Fight pandemic fatigue with activity, structure

Experts offer advice for staying the course - Excerpt from Isabel Keane

As the pandemic worsens, and many grow tired of following restrictions, now isn’t the time to let your guard down. According to public health experts, “COVID fatigue” has contributed to the spike in positive cases in recent weeks.

In place of socially distanced outdoor gatherings, people may be tempted to escape the cold and spend the winter months indoors with their loved ones. Some are growing tired of wearing masks and following certain guidelines.

Wendy Keller, a practice administrator at Behavioral Health Services of the Hudson Valley based in Newburgh, New York, described the phenomenon the way someone might talk about running a marathon.

“It’s almost like we saw the finish line and now we’re realizing there’s a spike, and another wave is coming,” Keller said. “And we don’t want to accept that.”

Much like marathons – grueling and seemingly endless – getting to that finish line requires stamina. But it’s within our human capabilities, public health experts and psychologists say.

When what’s familiar becomes dangerous

Finding healthy alternatives to activities we once took comfort in is crucial as we see an increase in COVID-19 cases, experts say.

“Pandemic fatigue is not about people wanting to be jerks. It’s not about people wanting to harm other people. It’s about fear and denial,” Keller said. “It’s about desperately craving something that’s comforting.”

As a society we’re not great at delaying gratification – we want to feel good and we want to feel good now, Keller said. But in a pandemic, that’s easier said than done.

“We’re very used to instant gratification. If you have a question, you can Google it. If you want something, Amazon brings it to you two days later. We are not great at delaying gratification – and that’s really all we’re being asked to do while scientists develop a vaccination so we can be safe,” Keller said.

The newness of these changes – wearing masks, staying six feet from others and washing hands – has worn off. The adrenaline that kept mitigation strategies intact has been replaced in part with stress and anxiety.

“When you layer the pandemic with the political and social unrest that we have been faced with, people are more vulnerable to breaking rules and seeking out the things that would provide them with a sense of comfort. The things we’re familiar with make us feel like we’re in control,” Keller said.

Between being isolated and being unable to see an end in sight, many long for normalcy, but when we stop resisting that urge and go for what would provide us with a quick sense of comfort, we see spikes in cases.

“It’s important to remember that the cases we see now are the result of maybe two, three weeks or a month ago,” said Dr. Mark Kittleson, chair of public health at New York Medical College.

From a psychological perspective, riskier behavior like large gatherings where no one wears masks, or super-spreader events, are caused by the fear of losing what we once had, according to experts.

“We’re wanting to go back to the things that are familiar to us, rather than live in fear or admit that we’re still at risk,” Keller said.

Why our brains pardon risky behavior

Dr. Jen Buchwald, a clinical psychologist at the Hudson Valley Center for Cognitive Therapy, echoed that sentiment, noting other emotions often tie in with fear.

“If you think about the stages of grief, there’s denial, anger, bargaining, depression and acceptance. I think those stages really mirror what people are feeling,” Buchwald said.

“For people feeling anger, it’s a question of ‘who’s to blame for this?’ Or rather, they are angry toward their financial situation or so angry for people they know who have gotten sick or have died,” she said.

There’s also the bargaining stage of “well, if I do this activity, but don’t do that activity, am I OK?” she added, noting people tend to look at these situations categorically.

Viewing the pandemic as an everchanging situation is necessary, according to Buchwald. “People may be thinking ‘Oh, I was doing X, Y, and Z in the summer and I didn’t get sick, so I can keep doing that,’ ” Buchwald said. “But they may have been able to do those things safely when the infection rate was low. It’s important to be evaluating the infection rate in your area, and basing your calculations around that.” Stress and anxiety – two things we’ve seen no shortage of this year – also have an impact on the way our brains process the information we use to make our decisions.

“There’s a phenomenon studied in social psychology called cognitive dissonance and that’s when there’s a conflict of information that causes stress,” Buchwald said. “To dissolve that stress people choose one side over another.”

A common example of this?

“Someone who is a cigarette smoker hears about how smoking can cause cancer. That’s going to cause stress for them, and so they’ll either decide to give up smoking or that they’re not going to believe that smoking causes cancer,” Buchwald said.

