbb677d210fe26ead144fb00 doc_id: 285803 cord_uid: r10b6bv8 Background COVID-19 pandemic has portentously frightened the existence of life all over the world. The lockdown approach was adopted as a containment strategy as the disease itself has manifested severe social, economic, and psychiatric implications. Objectives To explore the perception and preparedness of international medical students residing in university hostels amid the COVID-19 pandemic lockdown. Design A semi-structured interview guide was developed in this qualitative study design. All the interviews were audio-taped, transcribed verbatim, and then analyzed for thematic contents by standard content analysis framework. Setting Interviews were conducted in university hostels in Punjab, Pakistan. Participants A total of 11 international medical students were interviewed face-to-face through the purposive sampling technique to obtain in-depth individual viewpoints. Results The thematic content analysis yielded five major themes: Familiarity with COVID-19, Perceptions and attitudes towards COVID-19, Preparedness for safety against COVID-19, Barriers to lifestyle, and Psychological perspectives. A better general perception and preparedness among international medical students regarding COVID-19 was found. Good knowledge regarding the overview of COVID-19; adequate preventive approaches such as social distancing, use of masks, gloves, and sanitizers; and compliance with the lockdown measures were reported by the respondents. The pertinent issue raised by the respondents is the disturbance in normal routine due to distortion in social life and isolation that may cause psychological stress. Conclusions The findings from this study lighten the peoples perspectives that help the government to prepare public health strategies based on population-focused approaches. The present study demonstrates the respondents opinion on COVID-19 management by personal hygiene, social distancing, and complying with the lockdown measures. Furthermore, it demands that timely and evidence-based teaching-learning techniques should be adopted for students engagement which ensures mental health and self-motivation as well. Therefore, they can utilize their time productively which could have a long-term effect on their careers and healthcare services. pandemic ever since it has manifested itself as serious public health and developmental challenge that has viciously affected all the domains of quality of life including health, socio-economic, and education. 1 Till date, it has affected more than one hundred and ninety-five million people with more than four million deaths around the world. 2 Even after the passage of a year, the uncertainty of the approved therapeutic agent exists for the therapy of COVID-19. However vaccines are now being available recently for people aged older than 12 years, it still takes more than a year to fully cover all the countries around the globe. 3, 4 In such adverse scenarios, repurposing of prior available medications and supportive treatment is being practiced as a treatment option considering all the pros and cons. 5 Various preventive approaches such as lockdown, social distancing, adequate hygiene and sanitation, and wearing masks for breaking the chain of transmission are the mainstay of patient care as of now. 6 Though the international students are not enlisted in a high-risk group, they are severely affected during the lockdown period socially and economically given their immigration status. 7 International students, particularly from lower and middle-income countries (LMICs) are already facing challenging circumstances including financial crunches. Lockdown measures add to their plight and potentially lead them into social and psychological stress. 7 Pakistan takes students from different parts of the world for higher education in the medical and non-medical fields. Most of the international students stay in hostels provided by their universities. Amid the COVID-19 pandemic, they are confined to the hostels. Disruption in education, travel restriction, closure of the mess, isolation, closed border amid lockdown have impaired their daily activities. Fear of infection, anxiety, hoax calls, cyberbullying, and financial All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted August 5, 2021. ; https://doi.org/10.1101/2021.08.02.21261480 doi: medRxiv preprint crisis may cause a substantial impact on mental health amid COVID-19 preventive activities. [8] [9] [10] Such stress-associated disorders may lead to suicidal behavior as well. 11 In this scenario, assessing the stress level of international students who are confined in hostels amid the COVID-19 pandemic and understanding their perception and preparedness aspect regarding the COVID- 19 pandemic is crucial. Such information can be a milestone to make concerned authorities aware of adverse consequences that may arise in case of obliviousness in managing their daily activities. This study has been conducted to answer the following question: What are the perceptions and preparedness of international medical students residing in university hostels amid the COVID-19 pandemic lockdown in Pakistan? To the best of our knowledge, this is the first of its kind study designed to evaluate the challenges faced by international