Sood S, Kalra M. Pandemic fatigue: a global challenge Harvard Public Health Review. 2021; 31.
The first pandemic of the social media age, Coronavirus disease (COVID)—2019 pandemic, hit humanity hard on all fronts by surpassing the similar 2003 SARS outbreak in numbers and severity (Sood, 2020). The widespread nature of COVID-19 soon forced all nations to impose strict precautionary guidelines and quarantine measures to restrict the escalation of infection and death toll. Multiple countries went into lockdown, limiting social interactions and confining people to their homes. People were hopeful that the pandemic would fade away as the year ends and as vaccines are rolled out, thus making life slowly shift back to normality. However, increasing knowledge of the virus and disease suggest otherwise.
The World Health Organization (WHO) introduced a document titled “Pandemic fatigue: Reinvigorating the public to prevent Covid-19” in October 2020 and defined the term ‘pandemic fatigue’ to indicate the widespread feeling of distress and exhaustion in the entire population as a reaction to a prolonged state of crisis whose end cannot be foreseen (World Health Organisation [WHO], 2020a; Sukumar, 2020). The term has since then been used interchangeably with ‘quarantine fatigue’, ‘behavioural fatigue’, and ‘lockdown fatigue’. It is understood as a feeling of demotivation to follow recommended protective measures, emerging gradually over time and affected by a number of emotions, experiences, and perceptions. (WHO, 2020a). In October 2020, the Director General of WHO spoke of pandemic fatigue as “Working from home, children being schooled remotely, not being able to celebrate milestones with friends and family or not being there to mourn loved ones — it’s tough and the fatigue is real” (Sukumar, 2020). Moreover, in October, a Google search indicated around 200 million mentions of the term “pandemic fatigue” and currently, the figure has risen to over 240 million. It is a term that has entered both the academic and the popular lexicon in 2020 and continues to do so in 2021 (Reicher & Drury, 2021).
Pandemic fatigue has impacted people of all age, gender, and ethnicity. With ever changing guidelines to COVID-19, people have relapsed and have become complacent in social distancing, mask wearing, and handwashing. Explanation for falling off the bandwagon comes down to two important predictors of health behaviours. First, the perceived susceptibility, which is how likely do people think they are to get the disease? The second predictor is of perceived severity, which is, if they do get it, how bad do they think it will be? (Maddock, 2020).
The enforcement of lockdowns early on in various parts of the world, with additional restrictions on social gatherings, closing of public places for work and socializing, led people to be confined to their houses. While this was a good practical measure to flatten the curve of spread, supplemented with compulsory masking, it majorly disrupted the daily life functioning of all people. Implementation of work from home policies led to blurring of work-life demarcation and fragmented work hours. The home to workplace distance suddenly shortened to bed -to-desk. There was no clear demarcation of personal and professional commitments, which resulted in tasks interfering with each other and putting extra demand and effort on the mind and body (Badre, 2021).
Social isolation increased feelings of loneliness, especially in the older population and those living away from family. Even though technology served a major role in keeping people connected despite being miles away, the ‘zoom fatigue’ and ‘social media fatigue’ eventually kicked in. As time passed by, the initial enthusiasm and eagerness to tackle the pandemic wore off and got replaced with feelings of exhaustion (Murphy, 2020; Sood, 2020).
During the first wave, the emphasis was to ‘flatten the curve’ followed by a quick return to normal. However, with multiple newer and faster spreading strains (South African variant – B.1.351, Brazilian variant P.1, UK variant B.1.1.7, to name some) having been found in different parts of the world, it has become essential to re-impose lockdown and quarantine measures (Centers for Disease Control and Prevention, 2021). The United Kingdom’s second wave with a mutant COVID strain (B.1.1.7 or VUI202012/01) has led to imposition and extension of national lockdown till 31st March 2021. The variant has now spread to multiple other countries like India and Australia, causing a re-emergence of the strict pandemic life (Rai, 2021; WHO, 2020b).
Long term inactivity of local businesses during COVID-19 had an impact on the financial sector, which led to shutdown of local businesses, or resorting to non-compliance with distancing and quarantine measures to keep the businesses running. The general population comprising primarily families and parents felt added fatigue having to home-school and look after children, often in the same setting as their work from home (Durkin, 2021). Limited interactions with colleagues in the hospitals to prevent the inter-departmental spread of infection, in addition to the ‘pandemic work fatigue’ due to overburden of guidelines and infected patients have led some healthcare professionals to become lenient. Students, whose universities and schools shifted to online classes, are experiencing their own set of struggles and fatigue from sitting in front of a screen for hours together, without any interaction with peers (Labrague & Ballad, 2021). It is important to understand and reflect on all of the ways in which pandemic fatigue has entered the society, so that we can aim at the root causes while formulating solutions.
People who have been infected with the virus are more likely to become complacent as they may believe they are well protected and naturally immunized to the virus (Gavi, The Vaccine Alliance, 2021). However, research shows that natural immunity might not last long and might lead to cases of re-infection and rapid spreading of the virus, sometimes with no show of symptoms (Gavi, The Vaccine Alliance, 2021). Of late, rolling out of the vaccines has caused consistent decline of preventive measures further adding to a show of fatigue and letting go of safety practices. As the number of vaccinated people increase, more people are seen avoiding washing hands, maintaining distance, and even using face masks.
