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Prevention Fatigue

Pandemics have predictable phases that the public goes through. Those phases include identifying that there is a problem, reacting to the problem (usually panic), finding a solution to the problem, then tiring of the solution. Human immunodeficiency virus (HIV) is a perfect example of this. In the United States, when HIV was first described, there was panic. Then, some primary prevention steps were identified that allowed us to slow the spread (e.g., condoms). A successful treatment was also developed. Now, 30 years after the pandemic initially hit in the United States, we see fatigue of the primary prevention methods. Specifically, we see something we call safe sex fatigue1. HIV is no longer seen as a death sentence by many people due in large part to the prevention efforts and successful treatment options, so practicing safe sex doesn’t seem as important as it once did. However, it is precisely because of the success of these items that we are enjoying the success against that disease that we are. That means that we can’t let our guard down or cases of HIV will spike again.

In addition to predictable phases, pandemics can also have prolonged timelines. For example, the 1918 Spanish flu spanned 1918 and 19192. There was an influenza pandemic in 1957 through 19582. HIV has been an active pandemic since the 1980s3. Cholera has caused multiple pandemics, one of which went from 1961 through the 1990s4. COVID-19 has a lot more in common with the flu than HIV or cholera, given how it’s spread (i.e., respiratory droplets from coughing and sneezing). However, what all of these examples demonstrate is that pandemics are not necessarily short lived. That means that we need to figure out a way to live with this pandemic for potentially a long time.

So far, this pandemic seems to be on an accelerated timetable. The virus was first identified as infecting people back in November 2019 and here we are in July of 2020. In that time we have identified ways of slowing the spread (masks and social distancing) and people are already tired of those precautions. You may remember that back in March and April of this year, when most of the country was under some form of stay-at-home order, the main message was for us to stay home so that we wouldn’t overwhelm our healthcare system, like what happened in New York and Italy. Well, in July of the same year with those memories still fresh in everyone’s minds, we are now seeing the makings of crisis hotspots in Texas5, Arizona6, and Florida7. They are in very real danger of overwhelming their healthcare systems largely because of precaution fatigue.

We’re attempting to perform a delicate juggling act. We need to be able to live our lives and start to recover emotionally and economically. In this juggling act that we’re trying to perform, we have three balls: COVID-19, the economy, and emotional well-being. In order to be successful, we need to be able to keep an eye on all three balls. However, the three balls have different weights and textures, which make them more difficult to juggle. We’ve been practicing with the economy and emotional well-being balls, so we feel pretty confident with those but the COVID-19 ball is one that we’ve never juggled with before. It’s an entirely different weight and texture, which throws the whole act off. But, we do know how to juggle, so in theory we should be able to pull this off. The catch is, if any of these balls are dropped, it equates to a lot of lives lost.

Because we’ve practiced this juggling act for years with the economy ball, we’re very familiar with it. We can do a little bit more with that specific ball because of the practice that we’ve had in order to try to accommodate the new unfamiliar COVID-19 ball. There are certain things that we can do to try to get the economy up and going again while still respecting the danger posed by the unfamiliar COVID-19 ball that we’ve never juggled with before. Testing, contact tracing, masks, and accounting for social distancing are the ways that we can adapt our economy during this time so that the economy ball isn’t dropped and can continue to circulate in our juggling act with the new COVID-19 ball.

Like the economy ball, we’ve also practiced a lot with the emotional well-being ball. This ball also benefits from testing, contact tracing, and masks. Social distancing makes this a challenging ball to incorporate, but by wearing masks and engaging in activities outside with fewer people, we can still take care of our emotional health while respecting that new COVID-19 ball that we’re still so unfamiliar with. We have to be a little creative and inventive in how we are able to juggle all three balls, but since we’re so familiar with the weight and texture of two of them, we can incorporate that third unfamiliar ball with concentration and dedication. In order to accomplish this though, we do need to keep our eye on the ball.

Precaution fatigue/quarantine fatigue is real and it’s driving a lot of decisions right now, and we are in very real danger of dropping the COVID-19 ball. This is hard but if we concentrate, we can successfully perform our juggling act. Fighting the quarantine/precaution fatigue is now what people need to focus on. Come up with ways that you can adapt and make precaution just a part of your everyday routine. The mask is like your wallet and keys: it should always be with you when you leave the house. Social distancing can be built into your activities: more going for walks outdoors (if you’re able) and fewer parties. More phone calls, emails, and letter writing. Fewer bar visits. For right now, until we get used to the weight and texture of the COVID-19 ball, our juggling act will continue to be sloppy. But, little by little, we’ll start to get better as long as we concentrate, keep our eye on the ball, and are aware that the choices that we make are directly impacting the success of our act.

 

References

  1. Rowniak, S. (2008). Safe sex fatigue, treatment optimism, and serosorting: New challenges to HIV prevention among men who have sex with men. Journal of the Association of Nurses in AIDS Care, 20(1), 31-38. https://www.sciencedirect.com/science/article/abs/pii/S1055329008002069
  2. World Health Organization: Regional Office for Europe. Health Topics. Past pandemics. https://www.euro.who.int/en/health-topics/communicable-diseases/influenza/pandemic-influenza/past-pandemics
  3. gov. HIV Basics. A Timeline of HIV and AIDS. https://www.hiv.gov/hiv-basics/overview/history/hiv-and-aids-timeline
  4. World Health Organization. Health Topics. Global Epidemics and Impact of Cholera. https://www.who.int/topics/cholera/impact/en/
  5. The Texas Tribune. By Valeria Olivares. Several Texas cities worry hospitals may run out of beds in two weeks or sooner. July 5, 2020. https://www.texastribune.org/2020/07/05/texas-coronavirus-hospitals-houston-san-antonio-austin/
  6. Arizona Daily Star. By Justin Sayers and Patty Machelor. As COVID-19 rages, crisis plans could decide who gets critical care. https://tucson.com/news/local/as-covid-19-rages-crisis-plans-could-decide-who-gets-critical-care/article_d8d2f4f8-1e2c-5db7-887a-6e60300903ed.html
  7. Becker’s Hospital Review. By Molly Gamble. 44 Florida hospitals at ICU capacity. https://www.beckershospitalreview.com/patient-flow/44-florida-hospitals-at-icu-capacity.html