medical students residing in university hostels amid COVID-19 lockdown and their perceptions and preparedness towards it which might help the concerned authorities to prepare relevant public health strategies. The ethics approval was received from the Institutional Ethics Review Board of the University of the Punjab, Lahore, Pakistan (Reference number:183/DFEMS). Informed verbal consent to participate in the study was obtained from participants. A qualitative research methodology was adopted as it is flexible and focuses on non-numeric data that consent to an in-depth understanding of the respondent's perspective. Moreover, All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. A semi-structured interview guide was developed. It was tested for validity and reliability by two skilled researchers at the University of Veterinary and Animal Sciences, Lahore, Pakistan (B and E). It was pre-tested and verified for accuracy and consistency. The reliability of the findings was assured by recording face-to-face interviews with the international students following their approval. The study was conducted in Punjab Province, which is the most developed, populated, and the second-largest province of Pakistan. The participants in the study were recruited using the purposive sampling technique based on their availability until saturation was achieved. A total of 11 international medical students residing in university hostels were finally selected for interview. The targeted participants were international students from various faculties of medicines such as pharmacy, veterinary, medical, and dental in universities around Punjab Province, Pakistan. After giving an explanatory statement with the study objectives to the participants, verbal consent was taken. To ensure privacy, the identity of the respondents was kept confidential and All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted August 5, 2021. ; https://doi.org/10.1101/2021.08.02.21261480 doi: medRxiv preprint the anonymity of opinions was also confirmed by using codes by the two researchers (SK and MU). Interviews were continued until the saturation point from where new data doesn't occur. The respondents were aware of voluntary involvement in the interview, and the independence to drop the participation at any time. The co-authors of the study interviewed the participants in their hostel room between April 2020 and June 2020 in the English language. All the interviews were audio-taped, and additional field notes were taken by the principal investigator SK (male). Suitable probing was done to seek out more information. The respondents were free to describe additional views on the topic. The duration of each interview was approximately 20-30 minutes. All the recorded interviews were transcribed verbatim. The comments were changed to some extent for grammatical corrections during the data extraction process. Based on the method described by Braun and Clarke, the data were thematically analyzed manually by in-depth penetration into the interviews. 13 The significant answers were deductively highlighted. Then the answers were compared and contrasted to establish any variances and themes were identified by successively reorganizing the pattern. The transcribed interviews were analyzed for interconnected comments while categorizing the theme. This exercise helped cluster the statements that were previously considered unrelated or discrete. The interview was conducted in a very inductive and flexible manner to further explore the valid issues. All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted August 5, 2021. ; https://doi.org/10.1101/2021.08.02.21261480 doi: medRxiv preprint A total of 11 participants from seven different Universities in Pakistan were included in the study (n=11). The majority of them were from Universities located in Lahore (n=8) followed by Multan (n=2), and Faisalabad (n=1). The participants belonged to six different countries of the Eastern Mediterranean Region (n=3), South-East Asia Region (n=2), and African Region (n=1). There was a total of eight male students and the rest were female among the participants. The majority of the participants (n=8) were of more than 25 years of age. Under-graduate students were nine in number followed by post-graduate level students. All the participants were staying in Pakistan for more than one year. The majority of the participants (n=6) were from pharmacy faculty, three from medical, and one each from dentistry and veterinary faculties. A flow diagram of the participants' recruitment is given in Figure 1 . All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted August 5, 2021. ; https://doi.org/10.1101/2021.08.02.21261480 doi: medRxiv preprint The demographic distribution of the participants is described below in Table 1 . (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted August 5, 2021. The thematic analysis of the content of the interview led to five major themes: 1. Familiarity with COVID-19 (Knowledge), 2. Perceptions and attitudes towards COVID-19 (Attitude), 3. All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted August 5, 2021. ; https://doi.org/10.1101/2021.08.02.21261480 doi: medRxiv preprint 1 2 lower the transmission rate but cannot prevent it at 100%. Some of the participants believed