Lessons Learned and Mitigation Strategies

BY IMELDA WONG

The declaration of coronavirus disease 2019 (COVID-19) as a public health emergency in the United States immediately changed the way we work and live, and intensified feelings of stress and uncertainty about the future. New routines and behaviors such as adhering to stay-at-home orders, wearing masks, and social distancing, along with frequent messaging about handwashing, cleaning, and not touching our faces, are constant reminders of our “new normal” and have been shown to increase anxiety. Exposure to an abundance of news coverage, some of which is conflicting or has changed over time, has fueled feelings of uncertainty and fear. The closure of many businesses has led to job loss and financial instability for millions for an undetermined period. Essential service occupations—some of which might not have been previously recognized for exposure to infectious diseases—are now perceived as more dangerous due to the increased infection risk associated with working among the general public. Worries about the health and well- being of ourselves and loved ones have further affected our emotional health and added to fatigue. New terms such as “caution fatigue” and “quarantine fatigue” have emerged to describe the weariness we feel about our new restrictive circumstances as a result of the COVID-19 pandemic.

Fatigue in workplace settings is commonly associated with nonstandard work schedules such as shift work, long work hours, and the resulting poor sleep or sleep loss from these arrangements. However, it can also be attributed to many other occupational, individual-level, and lifestyle factors such as work demands, age, and health behaviors. The effects of fatigue include slower reaction times, reduced attention or concentration, limited short-term memory, and impaired judgment. Fatigue, in combination with time pressures and stress, can result in deliberate or accidental omission of critical work procedures, with implications for fatigue-related incidents. All of this can increase the risk for safety- critical events that have the potential to affect workers as well as their coworkers, families, and the general public (read more in the ). Recognizing the sources of fatigue can allow for targeted, effective mitigation strategies.  During stressful times, sleep problems are common and sensitivity to sleep disruption increases the likelihood of chronic insomnia. Insomnia is a major risk factor for post-traumatic stress disorder (PTSD) when people are exposed to major stressors. This, in turn, is associated with an increase in sleep disruption, which can create a spiral of stress, mental health issues, and sleep impairment. A recent study published in reported that PTSD symptoms were evident after the COVID-19 outbreak among Wuhan, China, residents and persisted for several months. A survey of British residents published as a preprint in found that worries and adversities related to COVID-19, including contracting the disease, financial difficulty, loss of paid work, difficulties acquiring medication, difficulties accessing food, and threats to personal safety, were associated with lower quality sleep. With each additional adverse event, the risk for poor sleep increased by 20 percent.  Especially during these times, it is important to remember that fatigue may be a symptom of depression or other mental health conditions, and sleep impairment and reduced sleep quality can exacerbate existing mental health issues.  When COVID-19 was declared a public health emergency in the U.S., more than 55 million workers were in jobs designated as essential to maintain critical infrastructure. Some organizations added overnight shifts to accommodate physical distancing requirements while keeping up levels of production or service. Many workplaces operated with reduced staff, which led to greater work intensity and work demands for individual workers. While the pandemic provided insurmountable challenges never before faced, some industries—those that traditionally encounter emergency situations, for example—were arguably better prepared. In other industries, employees who are not normally considered frontline workers, such as grocery clerks or delivery drivers, lacked training and resources to manage stress, long work hours, increased work demands, and fatigue.  Millions of healthcare workers on the front lines of the pandemic response put themselves at risk of exposure to SARS-CoV-2, the virus that causes COVID-19, while caring for the influx of COVID-19 patients. As the pandemic progresses, healthcare workers are reporting an overall surge in new cases of depression, anxiety, and insomnia as well as an exacerbation of existing mental health issues due to increased risk of COVID-19 disease exposure and transmission, limited resources and personal protective equipment, overwhelming workload, longer shifts, disruptions to sleep, process inefficiencies, overall lack of preparedness and response, insufficient training, and concerns about financial instability. Healthcare workers concerned about the potential spread of the virus to family members felt a loss of family support as they opted to not live at home or chose to separate themselves from others while living at home. The combination of workplace and personal issues and changes in living situations all had a greater effect on stress, well- being, and poor sleep quality among healthcare workers compared to other professions.