moderate or severe food insecurity. Severe food insecurity alone affects an estimated 38 million adults, or 23% of the adult population (Table S14). Using the pre-COVID-19 LSMS-ISA survey data, we can calculate household annual per capita income to generate consumption quintiles (see Supplementary Materials - Methods). Examining heterogeneity across consumption quintiles, poorer households (in lower quintiles) suffer significantly greater prevalence of food insecurity (Figure 2C). Further, there is significant heterogeneity in the prevalence of food insecurity, across countries (Table S15). Nigeria suffers from the greatest prevalence food insecurity where an estimated 76% of adults (63 million) are moderately or severely food insecure. This is followed by Malawi with 68% (6.2 million), Ethiopia with 47% (24 million) and Uganda with 33% (6.9 million). As with loss of income, there is a high degree of heterogeneity based on the gender of the household head (Figure S1B). Since the global pandemic began, female-headed households have significantly higher prevalence of moderate and/or severe food insecurity than male-headed households, though food insecurity is decreasing over time at an equal rate for adults in both types of households (Table S16).

Levels of concern are high across all four countries: an estimated 257 million individuals (78%) are concerned that someone will fall ill with COVID-19 and 292 million individuals (88%) are concerned about COVID-19-related financial threats (Table S17). Higher prevalence of food insecurity is associated with concerns about household health and financial status, especially in Malawi (Figure 2D). There is substantial heterogeneity in the degree of concern over health and finances based on food insecurity, initial wealth, and the gender of the household head. Those concerned about the financial threat of COVID-19 have a significantly higher prevalence of food insecurity than those unconcerned about financial threats (Table S18). At the same time concerns about household finances do not vary by the gender of the household head nor across pre-COVID19 consumption quintiles (Tables S19 and S20; Figures S1C and S2). The opposite is true for those concerned about household health: differences are not significant based on food insecurity, though male-headed households and households from the lowest two consumption quintiles are significantly more likely to be concerned about someone falling ill with COVID-19 than the relevant comparison group. This sort of variation provides no clear pattern regarding who is concerned about finances versus health and why, though it is clear that COVID-19 related concerns weigh heavily on individuals in many contexts.

**Households struggle to access medicine, staple foods, and education:** Since the closure of schools and the issuance of emergency stay-at-home orders, households have suffered a variety of economic shocks, including job loss, closure of a business, or the lack of availability of farm inputs. In total, an estimated 25 million households have suffered a virus-related shock to their income, around 42% of all households. This ranges from 26% of households (5 million) in Ethiopia to 56% of households (15 million) in Nigeria (Table S21). Households have adopted a number of strategies to try and cope with these shocks (Figure 3A). To employ a coping strategy a household must have previously experienced an economic shock; that is, our estimates for the adoption of each coping

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