that these measures help in the complete prevention of transmission of COVID-19. Different students expressed various views about the availability and survival of coronavirus in different mediums, Table 2 . Though the majority of the students reported that the adopted treatment methods are only being used as the best possible option, some of them were not being able to express a clear answer regarding the effectiveness of the ongoing therapy, Table 2 . Regarding the risk of contracting COVID-19, all of the participants considered that they are at risk but some participants claimed that they are in a safer state than any other persons as they were confined in the hostels, Table 3 . Regarding the lockdown approach as a containment strategy to prevent COVID-19, all the respondents showed a positive response, Table 3 . All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted August 5, 2021. ; The mixed views were obtained upon asking for university and hostel management amid the COVID-19 pandemic. Some of the respondents even indicated dissatisfaction about the local scene as the people were not taking the lockdown seriously, Table 3 . Upon a question related to tackling COVID-19 in case their fellow hostelers get infected with COVID-19, most of them asserted that they would suggest isolation and quarantine, while some of the respondents were intending to take them to hospital, while others did not state about isolation, quarantine, but discussed supportive therapy and other laboratory tests to conduct. While replying to the query "What will you do if symptoms of flu that resemble COVID-19 occur?", the respondents emphasized on calling an emergency number, some of them were intending to get the test done and isolate themselves, while others said that they follow preventive measures to tackle such scenario, Table 3 . All of the respondents were found positive towards complying with the rules and guidelines set for the management of such a global health threat in an optimistic way, Table 3 . Table 3 Thematic analysis of the interview data and selected quotes of the respondents (Theme 2) Theme 2 Perceptions and attitudes towards COVID-19 (Attitude) Subthemes All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. "I think, there are rules set even when one shows such kind of symptoms, he should isolate himself, and of course, I will also have to take the precautionary measures like not coming in touch with the infected." (IMS-10) "Ok! What I will do is, I will report. You know there is a number I'm supposed to call if I show such kind of symptoms. I will report and then, from there, I will take the instruction they will give me" (IMS-10) "Yes! I believe every individual is responsible for this condition, responsible for following the necessary guidelines for the prevention of this disease. Because this is not only yourself who is in danger, there is our family and the whole people of the world are in danger. So, we must do whatever we are responsible for to protect ourselves and the whole world." (IMS-11) "Umm! Yes! I want to comment that let's hope for the best and let's follow the guidelines that are provided by the local authorities and our government, and let's stay strong. We will get through this." (IMS-1) Abbreviations:-COVID-19: Coronavirus disease-2019, IMS 1-11: International medical student [1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] Theme 3: Preparedness for safety against COVID-19 All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted August 5, 2021. ; https://doi.org/10.1101/2021.08.02.21261480 doi: medRxiv preprint Regarding preventive measures adopted against the COVID-19 pandemic, it was found that they carry hand sanitizer, wear masks and gloves, usually wash their hands with soap water, and follow social distancing as per guidelines, Table 4 . Regarding vaccination, mixed views were obtained, Table 4 . Theme 4: Barriers to the lifestyle All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted August 5, 2021. ; https://doi.org/10.1101/2021.08.02.21261480 doi: medRxiv preprint The lockdown approach and social distancing adopted as a containment strategy were considered barriers to the everyday lifestyle during the COVID-19 pandemic. They were not shaking hands, hugging friends, sharing stuff such as phones and utensils, and touching any surfaces outside the room which they felt unusual, though following these as a guideline, Table 5 . Not getting an opportunity for conventional classes, not going out from the hostel frequently, not being able to go home, and being confined within the hostel premises were among the responses obtained, Table 5 . The majority of the respondents replied that changes in routine which disturbed timing to go for internship, physical activities, and meal timing were the most affected daily activities by the COVID-19 pandemic, Table 5 . Regarding lifestyle changes due to the COVID-19 pandemic, the responses are depicted in Table 5 . Lifestyle adopted due to COVID-19: Pastime activities of most of the respondents during the COVID-19 pandemic were reading books including course books and news articles, playing games, and using social media, Table 5 . Table 5 Thematic analysis of the interview data and selected quotes of the respondents (Theme 4) Selected quotes