Pandemic fatigue is an obstacle in the pathway of eradicating COVID-19 from the world. Despite the rising number of cases in the United States of America, crowds of people have been flocking to Florida, the premiere destination of spring break, which reopened months before other states. The state is believed to have the highest concentration of B.1.1.7 strain, yet it does not deter the spring-breakers whose patience has been worn down due to fatigue (Kitsantonis & Patil, 2021; Aratani, 2021). The timing of spring break combined with the more lethal strains currently surfacing has the potential to exponentially spread the virus. This would hamper the global trajectory towards vaccination-induced herd immunity. Even though vaccines are in the process of rolling out, scientists and researchers claim that it will take time to establish population-wide effects of immunization and to understand whether vaccinated people can no longer spread the virus to unvaccinated people (Mallapaty, 2021). There is also uncertainty around how long immunity to the virus will last after a person is vaccinated (Mendes, 2021). Surveys conducted in different countries show that current levels of willingness among people to accept a COVID-19 vaccine is insufficient to achieve herd immunity and varies across different geographical locations (Lazarus et al., 2020). This unwillingness also relates to misinformation on social media surrounding the importance, safety, and efficacy of vaccines, which can build on pre-existing fears, instilling doubt and insecurity amongst the public over the new vaccines (Loomba et al., 2021).
Amongst all this uncertainty, it is crucial for the population to not drown in the wave of pandemic fatigue and adhere to basic preventive measures, such as handwashing, social distancing, and mask wearing. The knowledge that we have from previous pandemics accounts for the fact that non-pharmacological interventions have been pivotal to control the spread of various pathogens. It is worth noting that vaccines were not developed in time to combat the 1957-1958 and 1968-1969 influenza pandemics and non-pharmaceutical interventions such as closing of schools, places of worship, restaurants, along with mask wearing and hand washing were encouraged back then to help stop the spread of the virus (Beach, Clay & Saavedra, 2020). Thus, the fatigue can have significant implications for the pandemic health policies moving forward.
Enforcements may be counterproductive for a population that is already facing pandemic fatigue. Rather than limiting social interactions altogether, it is important that people understand and learn ways to have socially distant interactions. The concept of ‘social bubbles’ or ‘social pods’ or ‘quaranteams’ are quite popular as they provide some sense of normality (Block et al., 2020). Social bubbles refer to a group of people who are a part of that circle and do not interact with persons outside of the bubble. This ensures that the chain of infection spread is never developed, and a safe bubble remains (Block et al., 2020). Secondly, it will also be beneficial to create awareness of low and high-risk activities. Risk cannot be mitigated altogether in a fast spreading pandemic like this one, therefore it is better to introduce the concept of ‘acceptable risk (WHO, 2020a). Attending large gatherings, eating inside restaurants, air travel, are some high-risk activities that should be avoided. While going hiking or running, going to a park, drive-in movie theatres, are relatively low risk examples (WHO, 2020a). Thirdly, with another infection wave hitting various parts of the world, guidelines and suggestions on living with reduced risk of transmission should be made. This will help in keeping the spread of COVID in check while also allowing people to live a new near-normal life (Badre, 2021). Fourth, leaders across organizations at the federal, state, and local levels, belonging to administrative, public health, academic, and medical domains must encourage practice of safety measures through effective strategic communication and propagate accurate scientific information via social media platforms (Vergara, Sarmiento & Lagman, 2021). More ‘localized’ public education and role-modelling from public officials and health authorities can help in building public trust in the vaccines. Voluntarily subjecting themselves to vaccination, authorities will increase the level of trust among people since sincerity for the vaccine safety will be visualized (Vergara, Sarmiento & Lagman, 2021). Fifth, reopening of public places needs to be done in phases as the vaccines are rolled out (WHO, 2020a). However, the onus is on the community and people to adhere to the guidelines, to take the pandemic seriously, despite their caution fatigue.
Whilst the public is being overloaded with information and changing guidelines, it is imperative to engage people as part of the solution. Engaging people from the general population to deliver messages and promote protective behaviors will act as a social norm and will more likely gain attention and support from the public. WHO (2020a) has rightly described the essentiality of having a positive approach, changing the delivery of key messages from “the pandemic controls our behaviors” to “we control the pandemic with our behaviors” and from “do not” to “do it differently.” The pandemic may have begun as a battle between the frontline workers and the coronavirus, but the war soon moved to the community. It is essential to understand that even though vaccination rounds have begun, the basic safety practices should still be adhered to till more data on herd immunity, and antibodies of vaccinated people are obtained.
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Dr. Sadhika Sood is a recent MBBS graduate from Kasturba Medical College (KMC), Mangalore, Manipal Academy of Higher Education. She currently works as a resident medical officer and clinical attache.
Currently studying Masters of Public Health at University of Sydney and working as a health quality assessor in the Aged Care sector.