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Maintaining Caution During the COVID-19 Pandemic

After months of taking precautions during the COVID-19 pandemic, many have grown weary of the limits placed on activities and the extra steps to take. Social distancing, quarantines, frequent handwashing, wearing masks, disinfecting surfaces, not touching your face—it all takes extra effort, and it isn't fun. You know these precautions are important to protect your health and the health of others, but they can be hard to sustain for months on end. After a while, it can start to feel like too much. Mental health experts have come up with a name for that weariness: caution fatigue.

Unfortunately, giving in to that weariness and letting down your guard has consequences. The coronavirus capitalizes on opportunities for transmission, whether in a noisy bar room, a skipped handwashing, or a too-close encounter without a mask. The evidence for those consequences is clear in the rise and fall of cases and hospitalizations in different places over time and in stories of social gatherings that have led to clusters of disease.

What is caution fatigue?

Caution fatigue is what happens when the energy that keeps you alert to danger starts to run down and your sensitivity to risk starts to dull. A feeling of resignation can creep in, along with an attitude of "why bother?" You might find yourself washing your hands less often, forgetting your mask when you go outside, or socializing in risky ways.

Why do you tend to let your guard down?

Early in the pandemic, fear and a sense of social responsibility combined to drive most people to change their behaviors dramatically to slow the spread of COVID-19. And, for the most part, it worked. Where the first outbreaks flared up, stay-at-home orders, social distancing, and diligent personal hygiene practices slowly turned the tide. The numbers of new cases, hospitalizations, and deaths stopped growing, then started to fall.

The Limits of Willpower

That effort took willpower and energy to deny everyone what they wanted—close social interactions, freedom to go anywhere, getting back to your previous routines—and willpower is like a muscle that gets tired and weakens with overuse.

Think of all the normal struggles you face between what you want in the short term and what you know is best for you in the long term: Spend now or save for the future? Eat that tempting dessert or meet your weight-loss goal? Those are examples of the conflict between your emotional drive ("I want it now!") and rational control ("But think about the future.").

This pandemic has brought those two forces into constant conflict. Caution fatigue is when your rational side—your willpower—starts to wear down and lose the battles with your emotional side. And in this pandemic, your emotional urge to abandon safety protocols has an added advantage. The benefit of giving up on caution has a clear and immediate benefit: It feels good now. The benefit of maintaining vigilance is less clear. It's a matter of intangible probabilities sometime in the future: lowering your risk of catching or spreading COVID-19. The human brain doesn't do well when comparing a tangible present want with an intangible future good, and it's terrible at weighing probabilities and understanding concepts, like the exponential spread of a disease.

The Numbing Effect of Hypervigilance

There's another effect of long-term vigilance: Your senses can grow numb after being in a high state of alert for extended periods of time. The jolts of energy you experience in response to sensations of fear and alarm serve a useful purpose in short-term episodes of danger, but your body isn't equipped to handle that hypervigilance for weeks and months on end. When you hear alarm bells constantly, you start to tune them out.

Distorted Thinking Due to Emotional Strain

Then there's the emotional cost of complying with the public health guidelines. Social distancing means less in-person, social contact, which can lead to feelings of isolation and loneliness and may get in the way of the day-to-day, social contact you need to maintain your emotional balance. You may feel confined or caged if you don't get outside. Emotions, like loneliness or frustration, can distort your judgment as you weigh risks in deciding how to act. Depression and extreme anxiety can distort your thinking even more, and these are health risks themselves that need to be attended to.

How do you sustain safe behaviors?

So how do you sustain safe behaviors when your emotions are tempting you to abandon them? There are several helpful approaches, including

• Taking care of your physical and emotional health
• Harnessing the power of habits and routines
• Strengthening social connections
• Understanding gradations of risk
• Focusing on others

Take care of your physical and emotional health.

In this time of unusual strain, caring for your body and mind is more important than ever. The better you feel, the stronger you will be, the clearer your thinking, and the more rational your decisions:

• Eat a healthy mix of foods. Include plenty of fruits and vegetables. Avoid overindulging in highly processed foods or foods with added sugar, which can be particularly tempting when you are anxious.
• Exercise regularly. Walk, run, or bike outdoors. Do yoga or cardio exercises at home or in a safe outdoor space. Do resistance exercises to build muscle strength.
• Follow a healthy sleep routine. Go to bed at about the same time every night after a quiet period of winding down in low light. Avoid screen time on your phone, tablet, or computer in the hour before bedtime.
• Practice stress management. When you feel tense, calm yourself with relaxation exercises, deep breathing, soothing music, meditation, yoga, or a short walk. Take time to think about everything you have to be grateful for—the good in your life.
• Avoid excessive consumption of alcohol.

Harness the power of habits and routine.

Your daily and weekly schedule is probably nothing like what it was before the start of the pandemic. One helpful coping strategy is to settle into a new routine that gives you a sense of security and comfort in its predictability:

• Stick to a regular bedtime and wake-up time.
• Frame your day around regular mealtimes.
• Make space in your new routine for time outdoors, breaks to de-stress, and regular physical activity.
• Make disease prevention easy. Keep a clean mask and sanitizer close to the door so it's visible and close at hand when you go out. Create a specific place to leave your shoes when you come back home.
• Make time for activities that give you pleasure. That might be art, woodworking, reading, music, time in nature, or a hobby. It might be undistracted time with your child or partner or telephone calls with a friend.