All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted August 5, 2021. ; https://doi.org/10.1101/2021.08.02.21261480 doi: medRxiv preprint (Experience/Outcome) "Yes! I was going back home but couldn't because of a virus." (IMS-9) "I only go to buy necessary things, like, once in a week or twice maybe, sometimes to buy goods; the necessary goods, the food that is necessary." (IMS-8) "Ah! We used to go to the hospital. We used to do our job like 5 to 6 hours a day, but now we are going only 1 day per week, and ah! I also cannot go outside and we used to go outside for exercise. Ah! And it has also affected differently -our food, our way of eating, way of sleeping, everything is affected." (IMS-1) There were mixed reactions regarding fear of COVID-19 such as some were scared, while others were cautious rather than being scared, Table 6 . The responses are depicted in Table 6 . All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted August 5, 2021. ; https://doi.org/10.1101/2021.08.02.21261480 doi: medRxiv preprint Death: Though the respondents were scared of being infected, they did not have fear of death, Table 6 . The mixed views were obtained regarding isolation, Table 6 . Effect on career or studies: Though the respondents indicated interruption of regular classes, they were managing time for study in the hostel room and some of them had even started scientific writing, Table 6 . Upon a question related to lowering of self-esteem due to either COVID-19 pandemic or due to lock down or both, mixed reactions were obtained. Some of the respondents stated both as a reason for lowering self-esteem. However, the majority of the respondents reported no lowering at all in their self-esteem as those approaches were adopted for a good reason, Table 6 . The majority of the respondents were missing their family members back home, while some were frustrated and facing difficulties, Table 6 . The respondents were found in stress as they were far from family members, staying inside the hostel room for so long, and their minds were filled with the uncertainty of disease progression, Table 6 . Table 6 Thematic analysis of the interview data and selected quotes of the respondents (Theme 5) Selected quotes All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The outcome of this study has portrayed the typical picture of international medical students amid the COVID-19 pandemic from several aspects such as; knowledge about COVID-19, perceptions and attitudes towards it, and preparedness and safety against it. The present study reported that the international medical students had adequate knowledge about the origin, causative agent, nature, and treatment strategy of COVID-19. However, some of them had less information about its treating agents and vulnerability issues. Our findings are in line with the findings of studies conducted in different parts of the world. [14] [15] [16] [17] Whereas the findings from a study conducted in Turkey were somewhat in different line where the knowledge of the medical students was found moderate. 18 The audio-visual demonstrations, online webinars, and regular capacity development activities help improve the knowledge and skill in such pandemics. COVID-19 pandemic has worryingly endangered the existence of people around the globe. The unavailability of proven therapeutic agents and lockdown and social distancing adopted as preventive measures to contain such pandemic has disturbed the normal pattern of life everywhere. 19, 20 It was identified that the preventive measures were adopted at an adequate level by all the international students. Social distancing, hand washing with soap and water or using sanitizer, wearing masks and gloves, maintaining social distancing, limiting movements, changing and washing clothes frequently, and taking showers were the most frequently adopted preventive measures to avoid infection. Different studies have demonstrated the effectiveness of preventive All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted August 5, 2021. ; https://doi.org/10.1101/2021.08.02.21261480 doi: medRxiv preprint measures as an appropriate strategy to limit the spread of coronavirus. 6, 21 Similar preventive measures were adopted by medical students in a study conducted by Khasawneh et al in Jordan. 16 Whereas medical students were least compliant towards the adoption of such preventive approaches in a study conducted by Haque et al. 22 The present study also demonstrates the social nature of students such as; willingness to help society with the COVID-19 pandemic and support friends in case of getting infected. Such an attitude depicts peace of mind. However, the concept of "first me" expressed in some cases might be attributed to the adverse scenario and mental stress caused by such pandemic. All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted August 5, 2021. ; https://doi.org/10.1101/2021.08.02.21261480 doi: medRxiv preprint The respondents of the study believe that lockdown is the proper approach for the management of such pandemics. Contrary to this, different studies suggest that the theoretical research used for implementing the lockdown approach was farther than the practical aspect which had neglected the associated psychological effects. 