When it comes to the pandemic, to relieve stress and dissolve anxiety, people will “basically convince themselves that either they themselves are not at risk or their family or community members are not at risk. They stop thinking about it in order to not feel that type of stress of anxiety,” she said.

Younger people especially are susceptible to this kind of thinking – and while they themselves are not at risk most of the time, experts warn of the possibility of spreading the virus, according to Keller. “But if they give it to their parents and their parents give it to their grandparent – who dies – they’re going to feel horrible. That’s a horrifying idea,” Keller said. “One of our defense mechanisms is to deny that. Who wants to think of that? That’s a terribly painful possibility and so we put it out of our minds. We tell ourselves we’re not at risk.”

Asymptomatic spread is a huge issue and cause of many coronavirus cases and deaths.

“So much about this virus is secretive – people could be walking around with a virus that could kill other people and not even know that they have it. It is depressing. It is a very natural thing to feel very sad about what’s going on,” Buchwald said.

There’s also the issue of not knowing how long the lasting symptoms or effects from the virus will stick around.

“And we don’t know yet if all those people are going to get totally better, or if it’s always going to be that way for them,” Buchwald said.

Another reason people might not be following public health and safety protocols? Sometimes our logic isn’t consistent with what’s backed by science and medical professionals.

“People don’t have any questions getting in their car, thinking it’s relatively safe, even though it was science that created the car,” Kittleson said. “And yet when it comes to things like vaccines people sometimes become skeptical. I don’t understand that logic.”

Keller added to this point, noting “trust is not something people are really feeling right now. You have to try to trust the institutions we have, like the Centers for Disease Control and Prevention and the Department of Health. I know it’s very hard to do in this social, political and economic environment – but follow their guidelines.”

Despite this, health professionals say there is reason to be hopeful, pointing toward vaccinations expected to be publicly available in 2021.

“There is an end in sight. And I think if we can focus on that, it makes it a little easier to make sacrifices today,” said Buchwald. “I think it’s helpful to think in terms of ‘at least this.’ Like, ‘at least we have technology,’ and ‘thank goodness there are people working in supermarkets and food delivery.’ ” “I think most people realize this is a serious infection out there,” Kittleson said. “You may feel handicapped to what you can do. It’s fairly simple: wear a mask, keep physically distanced from people, stay around familiar people, wash your hands. Those kinds of things can take care of an awful lot.”

Other tips from experts:

+ Get outside as much as possible.

+ “They say it takes a month, or month and a half, to form a new habit,” Kittleson said. “We use that same idea with a mask, but we can use it on our other habits, too.”

+ Keep structure. “Even though somebody may have less to do, it’s important to not sleep all day. It’s important to get dressed every day and go outside, even if it’s cold out,” Buchwald said.

+ In combating anxiety, what helps is a breath of fresh air. “When we get anxious we stop breathing. When we have masks on it makes that aspect of anxiety much worse,” Keller said. “Find a safe place, get away from people, pull down your mask and take a deep breath if you’re feeling anxious.”

+ Find creative, new ways to do things safely: utilize Zoom, or socially distanced activities while wearing masks. Connecting with people is important, and there are still ways to do so during a pandemic.

+ Pick up a new hobby. “I’ve been thinking about what it is that I’ve always wanted to do if I had more time, that I could do at home. Is that playing a musical instrument or learning a foreign language or painting? Even if it’s not ideal it’s important to have some activities like that,” Buchwald said.

+ Find healthy outlets and limit alcohol intake: “We’re seeing much more high functioning alcoholism,” Keller said. “Drinking in isolation is causal to depression.”

+ Exercise and avoid cabin fever. “We’re not meant to be cooped up inside. It’s important to be active,” Kittleson said. “And exercise can help depression immensely.”

+ Limit the amount of news you consume if possible – “Watching CNN for three hours and all they talk about is the pandemic can be pretty depressing. I don’t think we need to be constantly reminded,” said Kittleson.

+ Volunteer for a cause. “Help someone else out instead of worrying about your own comfort,” Keller said.

+ And remind yourself that this is temporary.