Fatigue in the Covid fight grows

Given the severity of the current situation, the preparedness and response to COVID-19 have differed vastly across and within countries.

(Written by Francis Joe Mathew and Shubra Jain)

COVID-19 has now spread exponentially across the world, directly impacting the lives of more than 27 million people. According to the World Health Organisation (WHO), the effects of the pandemic “will be felt for decades to come”. Given the severity of the current situation, the preparedness and response to COVID-19 have differed vastly across and within countries. Broadly, one can say that the difference has emerged due to the level of maturity of healthcare systems in different countries. However, if we evaluate their response closely, countries that have experienced similar crises in the past and countries that have been able to contain it in a shorter duration have fared better.

Countries situated along the Mekong River basin were successful in keeping the pandemic under control due to their previous experience in dealing with the SARS virus. Further, wearing a face mask is deeply embedded in their society and is often seen as a collective responsibility. Similarly, countries like Taiwan and South Korea performed extensive testing and contact tracing to reduce the spread of COVID-19. Within India, Kerala has drawn on its experience with the Nipah virus in 2018 to use extensive testing, contact tracing, and community mobilisation to contain the virus and maintain a very low mortality rate.

Despite some of the above-mentioned countries and states achieving initial successes in controlling the pandemic, recent data have indicated a resurgence of the virus. One such example is South Korea. The country has been reporting a three-digit rise in new cases for the past 16 days, fanning concerns about a worsening shortage of hospital beds. Kerala too has seen a steep spike in the recent weeks.

This leads us to critical questions: What could be the reasons for the resurgence of infections? Why have many countries failed to control the rising curve despite extensive lockdowns? Is it because it’s challenging to adhere to guidelines that can keep us safe? Is it the fear of job loss or are there other factors involved?

Although the resurgence has been attributed to various reasons including the ones mentioned above, an idea that is increasingly coming into the discussion is that of fatigue. A pandemic-like situation warrants the society to act in a defined manner, which can be strenuous over time. We have classified this fatigue into four types – behavioural, economic, social and administrative fatigue.

Human beings are considered to be rational and are expected to make responsible decisions based on the information disseminated to them. For instance, the awareness of an unforeseen health crisis should ideally encourage people to stay at home and adhere to social distancing norms, which was the initial response to the pandemic. Additionally, washing your hands, wearing a mask, not touching your face and not shaking hands with a friend or a colleague are a few things that were expected of people all of a sudden when the pandemic set in. However, to maintain this level of discipline for an extended timeframe required a great degree of effort and commitment, which has led to fatigue and noncompliance.

Extended lockdowns can often be financially devastating, especially for those who depend on daily wages. Closure of enterprises, and lower economic activity in general, have led to massive job losses. Countries around the world have announced financial stimulus packages. However, most countries have relaxed the restrictions that were imposed to regenerate economic activity despite very little to suggest that the curve has flattened. For instance, in India, apart from educational institutions, entertainment centres, and sports complexes, the central government has allowed everything else to open. So up to what point can countries take the economic burden of a pandemic? With depleting public finances and the need to borrow extensively to meet one’s funding requirements, how long can countries sustain this approach? How long does it take before the economic fatigue sets in?

Staying home is stressful, boring and, for many, emotionally unsettling. Human beings are inherently social beings, and meeting other people is part of our DNA. The pandemic required people to minimise interactions with everyone including one’s distant family, friends and colleagues. Although there was compliance towards the beginning of the pandemic, this has seen a massive decline now. People have started socialising despite an increase in cases.

Some rules and guidelines need to be defined during a pandemic, and most importantly, there has to be a collective effort to monitor and ensure compliance. However, the complexity of this pandemic has led to administrative fatigue. The government is also made up of human beings. The door-to-door surveillance and strict monitoring of quarantined people have come down drastically in many states in India. Public hospitals have been overwhelmed in most countries around the world. The police have plunged into the task of enforcement and surveillance without much strategic and logistical preparation. With increased workload and no relief in sight for many, fatigue is affecting the response to the growing pandemic in many countries across the world.

These incongruities of human behaviour should become a lesson for policymakers for the future. Any response neglecting the behavioural factors might be counter-productive and can result in a prolonged battle with the pandemic. Beyond addressing the public health expenditure deficiency, it is vital for countries to evaluate when these aforementioned detailed fatigues could set in. Even the most efficient governments and the most well-structured policies might be ineffective once fatigue takes over especially since the effort has to be collective. As the WHO chief reiterated, the current pandemic would not be the last one and countries around the world need to be better prepared for the next one.

Health experts and researchers need to study the existing data around fatigue and its timeframes. For instance, the various fatigues for people in India could be different from those in Germany, South Korea, Ghana or Kenya. There could be major differences between rural and urban areas within the country as well.

The writers work with the government consulting practice at Ernst & Young. Views are personal.

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