24, 25 Altman M describes lockdown as a misapplied and sub-optimal policy as it has disturbed the world's economy and emphasizes on the inclusion of more comprehensive governance and improvised mental models as crucial factors for human welfare in such measures. 24 A study conducted by Zheng et al reported that the lockdown approaches contributed a buffer effect on social anxiety and the mediating effect on psychological distancing. 25 The eagerness of international students to get vaccinated, as soon as it is available, implies their willingness to be stress-free of the pandemic and trust towards the immediate development of scientific research. However, at the same time, some of them were in a wait-and-see mood for the same. A similar type of result was reported by various studies where the majority of the people were willing but some were either unwilling or uncertain to get vaccinated. [26] [27] [28] [29] The reluctant respondents in the studies were mostly from ethnic minorities and had lower levels of education and income. 26, 29 Different reports suggest that the mistrust towards vaccines and fear of future side effects are responsible for people's reluctance towards getting a vaccination. 26, 30, 31 Doubt in the current treatment strategy being adopted as a therapeutic option is creating fear among students. Such poor compliance urges for an immediate policy response tailored to public health awareness programs. 26 The present study identified mixed responses from international students about the university and hostel management towards their welfare amid the COVID-19 pandemic. The majority of the respondents reported a satisfactory response, however, some of them were found a little bit All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted August 5, 2021. ; https://doi.org/10.1101/2021.08.02.21261480 doi: medRxiv preprint dissatisfied with the authority. The respondents said that their normal routine has been disturbed due to the university shut down, restriction in movement, and confinement within the hostel periphery. In addition to this lack of physical activity, mess closure, the uncertainty of the situation make them miss their family more which may lead to psychosocial stress. Opening of mess for international students, proper hygiene and sanitation measures, virtual teaching-learning process, and online awareness training and webinar regarding the containment aspect of disease to protect themselves and to the society is required. School closure and loss in their learning are some of the prime concerns raised by the respondents. Lockdown has affected the global education system. The education system in LMICs was already facing many challenges, COVID-19 adds more stress to it. This establishes the urgent need for multimodal approaches for achieving the course content objectives enabling learners in analytical reasoning to deal with the complexity of online education. 32 Timely and significant teaching-learning techniques must be implemented for medical students as it is mandatory to have a significant understanding and education that enhances performances in such pandemics for the safety of the country. 18 The study reports the compliance of respondents with the COVID-19 containment strategies of the government. The safety and security concerns, opening groceries for international students for a limited time, medical facilities, as well as regular and authentic sharing of COVID-19 information through newspapers, are praiseworthy steps taken government. The majority of respondents' intact self-esteem even at a bit frustrating scenario like this implies their intact mental status as well as good governance. Multiple stressors may contribute to psychological stress and anxiety such as the perceived risk of infection, reduced social communications, and augmented worries on academic performance. 33 The study also depicts the same. Most of the respondents had fear of getting All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted August 5, 2021. ; https://doi.org/10.1101/2021.08.02.21261480 doi: medRxiv preprint contracted and impact in study and career but nobody had any fear of death as the mortality rate of COVID-19 is very low as compared to many other common diseases. 34 A study conducted by Saddik et al reported higher anxiety levels in medical students during clinical rotation that decreased with online learning. 15 Crisis like the COVID-19 pandemic gives substantial psychosocial burdens on humankind. Therefore, developing interventions and preventive strategies are crucial to address the psychological impact on international students due to such a pandemic. 33 The focus must be given towards solidarity and social justice to deal with social stigma as well, which may occur at any point amid such pandemic and, if go unchecked, may lead to the mental disorder. 35 A proper health communication is an urgent requirement as per WHO's the current report for the quality of life both from the health and social point of view. 36 Cohesiveness and solidarity are effective coping mechanisms for stress and anxiety. 33 Therefore, there is a need for an immediate action plan, supported by behavioral and social sciences, for alleviating the possibly overwhelming impacts of such pandemics to help align human behavior. 