COVID-19 Q&A: Jason M. Harley on dealing with pandemic fatigue

"We need to strike a balance between taking our anxiety down from an unhealthy to a manageable level. The trick is staying realistic and responsible about the risks in the process"

After following all the COVID-19 guidelines issued by government officials and medical experts over the past five months, do you find you are letting your guard down a little? Are you washing your hands less thoroughly, and relaxing social distancing around family and friends? McGill’s Jason M. Harley, says you may be experiencing “pandemic fatigue” – and you are not alone. In this Q&A, Harley looks at the way pandemic fatigue manifests itself and the strategies we can employ to renew our energy, physically and emotionally

Harley is an Assistant Professor, Department of Surgery, at McGill; Junior Scientist at the Research Institute of the McGill University Health Centre; and Director of the Simulation, Affect, Innovation, Learning, and Surgery (SAILS) Lab. They are also an Associate Member of the Institute for Health Sciences Education and the Department of Educational and Counselling Psychology at McGill.

What is “pandemic fatigue,” and how does it manifest itself?

Experiencing emotions like anxiety is taxing, especially over a long period of time. That’s why so many of us are feeling emotionally and motivationally exhausted, presently. As a result, some may also be paying less attention and engaging in less or less careful pandemic precautionary behaviours like washing our hands and social distancing.

Heightened vigilance is not easy to maintain, even over a relatively short period of time. After 4+ months of social distancing and sometimes severe restrictions, many Montrealers have let down their guard. Is this normal, especially when one considers the shocking number of Quebeckers who have lost their lives or been hospitalized by COVID-19?

Great question. Let me answer it in two parts. Let’s start with ‘normal.’ For many, experiencing prolonged periods of stress is not normal. To be sharing a prolonged period of stress collectively, not only with fellow Montrealers, Quebeckers, and Canadians, but with people across the globe isn’t normal either. In other words: the psychological landscape isn’t a typical one.

Jason M. Harley

That said, we aren’t strangers to dealing with stress and the fatigue it creates. One of the challenges with the pandemic is that some of the strategies we might normally use are not necessarily good candidates for dealing with pandemic fatigue.

For example, an effective way of dealing with anxiety can be to change how we’re thinking and focusing on the control we have over a situation, including our expectations to deal with that situation effectively. When COVID-19 first appeared, many of us probably reminded ourselves that we could protect ourselves and others by engaging in social distancing and other measures. Such reminders stood to help us combat anxiety by reminding us there were concrete things we could do.

Months later, however, that same emotion regulation strategy (changing how we’re thinking about our control over a situation) that helped take us from freak-out to chill-out can work against us. We might tell ourselves, for example, that if we didn’t get sick our strategies were over-kill and that maybe we could get away with washing our hands less or being less attentive to social distancing.

Basically, we need to strike a balance between taking our anxiety down from an unhealthy to a manageable level. The trick is staying realistic and responsible about the risks in the process. In psychology, we talk about something called the Yerkes-Dodson law where a little bit of anxiety can help motivate us to behave responsibly but too much isn’t a help.

For example, a little anxiety can help motivate us to make sure we’re properly washing our hands and not just running water over them. Too much anxiety, on the other hand, can lead us to washing our hands raw. Similarly, not experiencing any anxiety when some concern and care is warranted might feel good but won’t help prevent us from spreading COVID-19 to our friends, family and co-workers.

When it comes to the pandemic, that means staying up-to-date enough to know what we can do, when, and how to keep ourselves and others safe. Having facts and guidelines to work from can help keep us from feeling powerless while also avoiding the temptation of overconfidence. After all, throwing caution to the wind after months might feel great, but there’s a gap between how we feel – or want to feel – and the facts. That distinction is one that will be important for us all to keep in mind.

As the pandemic grows longer, will this exhaustion grow more acute? If so, will it be increasingly incumbent upon the government to mandate safety measures, such as mandatory masks in indoor public spaces, as people grow weary?

Exhaustion has the potential to grow more acute and with it, waning compliance with safety measures. Broadly-speaking, we know that people tend to respond best, motivationally, to following recommendations they believe in or agree with and for causes they value. Therefore, continuing to invest in public advertisements and initiatives to clearly explain to the public the current state of COVID-19, particularly as things evolve, to the public and the important role we can all play to help protect ourselves and others remains critical – especially to keep people realistic and avoid over-confidence.

