March 15, 2021
Writer: K Ballesteros
Researchers: Alvin Joseph Mapoy, Angelica Jane Evangelista, Azie Marie Libanan
Creatives: Bee Fukumoto
Moderator: Eula Mei Labordo, Marga Miñon
A registered nurse at Philippine General Hospital (PGH), Paul Ross Sison writes:
“COVID-19 is an illness that plunges the patient into complete literal isolation. It’s a disease that robs a family of the opportunity to hear their loved one’s last words. We are treating patients, not just a virus, and they are not mere numbers–they are a mother, a brother, a friend.”
This excerpt was from Sison’s work titled “When Nightingales Cry”, as part of the PGH Human Spirit Project. On social media, the Human Spirit Project acts as an archive, releasing curated stories from frontliners at PGH. This online presence is an ongoing accompaniment to the recently published three-part anthology of creative works produced by the PGH community: Pagkalinga, Paggunita, and Pagninilay.
The ongoing General Community Quarantine (GCQ) has put a strain on social support systems. Those who feel this strain the most are individuals whose jobs are based on providing different levels of care, including physical, financial or economic, and emotional. While Sison was writing about their patients’ experience, the ‘complete and literal isolation’ can lead to community-wide pandemic fatigue.
Recognizing pandemic fatigue
Burnout occurs in extreme environments where an individual’s ability to concentrate suffers. It is harder to stay alert and pay attention, and memory and sleep issues arise (Marsh, 2021). Pandemic fatigue is remarkable because the global health crisis caused by COVID-19 is being simultaneously experienced by a global community, whose members feel stressed over a long period of time.
According to Elissa Epel and Elena Fromer at the Weill Institute for Neurosciences, a sure symptom of pandemic burnout is feeling fatigued or tired without reason. They added that living with uncertainty requires “a certain amount of attention and vigilance, all the time” (Weill Institute for Neurosciences). These uncertainties in life include: news about the escalating effects of COVID-19 around the world, the uncertainty of when the pandemic will end, or when you or your family will be eligible to get inoculated against the virus.
During this ongoing crisis, according to the professor and clinical psychologist at the University of British Columbia, Steven Taylor, “people are exposed to chronic stressors as pandemics drag out over many months and multiple lockdowns. That wears people down” (as quoted in Marsh, 2021). This is called COVID-19 fatigue (Berg, 2021), and the protracted stress that accompanies it can lead to “careless behaviors, excessive exhaustion, increased isolation, and a sense of ineffectiveness in life” (Berg, 2021).
Taylor further described pandemic fatigue’s emotional aspect as feeling irritable, emotionally exhausted, and prone to despair (Marsh, 2021). Pre-pandemic lives were structured around daily landmarks and semi-fixed schedules. Without these, and the social interactions with peers and colleagues, people are prone to fatigue and to experiencing “difficulty recalling what they did” (Marsh, 2021).
Burned out but still burning
Aside from frontliners in the medical professions, students across all levels and educators are among the most vulnerable to pandemic fatigue. According to the January 2021 study on social and emotional loneliness among Filipino college students during the COVID-19 lockdown, students are aware of the adverse effects on their mental health and have attempted different coping styles to help address their issues (Labrague, De los Santos, & Falguera, 2021). These students exhibited problem-focused behaviors which “reduce the sources of stress by targeting its causes, and they have been associated with positive physical, mental, and psychological outcomes” (Labrague, De los Santos, & Falguera 2021).
Jennifer Moss’s article “Beyond Burned Out” (2021) in the Harvard Business Review lists the main causes of pandemic fatigue: unsustainable workload, perceived lack of control, the lack of a supportive community, lack of fairness, and insufficient rewards for effort. Filipino students, especially those from even more marginalized communities, are likely trapped in the perfect storm. Aside from the sudden shift to online modules, students struggle to accomplish workloads, on the false assumption that being at home means they have more time for assignments. Unfortunately, the reality is that “some parents resort to answering modules themselves to help their children finish their schoolwork for the day” (Adonis, 2020). A challenging academic workload is not the only, outstanding problem; students and their families must also deal with new, expensive requirements needed to join class, including using “unstable internet connectivity that hampers their participation” (Bernardo, 2020).
