‘COVID Fatigue’ and ‘COVID-19 Caution Fatigue’

By Dr B. J. C. Perera

Specialist Consultant Paediatrician

Physical fatigue, marked muscle aches, weakness of the body and bodily exhaustion are well-recognised clinical features of COVID-19 disease. Some patients feel really ill, lifeless and have severe muscular and joint pains during the acute illness. In some of them, these effects last a long time, even after recovery. By now, all these things have become well-known and sort of ‘old hat’ type of details of the actual disease.

However, the terminology of the title of this article, COVID Fatigue and COVID-19 Caution Fatigue, DO NOT, I repeat, DO NOT, refer to the physical effects of the illness. These really denote some of the mental effects and their repercussions in those who have not contracted the disease, but are being constantly bombarded and reminded, especially over mass media, of the implications of the disease itself. These may also result in certain undesirable behaviour patterns on the part of those who exhibit these phenomena. The medical circles are just beginning to see the significance and the importance of these manifestations with regard to the current scenario.

COVID Fatigue is a new phrase that refers to the general thoughts and psychological feelings that many people get of being mentally tired, discouraged, and even disgusted by everything that is going on with their lives that are being dictated to by this tiny coronavirus. This includes being isolated and preached on for so long that they have become totally sick of hearing these mantras, over and over, again and again. In some cases, the reaction on the part of some people have been one of irritation, intolerance, resistance, leading to even non-compliance. Some have given up on masking, regular washing of hands, physical distancing, and generally in all forms of self-protection. This type of risky behaviour and disregard for the health rules is an unwholesome way through which people try to cope with the stress that is piling up. Though this kind of behaviour may provide one with short-term relief, it is not truly beneficial and may even lead to disastrous results.

The COVID-19 Caution Fatigue is a related phenomenon that has slightly different connotations. When the pandemic began and lockdowns were ordered, many people were tremendously energized to do their very best and help to reduce the spread of the disease. They were an absolute model lot. However, months of isolation, all kinds of restrictions and the ever-present anxiety have drained people of their motivation. It has caused many to become less strict and less concerned about following the guidelines issued by the health authorities. They have become sort of immune to being constantly reminded of all kinds of cautions and restraints. They have become quite a bit nonchalant about the statements advising caution. It has led to a kind of ‘fatigue of caution’ after being cautious about the disease for far too long. Many people can only remain vigilant for so long before they start to become exhausted and throw caution to the winds. These could become the straws that finally break the camel’s back.

Ultimately both these components end up in a single common final pathway which may induce the public to assume a blasé attitude and take things for granted. It may appear to be the case that these affected people could not care less. In another perspective, they may sometimes even be tempted to behave like COVIDIOTS; yet another newly introduced terminology which is a kind of a slang-word, combining ‘covid’ and ‘idiots’. It describes some people who cause many a problem by going against the very grain that is designed to ensure their safety and freedom from the virus.

The problem with those who suffer from COVID Fatigue and COVID-19 Caution Fatigue is that they start to lose interest in life, stop enjoying the joys of living, give up general happiness with things around them and get into a state where they do not get any satisfaction from life. They may also become so disgruntled as to exhibit some irrational behaviour patterns. This could affect even highly educated and intelligent professionals but for clear socio-political and economic reasons, they are a lot commoner in the lower social strata. People who have all these problems may respond in one of two ways. Some may take the path of resolute resistance and fight back against society and the restrictions imposed. Others may become rather indifferent and get inevitably committed in their mindsets to any and every unfortunate eventuality that may come their way.

The coronavirus itself may be novel, but the outbreak is stirring up some very fundamental instincts in people. A keen sense of warning and coping mechanisms that have been with humankind since the dawn of time are also programmed to induce fear and anxiety. According to mental health experts, feeling worried in such a situation is absolutely normal and even healthy. This evolutionary trait has stuck around for millions of years because it alerts us in times of danger and prompts us to come up even with newer survival skills.

The catch is when anxiety becomes somewhat disproportionate to the situation. It can turn into intense fear or a feeling of hopelessness and it starts to interfere with our day-to-day lives and wellbeing. Following official instructions, things such as staying at home, social distancing, washing of hands, etc., become important to people because it engages problem-solving behaviour. But the uncertainty of how long this situation will last, the constant stream of new information and the social isolation, all create a fertile ground for escalating anxiety. It is important to realise that panic, could also be contagious. The biggest problem at the present time is that there does not seem to be any decent light at the end of the tunnel.