But is that always enough? For everyone? Unfortunately, the answer seems to be no.

Many people recognize the importance of protecting themselves and others from COVID-19 and will actively seek out best practices from health agencies and the news. For some, however, those good intentions might not be reliably translating to attentive behaviors anymore. And for others still, they may believe they aren’t at risk and therefore pay little heed to best practices. Concrete public safety rules can act as a motivational safety net to encourage the otherwise un-motivated and under-motivated to respect public health guidelines, such as mask wearing.

Given the context, including the stakes, taking a two-pronged motivational approach is therefore likely to be most effective for reaching and inspiring continued change for a broad and varied population. Such an approach requires easily accessible information to educate and appeal to our good natures but also rules to help sway the stubborn. The former is likely to be effective for most while the second serves as a motivational safety net.

Since less vigilance can spark a spike in COVID-19 cases, are there strategies people can employ to renew their energy, physically and emotionally?

The best way to deal with pandemic fatigue is to remember to be kind to yourself and others. To remind yourself of the good things that happened every day, even if they are small so we don’t focus just on the bad. To remind ourselves of what’s under your control and to avoid catastrophizing. To takes breaks. And set reasonable goals – with other stakeholders whenever possible – that account for ourselves and others having less energy.

How important is health literacy to combat this complacency? Are people who are more informed less likely to let their guard down? Or are we being overwhelmed by information (and misinformation) to the point where we stop hearing the message anymore?

Health literacy is an essential part of managing the pandemic. That means being critical and reflective about the quality of sources we’re consuming, potential biases (our own and others’), what we’re considering, AND what we’re discarding. Developing good habits about what and how we consume health-related information can help us avoid filling in gaps in our understanding with overconfidence rather than fact.

To help improve your health literacy, ask yourself: Am I changing my behaviours? And why? Or why not? What’s the evidence? Who is presenting it? What are their credentials? Am I doing what feels good or is a good argument or expert source guiding me? In the long run, caution now makes for a happier more hopeful future.

My lab and I are currently working on a Social Sciences and Humanities Research Council of Canada (SSHRC)-funded project that involves the creation of multimedia videos that leverage story-telling, animation, humour, and educational resources and research to teach people about the role of emotions and media literacy in supporting health literacy during the pandemic. These resources will be publicly available in the coming months to help people enhance their health literacy during the pandemic as well as other health issues.

Given the protracted nature of this pandemic, how are healthcare workers faring? Are we seeing more cases of burn out? What are some of the more effective coping strategies healthcare workers can employ to combat stress and anxiety?

The pandemic has created a tremendous demand on healthcare workers to come up with new protocols, identify resources for those protocols, and rapidly implement them – all the while coping with stress about catching COVID-19 themselves and passing it along to their loved ones. Burnout is a concern for our healthcare workers and it’s critical that they feel appreciated and supported. It’s more important now than ever that healthcare professionals recognize that experiencing anxiety is normal, avoid isolation and rumination, and feel comfortable and safe reaching out for support, whether that be to friends, colleagues or counselling services.

Another research project I’m leading is one seeking to identify opportunities to better support healthcare professionals’ psychological wellbeing with a special focus on personal and institutional sources of support as well as coping strategies. This project is supported by the McGill Interdisciplinary Initiative in Infection and Immunity (MI4) with fellow psychologists Drs. Montreuil (co-PA/co-lead), Lou, and Physicians Drs. Feldman, Fried, and Bhanji, and Nurses Drs Drouin and Lavoie-Tremblay. We’ve recently completed data collection and look forward to sharing our findings.

I would imagine frontline healthcare workers don’t run the risk of complacency, but what kind of impact does it have on them when they see others letting down their guard?

Thank you’s can go a long way to making a healthcare worker’s day brighter. Not following public health guidelines doesn’t help the psychological wellbeing of anyone, perhaps least of all, our healthcare professionals who are working incredibly hard to keep us safe and reduce the impact of COVID-19 as much as possible on non-emergency healthcare.

Similarly, we can help reduce the stress of healthcare professionals by recognizing our own anxiety and trying to prevent it from bubbling out as irritability or anger in our interactions with them. We all have a role to play in combatting COVID-19, it’s critical that we don’t let pandemic fatigue blind us to the risks, suffering of those affected, nor those working tirelessly to keep us safe.

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