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Now Is the Worst Time for Covid-19 Fatigue

Scientists fear an exhausted nation will let down its guard just as cooler weather raises risk of a twindemic

Photo: picture alliance/Getty Images

“Are we there yet? Are we there yet? Are. We. There. Yet?” That’s how Andrea Taylor, PhD, describes her own growing exhaustion with the Covid-19 trip we’re all on right now, the frustrating and inconvenient detour in the journey through the longest year ever.

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While the growing and horrific U.S. coronavirus death toll exceeds 200,000, Covid-19 fatigue is spreading even among people least affected by the pandemic, according to more than a half-dozen experts interviewed for this article.

The common sentiment: “Boy, do I really need some contact with people, and some normalcy,” says Taylor, a clinical psychologist and assistant professor at the University of Texas Health Science Center at Houston.

“A mood that ‘we’re past this’ is palpable and worrisome,” says epidemiologist Saskia Popescu, PhD, an adjunct professor of public health at the University of Arizona, who sees the fatigue turning to complacency already, in a trend of fewer people wearing masks. “After nine months and a lot of failures in response, people are tired and it’s hard to stay vigilant. Now though, it is more important than ever.”

With the high season for viral transmission looming, scientists worry Covid-19 fatigue and a resulting complacency will help the virus spread more than ever as people migrate indoors, take more risks, and otherwise let their guards down. While scientists can’t predict whether this year’s flu season will be mild or severe, concern is brewing over a “twindemic” that could overload the health care system.

Changing view of risk

Covid-19 fatigue is causing people to change their cost-benefit analyses, perhaps making more trips to the grocery store or planning a holiday gathering that would have been unthinkable in the spring. This is how our brains deal with risk, says Kaye Hermanson, PhD, a clinical psychologist and assistant professor at UC Davis Health. Imagine you’re in a car crash. The next time you drive, you’ll be anxious. But with each successful trip, your brain can unlearn the danger and you start to feel safer behind the wheel. This psychology works even on psychologists.

“After seven months of going to a hospital every day, I don’t really think about or worry about getting Covid-19,” Hermanson says. “I’ve gone to the grocery store and been fine. I’ve gone to work and been fine.” She still takes precautions, of course, but each time the bad thing doesn’t happen, she says, it becomes easier to discount the threat.

But now there’s a big problem: We’re not winning this war, and that’s affecting the motivation to fight.

How ardently people continue to fight the invisible enemy called the coronavirus will depend on each person’s view of the pandemic, says Jed Magen, DO, a psychiatrist at Michigan State University.

“If it seems that there is not a lot of risk in the community, you are likely to be less vigilant,” Magen says. “If it seems like there are a lot of cases around and/or you know someone who becomes ill, you are probably going to be a lot more likely to be careful.” It’s also vital that political leaders set good examples on prevention efforts and give an honest portrayal of the risks of Covid-19 and hopes for a vaccine, he says.

“We can only take so much.”

Not since WWII have Americans been asked en masse to endure so much behavioral change for the common good, psychologists say. And the majority of people have willingly adapted, polls show. Consistently across several weekly polls by USC Dornsife project, more than 90% of people say they wore a mask at least once in the past week.

But now there’s a big problem: We’re not winning this war, and that’s affecting the motivation to fight.

“This has been so emotionally taxing, and we can only take so much,” says Neda Gould, PhD, a clinical psychologist and assistant professor of psychiatry at Johns Hopkins Medicine. “People are feeling exhausted and burned-out from having to do certain things a certain way, and then not do so many things.”

“A lot of people are feeling fatigued and distressed around the lack of light at the end of the tunnel,” says Arianna Galligher, a social worker and associate director of the trauma recovery center at Ohio State University Wexner Medical Center. “Folks don’t really have a sense of when this will be over.”

Amid all this fatigue, trust in government and health officials has been eroded by the lack of federal leadership on the pandemic, President Trump’s repeated slap downs of health experts, and pandemic rules that are wildly different from one state or city to the next.

“This has been so emotionally taxing, and we can only take so much. People are feeling exhausted and burned-out from having to do certain things a certain way, and then not do so many things.”

“Some people are feeling fatigued because they don’t really know what’s true,” Galligher says. “It’s hard to know what to believe and which experts to trust.”

Meanwhile, after months of masking up and avoiding people, the social animal in all of us is begging to be uncaged. The USC polling shows the percentage of people who think it’s safe to eat at a restaurant or visit friends or relatives at their homes has been inching up.

“We need to be touched, we need to be hugged, we need social interaction,” Hermanson says. “Zoom was pretty good for a little while, but it doesn’t really meet those needs on a long-term basis.”

Poised to rage

Respiratory viruses like the coronavirus need human hosts to survive. Cold and flu viruses hang out in small “reservoirs” during summer — a few infections here and there, waiting for the cooler temperatures they thrive in and for people to gather more frequently in enclosed spaces. Even in past flu pandemics, infection rates fell significantly during summer, says Stephen Kissler, PhD, an expert in immunology and infectious diseases at the Harvard School of Public Health.

It’s not yet clear if SARS-CoV-2, the coronavirus that causes Covid-19, is suppressed by summer heat, but if so it’s clearly not by much, as surges across the Sunbelt showed. That coupled with failed mitigation efforts have given the virus a huge head start across the United States heading into fall. Assuming no safe and effective vaccine is available on a widespread basis soon — experts do not expect one until sometime next year at the earliest — the virus will take advantage of any opportunity we give it.

“With SARS-CoV-2, we don’t have reservoirs of the virus. We have lakes and oceans,” Kissler tells Elemental. “There’s plenty of virus around to keep the epidemic raging through the fall and winter.”

There are two big unknowns: How many people have been infected, and how immune they are to future infection.

The number of people who’ve had Covid-19 varies greatly by location, Kissler says. It might be 60% or more in some of the hardest-hit New York City neighborhoods, and 10% or less elsewhere in the city and beyond. It’s reasonable to expect that most people who catch Covid-19 have at least a few months of protection, he says. Those people count toward what scientists call “herd immunity.”

In places where herd immunity reaches 40%, the rate of spread could slow, Kissler says — assuming people remain vigilant about prevention. At around 50% or 60%, the virus might largely subside, he says, though that threshold could be as high as 70% — nobody knows yet.

Achieving 70% herd immunity could result in at least one million U.S. deaths, scientists say. While herd immunity can be achieved through a vaccine, scientists do not consider natural herd immunity to be a morally conscionable strategy.

Kissler is optimistic that a worsening of the pandemic can be prevented if people stick with masks and physical distancing. Those same measures would also help reduce spread of flu (as would flu vaccines, which doctors say people should get now).

But Kissler worries about the confluence of school reopenings, cooler weather, and holiday gatherings with Covid-19 fatigue. The rate of new infections could rise to unprecedented levels this fall, he says, “if we do nothing.”