Department of Education (DepEd) undersecretary for planning, Jesus Mateo, had attempted to employ Learner Support Aides (LSA) to “assist teachers in lesson preparation and delivery, guide learners and households…and monitor students’ progress and achievements” (Adonis, 2020). DepEd’s proposed salary for LSAs will range between P6,204 to P11,000 per calendar month (Adonis, 2020).
All this ineffectively shifts the burden of care onto individual households, the students and the teachers, and their local network of support providers. It is not surprising, therefore, that “students…lost peer support, while others find it difficult to learn their lessons by themselves” (Bernardo, 2020).
For working professionals, Moss (2021) explains how an unmanageable workload was “the most-cited reason for burnout and decreased well-being in our pre-pandemic qualitative research”. She claims that pandemic fatigue was greatly impacted by short-sighted and short-term, band-aid solutions for professionals who suddenly found themselves having to build a home office. Video calls and conferences, for example, have become staples of working-from-home. For a lot of professions, this adds up to unhealthy levels of screen time. According to Moss (2021), “video calls are harder on us physically and mentally…our brains find it challenging to process nonverbal cues like facial expressions and body language, making it tough to relax during conversations”.
Sharing a living space means juggling and balancing peoples’ needs, which can also take its toll. Working at home where our families accomplish other tasks “diminish our ability to focus on one thing for a prolonged period. This type of multi-tasking and distractions also take their toll on our energy and well-being” (Weill Institute for Neurosciences, n.d.). Having enough space for every member of the household is a recurring theme in these studies, and for good reason. According to Alyza Berman, the founder and clinical director of The Berman Center “when you don’t have ‘me time’ that’s when you might feel emotionally claustrophobic” (as cited in Millard, 2021).
Seeking professional help is among the most effective ways of dealing with COVID-19 fatigue (Berg, 2021). However, during the ongoing pandemic, social support systems and private institutions offering mental health interventions are fully engaged and stretched thin. While everyone must share the responsibility of stopping the spread of COVID-19, the effect of treating those who are infected is a burden placed primarily on frontliners, including mental health providers.
“Even before the pandemic, there was a shortage of mental health providers”
Pandemic fatigue is a different story when it comes to frontliners. Jessica Gold in Forbes describes the struggles of clinical psychologists, psychotherapists, and other mental health professionals struggling to keep up with escalating demand. She states that “even before the pandemic, there was a shortage of mental health providers to meet the demand that is only going to increase” (Gold, 2021).
Doctors in this field may be prone to skipping breaks, making sessions shorter to accommodate more patients, or even scheduling sessions at strange hours (Gold, 2021). Therapists across different disciplines explain how their caseloads have remained full and how “clients have increased the frequency of sessions that they need” (Gold, 2021). The doctors also report that they have been speaking with patients whose complaints are “full of chronic, persistent mental health issues instead of episodic ones…this means that patients are likely to be seen for longer” (Gold, 2021). This may be due, at least in part, to the stress and fatigue experienced by so many across sectors as the pandemic continues.
Gold quotes Ellie Herman, a clinical social worker, who pinpoints the problem: “we are all experiencing trauma together. Many of the stressors clients bring up are stressors we all share” (Gold, 2021). However: maintaining and preserving therapists’ mental health is even more vital during a pandemic. Although pandemic fatigue is felt most keenly at the individual level, the experience of living through the pandemic and other extreme situations are also systemic problems.
Combating pandemic fatigue
Studies about pandemic-related burnout and fatigue have focused on specific communities, including students, healthcare workers, social workers, and professionals. Throughout, an emphasis on finding support systems and relying on communication have been vital to alleviating symptoms of fatigue. Although Filipino students approached the logistic challenges posed by the pandemic by finding solutions, they scored low on personal resilience, which “offers protection against stressful events…and strengthens an individual’s ability to endure the burden” (Labrague, De los Santos, & Falguera, 2021).