36 This study depicts the compliance of international students with the guidelines for effective management of the COVID-19 pandemic. The finding of the study aligns with the study by Saddik et al where medical students were found to be utilizing reliable sources of information for COVID-19 management. 15 Such adherence is critical for the effective management of such a global health threat. Lifestyle adopted for well-being amid such a pandemic by international students were timely and productive as well. Many of them were engaged in scientific publications which was a quality fruitful way to live for medical students. All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. This study is novel as it is the first of its kind study. It has delivered a convenient and comprehensive understanding of the knowledge, perception, and preparedness of the international medical students residing in hostels of different Universities of Pakistan towards the COVID-19 pandemic. A significant strength of this study was the inclusion of international students of six countries who are pursuing medical courses in seven Universities in different places of Pakistan. This enabled an in-depth exploration of the range of knowledge, perceptions, and preparedness as well of such students towards the COVID-19 pandemic. This study informs about the status of international medical students in Pakistan that can help their management with a quality stay in such a global pandemic. In this context, this study can have an impact in filling the prevailing gap in the qualitative, academic, and administrative issues between the international medical students and the respective authority and the literature as well. All the participants were guaranteed the secrecy and confidentiality of their profile, and the interview was also taken by international students in Pakistan. Therefore, the participants liberally and decently communicated their feelings. Besides, the data analysis based on a thematic analysis method simplified the generation of typical findings. Moreover, there are some probable limitations linked to this qualitative study. This study was carried out only in the universities located in the Punjab province, Pakistan. Therefore, the findings of this study may not be generalized to the whole country, but the findings in other provinces may not vary with our findings. The study furnishes important information on the perception and preparedness of international medical students regarding the COVID-19 pandemic. Respondents believed that maintaining All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted August 5, 2021. ; https://doi.org/10.1101/2021.08.02.21261480 doi: medRxiv preprint personal hygiene using masks, gloves, and sanitizers and frequent hand-washing; maintaining social distancing; and complying with lockdown measures aid in COVID-19 management. The majority of them had a clear understanding of the COVID-19 pandemic. The support from the universities is the primary requirement for international students to cope with such pandemic as there is no approved therapy and preventive measures cannot always be adequate to sufficiently thwart COVID-19. Furthermore, the chance of psychological stress is high that could substantially harm their quality of life. The findings from the present study demand timely and evidence-based teaching-learning techniques for medical students as it is mandatory to have a significant understanding that enhances performances in such pandemics for global safety. Such a technique could ensure their mental health and make them self-motivated. In such a situation, the students prefer to use their time productively and this could have a long-term effect on their careers and academic progress. The respondents' perspectives from the present study help government to prepare relevant public health strategies based on population-focused approaches for effective management of such a disaster. Aryal for their support in the finalization of this manuscript. All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted August 5, 2021. ; https://doi.org/10.1101/2021.08.02.21261480 doi: medRxiv preprint Tables/Figure Legends Table 1 Demographics of the participants Table 2 Thematic analysis of the interview data and selected quotes of the respondents (Theme 1) Table 3 Thematic analysis of the interview data and selected quotes of the respondents (Theme 2) Table 4 Thematic analysis of the interview data and selected quotes of the respondents (Theme 3) Table 5 Thematic analysis of the interview data and selected quotes of the respondents (Theme 4) Table 6 Thematic analysis of the interview data and selected quotes of the respondents (Theme 5) A flow diagram of the participants' recruitment for the qualitative interviews All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted August 5, 2021. ; https://doi.org/10.1101/2021.08.02.21261480 doi: medRxiv preprint Gender Issue in COVID-19 Pandemic Covid vaccine tracker: How's my country and the rest of the world doing? 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We declare that we have no conflict of interest.Ethical approval The ethics approval was received from the Institutional Ethics Review Board of the University of the Punjab, Lahore, Pakistan (Reference number: 183/DFEMS). Informed verbal consent to participate in the study was obtained from participants.