We’re all tired. We’re all stressed, unsure of what lies ahead. It’s been nearly two years since the COVID-19 pandemic upended our lives, and it’s getting old. The result? Pandemic fatigue – a mixed bag of emotions and behaviors that leaves us feeling just not ourselves. It takes a notable toll on both our mental and physical health. We talked with psychiatrist and Oregon Health Authority senior health advisor Dr. Margaret “Meg” Cary about pandemic fatigue, its effects and what we can do about it.

OHA: What is pandemic fatigue and what causes it?

MC: “COVID fatigue, fundamentally, is the natural response to prolonged, all-encompassing stress that demands our emotional, cognitive, physical, and spiritual energy. The stress comes from what we are experiencing, as well as from the emotional and cognitive energy required to continually respond to uncertainty and changing circumstances. The pandemic has resulted in losses. Grieving is a whole body, mind, spirit process that exhausts us even though it also eventually helps us heal.”

“In addition, it is taxing to have to remain flexible, to do complex thinking, to weigh costs and benefits. This pandemic has demanded everything from complex risk assessments to unexpected problem solving to daily decisions. How many masks do I wear in the grocery store? How do I balance my work and support my child with schoolwork. I have a sore throat, so do I figure out how to get a test? Do I call my primary care? That we are fatigued is an expected and natural response to all that we are holding and responding to. The problem may not be that we are fatigued, but that we are managing too much.”

OHA: What can we do about it?

MC: “It might be helpful to identify the different things we are fatigued by. What drives our emotions? If it’s because of a loss, it‘s important to acknowledge who or what we lost, allow our emotional reactions, and grieve. Connecting with others, our community, our faith and our ways of saying goodbye are core to grief. If, instead, we are fatigued by complex decisions, we might respond by giving ourselves a break from having to make decisions. When we can better diagnose what has caused our fatigue, we can better address it. An example I use is – at the gym, we can get fatigued from lifting a heavyweight just a few times, and we can also get fatigued from lifting a lightweight many times. Either way, we can lighten our load by making fewer decisions and by taking a break to do something simple, joyful, even silly. Do something where there is a clear start and end to the task. Do a puzzle, dance to a favorite song, text a joke to a friend, clean the bathroom, go outside and look at the clouds. Schedule some of those easy tasks.”

OHA: What are the signs of pandemic fatigue?

MC: “Oftentimes, fatigue can show up when we are out of harmony, when we have too much or too little of something. We might sleep more than usual, or we can’t sleep at all. We have lots of focused energy or we can hardly get the day started. We might be hyper-focused on a task and have trouble being flexible, or we struggle to maintain our attention and leave tasks unfinished. We might be more readily angry, impatient, sad, or feel numb. We might be more readily overwhelmed and indecisive, or the opposite, make decisions too quickly without thinking through the consequences. We might have a harder time feeling joyful, or we feel more critical of ourselves and others. We might be more hungry or less hungry. Kids may start acting younger and doing things that they have not done for months or years.”

OHA:  How do we know when it’s not just everyday stress?

MC: “If we start to feel stuck for consecutive days, it may be a signal that we are dealing with more than just COVID fatigue. If day after day, you cannot feel joy, cannot muster energy, cannot sleep or sleep too much, struggle to go to work, take basic care of yourself or meet your responsibilities, it’s likely more than everyday stress. Disrupted sleep can have a significant impact on our ability to calm our stress. Thoughts of suicide are associated with insufficient sleep. If you’re thinking of suicide, please reach out to someone. Text OREGON to 741741. Talking to a professional or trusted family member is really important and can help you reconnect to what is important to you. If you are stuck in a feeling or are doing things uncharacteristic of you, like isolating from loved ones, disengaging from activities, using drugs or alcohol excessively, you should talk to someone. One of the unexpected blessings of stress associated with COVID-19 is more people are talking about mental health.”

OHA: How is pandemic fatigue harmful to our health?

MC: “Being fatigued during this pandemic is a totally justified human response to unprecedented circumstances. Being fatigued is what happens to our bodies during times of stress. As much as we can, acknowledge that this is not a sign of weakness, moral failing or illness. It’s a natural extension of what we’re living through. In addition, the most common outcome of this kind of stress is healing and a return to our baseline health, if not growth and fortified health. However, the stress is not equally distributed over time and over all people. Most of us have moments when we are more fatigued and hopefully moments when we can share resources and support to help lighten the loads of those carrying more.”

OHA: Do people understand they have COVID fatigue?

MC: “Sometimes we do and sometimes we don’t. That’s where it’s important to take a pause and look at how we’re doing a little more objectively, with curiosity. Sometimes we’re quite cognizant of what we’re stressed by. Other times, we are so stressed or exhausted it’s almost as if we don’t have the energy to reflect on how we are doing.  Sometimes, in our efforts to show up, to rise to this challenge, we don’t often cut ourselves slack and really acknowledge how fatigued we are. When we’re tired, we cannot show up in the ways we want and are capable of. We, as communities, in workplaces and social groups have a role in helping each other get some rest.”  

OHA: What can people do to stay alert to important developments and guidelines, without letting ourselves get depressed?”

MC: “We all have this cognitive overload. If we don’t give ourselves time for rest, just as any other muscle, our brain won’t work as well. If we don’t allow our emotions to rest, they will not be able to respond. Here are three ideas to organize how to take care of your emotional health and stay engaged in what’s important.”

• Check in with yourself. Every day. A couple of times a day. What am I really feeling? Am I tired because of doing a lot of complex decision making or because I haven’t eaten well or slept well? Really try to push yourself to figure out the root cause.
• Connect with who and what matters to you. At least once every day.
• Take care of your whole self. Maybe you cannot take care of your full self every day, but make a point to take care of yourself every day. Maybe a one-minute stretch, maybe a 30-minute talk with a close friend, maybe a prayer or meditation. Prioritize your sleep. Take a moment outside. This is a relay, a really long relay. We need to be able to pass the baton and step out to rest. 

OHA: What can we do for others who may be suffering pandemic fatigue?

MC: “Check in with yourself and others. If you have some emotional reserves, are in a time when you are rejuvenated, check in and just be an ear and a friend to what they are experiencing. Reach out, ask how you can be a support or make your best guess. And if you are concerned about it, ask about suicidal thoughts. Asking will not put the idea in someone’s mind and it can be a lifesaving way to take the idea out of their minds. If you are interested in increasing your skills, consider taking Mental Health First Aid Oregon (MHFA Oregon) course or signing up for mental health training.”

Dr. Margaret Cary, MD, MPH, is a senior health advisor for Oregon Health Authority.