The following techniques can be effective in preventing pandemic fatigue, as well as treating its effects. The first three (3) techniques are meant for individual self-soothing, while the final two (2) are meant to build a more supportive relationship with members of the same households.
Practice radical acceptance. Radical acceptance is the practice of acknowledging reality (Sheri Van Dijk as cited in Tartakovsky, 2015), and recognizing that denying the reality of what is happening “only intensifies our emotional reaction” (Sheri Van Dijk as cited in Tartakovsky, 2015). Radical acceptance during the GCQ may look like accepting and working under current restrictions and so focusing on immediate communities–the neighborhoods, subdivision communities, and our households–so that we can draw clear and healthy boundaries for our families and ourselves. Individuals practicing radical acceptance set boundaries for sustainable and healthy productivity, which means including rest and breaks, as needed, without suffering from guilt or shame.
Find and contribute to spaces online that can foster community spirit. The International Pandemic Art Archives was initiated by professor of clinical psychology Emily Diamond, clinical psychologist Cale Wright, and Nouf Al-Rashid. Reading through the archive is a balm for periods of loneliness and exasperation.
Create structure in your daily routine. According to Berman, creating a distinct structure between day and evening will help give individuals a sense of control, and a sense of certainty about their days (as cited in Millard 2021).
Practice compassion. Expressing gratitude to others, and to ourselves is an easy way to create compassionate spaces. Compassionate listening is the practice of “listening without responding, judging, or giving advice” (Schairer, 2015), and may encourage individuals in conversation to self-disclose, and unburden. Recognizing our capacity to remain compassionate, to stay kind, and to offer support for others will help alleviate our sense of isolation and also lend support to the rest of our community who are nearest us.
Set boundaries with people in your household. This may be as simple as closing a door, leaving a room, or erecting partitions to give individuals some private space. The goal is to create some time for the individual, outside their interactions with household members.
Higher-level interventions
Having described pandemic fatigue on the individual level, Moss (2021) stresses that “it’s an organizational problem that requires an organizational solution”. This is why DepEd’s failing to provide concise guidelines on how schools should operate, and on revisions to subject matter curricula during the pandemic, has caused so much consternation.
At the institutional and national level, governments must provide an incentive or insurance (Sunjaya, Herwati, & Siregar, 2021) to compensate healthcare workers, and other frontliners–especially those who are not usually recognized for the work that they do. Essential workers must also enjoy access to mental health services, facilities, and privileges, as a response to the reality that “healthcare personnel exhibit a higher risk to experience depressive symptoms and burnout” (Sunjaya, Herwati,& Siregar, 2021).
For those working in the private sector, reduced and flexible hours, peer-to-peer outreach programs, and empathetic managers who practice active listening (Moss, 2021) are proven to help alleviate pandemic fatigue.
As we combat pandemic fatigue, join us on #UsapTayo this Saturday, March 20. We discuss your experiences during this pandemic including your support system. Always remember that we are here for you, mental health champions!
Questions
- Have you experienced or are you still experiencing pandemic fatigue? What are the major factors that contribute to this feeling/ experience?
- What have you been doing to seek & maintain support? What kind of support did you need or are still needing the most?
- What are your feel-better rituals? What can you tell people who are still struggling with pandemic fatigue?
