Fighting COVID-19 Fatigue Along with Peers and Patients

"They're over it," said psychiatrist Jessica Gold, MD, of Washington University in St. Louis, to The New York Times. "Nobody's clapping anymore."

She's talking about the lack of adulation that's now noticeably silent, as healthcare workers try to muster the strength and will to keep dealing with COVID-19.

Then there are people who don't work in healthcare who are also over it—over being told to wear masks (many didn't ever wear them), socially distance, wash hands, and stay away from friends and family they don't live with (which seems to be the cruelest punishment of all during this past COVID year).

A November 2020 study in The BMJ found that a Google search for "pandemic fatigue" resulted in around 200 million hits. "Instead of using the concept of 'fatigue' to understand a lack of adherence to COVID-19 rules, we should focus on—and tackle—people's capability, opportunity, and motivation," the University College, London authors wrote in an optimistic note.

More broadly, the World Health Organization (WHO) has said that pandemic fatigue is an expected and natural response to a prolonged public health crisis, due to "implementation of invasive measures with unprecedented impacts on the daily lives of everyone."

The WHO recommends four key strategies for governments, which also have wide application in general:

• Understand people
• Engage people as part of the solution
• Allow people to live their lives, but reduce risk
• Acknowledge and address the hardships people are experiencing

With strong doses of "Yes, you can," The New York Times addressed how to build mental endurance like a pro, and asked top athletes how they've done it—able to embrace a special kind of exhaustion, able to push through beyond their pain threshold, and able to approach fatigue as a challenge, an opportunity. These takeaways from the athletes are good for any time we need inspiration, pandemic or not:

• Pace yourself and embrace discomfort. Take control of daily habits. Always have a little in reserve.
• Create mini-goals that makes it easier to adapt.
• Create structure. "You need to get up in the morning knowing you're going to make something happen."
• Focus on something new: a new hobby, a new goal, a new experience. Adapting, adjusting expectations, and discovering new goals or hobbies can allow you to continue to build the muscle that is mental toughness

Five Helpful Tips for Healthcare Professionals

When it comes to the nuances of standing up to COVID—or not—differences between healthcare professionals and the public are pretty clear, says Amy Locke, MD, Chief Wellness Officer at the University of Utah Health and a professor of preventive medicine.

Let's see how your fellow healthcare professionals are dealing with COVID fatigue, and consider their advice when it comes to managing your own COVID fatigue and that of your patients—both tall orders right now:

1. Get tough about long-term needs. Locke says she knows you really dug in initially, and now you're still in a challenging situation that doesn't have a foreseeable end. "It's a time of unusual intensity and duration of a traumatic event, and we have to ask 'What do I need to stay in this for the long haul?'"

The only antidote to "pandemic fatigue" is "pandemic stamina," says Eric Toner, MD, with Johns Hopkins Center for Health Security.

2. It is about you, too. Self-care is often touted as one key component here, and that includes physical movement, quality sleep, spending time with family—and yes, healthcare professionals working 60- to 80-hour weeks undoubtedly may not be able to do that. Try to find the way and the time, Locke says. For her, cooking is a mainstay, and she even teaches a culinary medicine class.

That old adage about "putting the oxygen mask on first" is true, adds Claude Ann Mellins, MD, in the department of psychiatry at Columbia University Irving Medical Center, and a professor of medical psychiatry. Take breaks when you need them—if you actually can, of course—and do what works for you when you leave work, whether it's running, meditation, or yoga.

Asking for mental help during these admittedly rough times is a good thing—a sign of strength and not weakness, she says.

3. Connect, open up, and listen. "In the middle of a crisis, it's easy to forget about your own resilience and coping skills," Mellins says. Brainstorming together may reveal a range of things different people find helpful, so make the most of connections at work. Actually being vulnerable and admitting "It's been a really tough week" can help increase your comfort, Locke says, especially if you're one of many people experiencing loneliness. "Create a space to build community in a team setting, and then do check-ins with the team."

Locke adds that her team has been doing training and validation—validating thoughts and feelings someone else is experiencing. "We [as medical professionals] are not trained to sit with discomfort," she says. "It's more like, 'This is wrong with me, so if I do this and this it will be fine.' [But] nothing magically makes COVID go away."
The art of sitting and listening actively can be "super powerful" for the person you're talking to, she says. "It can make it easier to stick with the discomfort of not being able to change a situation."