Making habits of healthy eating, regular physical activity, wearing a mask when outside your home, disinfecting surfaces, not touching your face, and frequent handwashing can make these activities unthinking parts of your routine rather than chores or sacrifices.

Strengthen social connections (safely).

One of the biggest disruptions of the pandemic has been to social lives. As a human, you need social interactions. You need time with friends and family. You value conversations with coworkers at work. While you may not be able to resume the social life you led before the pandemic, you can make efforts to strengthen aspects of it:

• Phone and video contacts are safe and can fill in for some of the in-person contacts you miss. They may even present an opportunity to spend more time with geographically distant friends and family members. Video gatherings can be used to play games together, eat parallel meals, or continue a book club. Friends can agree to watch a movie at the same time, then get together on video when it finishes.
• Limited in-person connections, following public health guidelines, are likely to be more satisfying than phone or video connections. A walk or outdoor meeting with a friend, even with masks and appropriate social distancing, gives more of a chance to talk about emotional issues and process what you are going through. The key is to follow safe practices as to the number of people who get together and whether you meet outdoors (safer) or indoors (less safe).

Understand the gradations of risk.

It's important to be aware of the gradations of risk for different types of activities. An overly rigid approach to dealing with the pandemic can lead to an all-or-nothing mindset. With that approach, if narrow restrictions feel too constraining, you can be tempted to abandon all your cautions and surrender to your immediate wants, risking greater exposure to and spread of the disease.

At different times and in different places, government leaders and public health experts have recommended different types of restrictions—on maximum group sizes, for example, or on outdoor or indoor restaurant dining. These recommendations change with the prevalence of the disease in the community and the likelihood of transmission. As fewer people in the general population are found to have COVID-19, a wider range of activities is deemed to be safe. As the number of COVID-19 cases goes up, more restrictions are recommended to bring the spread of the disease under control.

To make rational decisions about your own behavior, take the time to learn about the restrictions in your community and what health experts have discovered about the risks of different activities. Don't simply rely on your assumptions about risk, which could be distorted by your emotions or by the fact you don't know anyone who has had the disease.

Pay attention to the sources of your information, too. Try not to rely on secondhand information. Look at the websites of institutions with expertise in medicine and epidemiology (the science of how diseases spread).A COVID-19 risk chart created by the Texas Medical Association (Link opens in a new windowhttps://www.texmed.org/uploadedFiles/Current/2016_Public_Health/Infectious_Diseases/309193%20Risk%20Assessment%20Chart%20V2_FINAL.pdf) offers a good visual guide to these gradations of risk. It's riskier to attend a backyard barbeque than to go for a walk with a friend, for example—and it's much riskier to go to a bar. The Centers for Disease Control (CDC) (Link opens in a new windowhttps://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/index.html) offers good information on measures to protect yourself and people you care about from COVID-19. The CDC's recommendations are updated periodically as researchers learn more about the disease.

Focus on others.

A common mistake people make about wearing masks is to assume they put them on only to protect themselves. Actually, except for the medical-grade masks worn by medical professionals and first responders, most masks don't do a very good job of protecting the people wearing them. They are recommended to reduce the risk of spreading the disease to others.

Focusing on the health and safety of other people can be helpful in maintaining your motivation to practice safe, disease-prevention habits. Instead of thinking of these measures as protecting only you, think of them as protecting your family members, people you love, the stranger you pass in the grocery store aisle, and that stranger's older relatives.

Bringing the spread of COVID-19 under control is a collective activity that succeeds or fails based on the behavior of all members of a community. Even if you don't feel at great personal risk from the disease—because you are young and healthy, perhaps—you are a member of a community in which many people are at great risk. If through your behavior you catch and spread the disease, without even realizing it, you might be responsible for the illness or death of someone else.

By maintaining your caution, you are helping to keep hospitals from being overloaded and older and other at-risk people from becoming sick and dying. You're helping keep the level of the disease low enough in your community that businesses can reopen, jobs can be saved, and schools can get back to teaching children.

Focusing on others has a selfish benefit, too. People feel better about themselves and more optimistic about the future when they help other people. Doing yard work for an older neighbor, picking up extra food and supplies for someone else when you go shopping, or checking in by phone on someone who is housebound can help others get through this difficult time. Those acts of altruism and friendship can give you extra motivation to maintain precautions to keep yourself and the people around you healthy.

Ask for help.

If feelings of sadness, anxiety, or loneliness are interfering with your daily functioning, if you are losing or gaining weight, or if you are not sleeping well, these may be signs that you need additional help. Your employee support program can help you find a mental health professional. In many cases, a few sessions can give you the tools to turn around your mood and get back on your feet.

If you're not ready to talk with an expert about what you are going through or feeling, talk with a friend. Opening up about your emotions with someone you trust can be a step toward healing.