Works Cited
Philippine General Hospital [PGH] Human Spirit Project (2020) 15 June. Available at https://www.facebook.com/pghhsp/photos/a.118898153178153/128887085512593/?type=3&theater (Accessed: 10 March 2021)
Tabula, J.A., Caballes, A.B., & Pingoy, N.P. (eds.) (2020a). PGH Human Spirit Project: Pagkalinga. Manila: University of the Philippines, Manila. Available at: https://drive.google.com/file/d/1DrKt99TvSZ11GbQC7IGBiQknqfDrBgz-/view (Accessed: 10 March 2021)
Tabula, J.A., Caballes, A.B., & Pingoy, N.P. (eds.) (2020b). PGH Human Spirit Project: Paggunita. Manila: University of the Philippines, Manila. Available at: https://drive.google.com/file/d/100Xs5ACjoT4wMcz5ZUl_qg7V4D5BxjNN/view (Accessed: 10 March 2021)
Tabula, J.A., Caballes, A.B., & Pingoy, N.P. (eds.) (2020c). PGH Human Spirit Project: Pagninilay. Manila: University of the Philippines, Manila. Available at:
https://drive.google.com/file/d/1_XBinaDc7zcuUtE8Es2v682rka0w3-rk/view (Accessed: 10 March 2021)
Tartakovsky, M.S. (2015). “What it Really Means to Practice Radical Acceptance”, Pysch Central, 04 October. Available at: https://psychcentral.com/blog/what-it-really-means-to-practice-radical-acceptance#1 (Accessed: 08 March 2021).
Schairer, S. (2015). “Compassion in Action: 15 Easy Ways to Spread Kindness”, Chopra, 08 June. Available at: https://chopra.com/articles/compassion-in-action-15-easy-ways-to-spread-kindness (Accessed: 09 March 2021).
Marsh, S. (2021). “Pandemic burnout on rise as latest COVID lockdowns take toll”, The Guardian, 05 February. Available at: https://www.theguardian.com/society/2021/feb/05/pandemic-burnout-rise-uk-latest-covid-lockdowns-take-toll (Accessed: 09 March 2021)
Berg, S. (2021). “What doctors wish patients knew about pandemic fatigue”, American Medical Association, 29 January. Available at: https://www.ama-assn.org/delivering-care/public-health/what-doctors-wish-patients-knew-about-pandemic-fatigue (Accessed: 09 March 2021).
Moss, J. (2021). “Beyond Burned Out”, Harvard Business Review, 10 February. Available at: https://hbr.org/2021/02/beyond-burned-out (Accessed: 10 March 2021).
Gold, J. (2021). “We Need to Talk About Another Pandemic Mental Health Crisis: Therapist Burnout”, Forbes, 19 January. Available at: https://www.forbes.com/sites/jessicagold/2021/01/19/we-need-to-talk-about-another-pandemic-mental-health-crisis-therapist-burnout/?sh=ee1d15a4d18a (Accessed: 08 March 2021).
Millard, E. (2021). “How to Not Let Pandemic Fatigue Turn into Pandemic Burnout”, Everyday Health, 17 February. Available at: https://www.everydayhealth.com/coronavirus/how-to-not-let-pandemic-fatigue-turn-into-pandemic-burnout/ (Accessed: 10 March 2021).
Sunjaya, D.K., Herawati, D.M.D. & Siregar, A.Y.M. Depressive, anxiety, and burnout symptoms on health care personnel at a month after COVID-19 outbreak in Indonesia. BMC Public Health 21, 227 (2021). https://doi.org/10.1186/s12889-021-10299-6
Weill Institute for Neurosciences (n.d.). “Emotional Well-Being and Coping During COVID-19”. Available at: https://news.tulane.edu/pr/burnout-among-social-workers-real-issue-amid-pandemic-tulane-researchers-say (Accessed: 09 March 2021).
Adonis, M. (2020). “DepEd to Teachers: Take steps to prevent student ‘burnout’”, Inquirer Online, 14 October. Available at: https://newsinfo.inquirer.net/1347488/deped-to-teachers-take-steps-to-prevent-student-burnout (Accessed: 10 March 2021).
Bernardo, J. (2020). “Exhaustion top emotion students feel amid shift to online classes: Veritas survey”, ABS-CBN News Online, 11 November. Available at: https://news.abs-cbn.com/news/11/11/20/exhaustion-top-emotion-students-feel-amid-shift-to-online-classes-veritas-survey (Accessed: 10 March 2021).
Labrague, LJ, De los Santos, JAA, Falguera, CC. Social and emotional loneliness among college students during the COVID‐19 pandemic: The predictive role of coping behaviors, social support, and personal resilience. Perspect Psychiatr Care. 2021; 1– 7. https://doi.org/10.1111/ppc.12721