4. Be here now. “When so many people are still suffering, it may be difficult, but try to be grounded in the present and allow yourself to feel what's going on now,” Mellins says.

Remember what is valuable to you about your job, and what's important in life, and think about the things that bring you joy, she says. It may take creativity on your part, but try to spend a few minutes each day doing this.

5. Give yourself and your colleagues space. At Columbia, a remarkable peer support program called CopeColumbia is available for providers, staff, and faculty at the downtown campus. Per the website, it "provides information and resources for the CUIMC community, including counseling sessions, peer support groups, guided meditations, suggested reading, and other resources for managing stress, fear, and anxiety."

Mellins says she understands that staffers need a space to recognize the range of emotions they are feeling and will feel, from anger to sadness, to feelings of loss and trauma—they're seeing so many people dying. Often their reality is one of being the only connection between patient and family, who are saying goodbye with a digital device—and that's incredibly difficult.

Five Tips for Helping Patients Cope

They may sound like a broken record, those messages about what to do to prevent the spread of COVID-19. Still, back in November, one in three parents felt the benefits of gathering with family for Thanksgiving were worth the risk of spreading or getting the virus. Yes, really.

That's according to the Mott National Poll on Children's Health, published November 23. It's also a sure sign of ongoing pandemic fatigue, and it requires some skillful rebuttal on the part of healthcare practitioners. Try these tactics of gentle, purposeful persuasion with your patients:

1. Remind them: This time, it's about more than you. "Everyone in healthcare is pretty clear on what needs to happen to get this [pandemic] done, but for some in the general population, it may feel like 'If I put my head in the sand, and not think about it, maybe it'll go away,'" Locke says. But it won't.

"It can be hard to focus on other people's health as opposed to my own wishes and desires, so really thinking about how wearing a mask helps me and my family in addition to helping community is a good frame of mind to have," she adds.

Try this approach, Jeni Stolow, PhD, MPH, at Temple University College of Public Health, told The New York Times. Suggest patients change their perspective, like this: "Don't say, 'I can't see my grandmother, and I miss her.' Instead, you should say, 'I'm protecting my grandmother because I love her.'"

Mellins told ABC News that everyone needs to identify the positive reasons for doing what they do to help, because that makes them more likely to engage in healthy behaviors—seeing a means to an end. It's much more effective than shaming, even though it's easy to want to shame someone who's not doing what we think they should do to help keep themselves and others safe.

2. Share healthy coping strategies. Try to check in with how patients are doing and coping, asking what strategies are working, and also discuss strategies that are working but not really sustainable, Locke says.

"Healthy coping strategies are those that people can rely on when things get really rough," she says. "When people say they'd like to 'do these 'big' things,' sometimes they're risky things to be successful and make it through this process that can come from a place of being really tired—like 'I can't do this anymore.'"

The more strength you can help patients develop to manage in a sustainable way, the more likely they'll get through the period of COVID fatigue. "It's better for them to have reasonable expectations," she says.

3. Let them acknowledge how they feel. This includes frustration, but remind them they can't let up on messages around masks, social distancing, and more, Mellins says. Help them figure out what they need to stay grounded—brainstorm in the same way you would with fellow providers.

4. Encourage them to get out and about. Help them figure out how to socially connect in other ways, Mellins says. Even though temperatures have been cold all winter, they can try to be outside in the sunlight and see other people (and warmer weather is on the way).

5. Ask them to look around. It may seem like a given, but in times like these, UW Health psychologist Shilagh Mirgain, PhD, reminds us all to have a radical acceptance that life may continue to be difficult for a while longer and to find the silver lining. That might include looking for activities new and old that continue to fulfill us, just as those determined athletes shared earlier.

Mellins also cites an apropos quote from concentration-camp survivor Viktor Frankl: "An abnormal reaction to an abnormal situation is normal behavior."

In other words, everyone's doing what they think they should be doing, and everyone is different. With a little creativity, and a lot more determination, we will make it past "fatigue" to "being OK" and hopefully, finding more joy.