To get through this time as efficiently, serenely and healthily as possible, it is important to be familiar with some ways to calm ourselves. It is quite essential, to try and ward off such mental complications brought on by utter despair and try to get on with this ‘NEW NORMAL LIFE’. In that context, there are some possible coping mechanisms to try and mitigate the effects of COVID Fatigue and COVID-19 Caution Fatigue.

For a start, staying informed does not mean that one has to be perpetually connected and follow live news 24/7. It can really become exhausting. Turning the push notifications off on news apps can help relieve some of that pressure. It is necessary to choose just one or two reliable sources, and keep track of their updates at allocated times once or twice a day. It is also recommended to set a specific length of time for social media to avoid getting caught up in it, which is often, very likely to increase anxiety. Of course, it is not possible or recommended to completely bury your head in the sand and be totally oblivious to what is happening. One is bound to see some unnerving headlines on social media and in news reports. It is essential to remind yourself that a lot of it is speculation and not fact. A concerted effort must be made to follow the clear instructions of the health organizations and try to avoid news headlines that do not contribute to your wellbeing.

One should not be deterred if the exercise or dancing class that one is enrolled in is not taking place at the moment or your regular walking sessions in the designated exercise sites are impossible because of locked-in situations or curfews. Aerobic exercise is known to allay anxiety, especially if it was already a part of your usual routine. Practicing a dance routine, exercise sequence, or yoga are all healthy ways to keep your mind distracted and channel your adrenaline elsewhere. You can turn your garden into a workout area, or move around some furniture in your living room for the purpose.

For some people, it is not just the prospect of catching the virus itself that is causing stress, but the feeling of emptiness and the disruption of daily routines. You need to connect with others. Staying indoors means being by yourselves, or with your family or housemates for a much longer period of time than you are used to. Some might be asked to self-quarantine, but that does not mean completely isolating yourself from your social contacts, apart of course from physical isolation. Maintaining human interaction at such times is very important. Being able to express your thoughts concerning the virus, exchanging opinions and even making jokes will make you feel supported and make it easier to overcome the anxiety. Humans are social beings, wired to be loved, to love, to belong and of course, to meet in-person. It is no wonder that people are finding physical distancing so difficult. In such a case, technology is quite a blessing: call people via a telephone, have a video chat and check on your friends and acquaintances as frequently as possible.

One also needs to guard against certain things that may accompany these changes in the mental status. Spiralling into undesirable and even destructive behaviour is easy when confined to your home. Sleeping in and walking around in your night-clothes might feel nice for a couple of days. However, if it is to be done for days on end and perhaps even for weeks, it will only increase anxiety in the long run. Try to keep the sleeping routine as consistent as possible and get at least eight hours of good-quality sleep. Wake up at a reasonable time in the morning, change out of your night clothes and set a structure for yourself. Work or study from home if possible, cook for yourself and the family, and eat three proper meals a day.

Many experts advocate focusing on the immediate future so that uncertainty about the longer-term outlook does not make one feel hopeless and helpless. However, it is also important to work against the ‘current-moment’ type of biases during the pandemic. Avoid the temptation to do something that brings you pleasure in the moment without acknowledging the risk it may pose in the future. In the case of the pandemic, this could mean going to a large group gathering in your lane without thinking about how this may affect the spread of COVID-19 down the lane. It is hard to assess the perils and risk, especially when the risk is invisible, like the coronavirus and most of the infected people are symptom-free. One needs to find a balance; an equilibrium which may mean less pleasure in the current moment, but more risk mitigation in the future and put risks into their proper perspectives. It may be hard to stay committed to goals like improving public health by staying home, because they are so abstract and can often seem to have no effect on one personally. However, it is necessary to reframe this thought to acknowledge how your behaviour could increase the chance of you or your loved ones getting sick.

In the current scenario, when anxiety takes over a person in a sort of big-time way, it can feel like as if this catastrophe will never end. But it always does end. Remember the Spanish Flu of 1918 which killed over 50 million people? There were no effective anti-viral drugs and there was no vaccine. However, although the scientists are not quite sure as to how it happened, the epidemic died out within about two years. The current pandemic is a worrying time for almost everyone, but this situation is temporary. Be kind to yourself and your loved ones. It may sound rather optimistic, but we will overcome this together.

Finally, people need to be warned against falling into “thinking traps” such as the assumption that since you have not been sick, you will not get sick in the future, or convincing yourself that an outing is necessary when your motivation behind it may just be boredom. Now is not the time to let our guard down. For the good of everyone’s health and the well-being of the country, we need to do our part to maintain an appropriate level of caution and try our very best to re-flatten the curve. Indeed, sanity must prevail, through sheer necessity of course. Come rain or sunshine or this miserable corona, life must surely go on.