COVID-19 Fatigue Syndrome (C-19FS) is a biopsychosocial descriptor that identifies a range of individual experiences that magnifies vulnerabilities into a variety of life stressors. C-19FS is composed of three phases: primary, secondary and tertiary. Identifying at-risk populations and assessing biopsychosocial functionality is essential to working in population mental health services.
Large population communicable diseases, in general have multiple consequences, ranging from disruption of the community infrastructure, to tragic loss of life. Physically, individuals may experience an increase in medical complaints, specifically related to infectious diseases; as well as exacerbations of chronic conditions, such as hypertension, diabetes, and respiratory problems (COPD, emphysema).
The nature of communicable disease from its physiologically infectious progression cannot capture the complexity of variable individual human behavior. One of the major causes of psychological distress is stress itself (the problem is the problem); watchful waiting becomes emotionally exhausting with the inundation of mass and hyper-communications, as well as the magnitude and duration of the disruptions in the basic functionalities of day-to-day life.
Even though there have been some interventions for evolving mental health issues (hot lines, telehealth, professional networking) this represents only one small portion of the population. These individuals represent the “know” population. They have specifically self-identified as having a behavioral health issue.
A second population is the “unknown”. This group represents individuals in the community who may not present to health care providers (either in the short term or unfortunately at some time in the future). For example, the hypertensive person that experiences increase in headaches and general malaise but does not explore some of the co-occurring stressors and the behavioral changes taking place in the person’s life.
Many underlying mental health issues will not be assessed potentially resulting in increases in episodic health care costs and over time and a diminished quality of life.
The third category of the at-risk population is the “unknowable.” What will be the actual life time impact of large population communicable disease events on behavioral health – it is immeasurable. Appreciating the concept of population fatigue syndrome lays the groundwork for a different perspective on lifespan development with implications on the physiological, psychological, and social-economic contextual processes of vulnerability.
The concept of vulnerability expresses the multidimensionality of disasters by focusing attention on the totality of relationships in a given social situation which constitutes a condition that, in combination with environmental forces, produces a disaster (Bankoff, et. Al. 2004).
The Three Phases of C-19FS
COVID-19 Fatigue Syndrome (C-19FS) is composed of three phases. The first is Primary C-19FS and is related to the natural reoccurring cycle of infectious and communicable disease. Individuals may become more vigilant as reports of pending communicable diseases in their community are developing (even a common flu season) and they re-experience their individual previous involvement with COVID-19.
Taking in consideration all world-wide events, the population is developed differing perspectives of the personal/societal impact of communicable diseases. Many voiced that sheltering in-place and social distancing is the better universal approach to protection. Others voiced fervent opinions in resentment that became more intensified as the number of cases and deaths changed and local authorities and pundits required the population to comply to restrictive directives.
During this primary phase, some of the biopsychosocial feelings that individuals may re-experience include: fatigue, trouble initiating or maintain sleep, chest pain, shortness of breath, tightness in the throat, palpations, and anxiousness.
Secondary C-19FS spans the time that a seasonal event, epidemic or pandemic is officially designated. This becomes a time of sensory overload. The basic human response of flight-flight-freeze are heightened. During this time, individuals are faced with the reality that life is always in flux.
Thoughts and emotions become overpowering and people find themselves functioning on “auto-pilot.” For many, this is difficult because of the fear of isolation, loss of self-agency, and for those who have not recovered from the last event, it becomes very disheartening. If the crisis goes on for any extended length of time, family relationships are stressed, economic resources are strained, and the impact becomes even more profound for the socially vulnerable. Once again, daily routines and relationships are disrupted, burdened, and compounded.
During the secondary phase, some of the biopsychosocial feeling individuals may experience include: anger, irritability, panic meaninglessness, and apathy.
Tertiary C-19FS is a more lasting experiential process. The central issues during this phase is that of control. Individuals’ ability to have a sense of influence in their life circumstance is diminished. Following a large population communicable disease event, there will be numerous forces at work. Previous community-based resources and providers may be limited or no longer in existence.
It is not easy to capture and define a specific term that actually captures the span of variable human experiences in a post COVID-19 world. However, the biopsychological functionality of a population may be conceived not just in terms of hard and fast categorical terms (depression, anxiety, etc.) but may be more reflected as a continuum where the individual’s life is livable and doable, thus C-19FS.
The fundamental problem is what has been addressed earlier pertaining to the “known, the unknown and the unknowable.” The known population of those diagnosed with mental health conditions and being able to measure things like medication, clinic visits, and hospitalization are relatively easy to count, however they reveal only a small portion of the total at-risk population in our society.
What is the actual number of individuals who would benefit from behavioral health services? What is the true magnitude of the unknow and unknowable population? What is appreciable is that people exposed to uncontrollable events experience psychosocial distress. Any event that disrupts normalcy of a community impacts an individual’s biopsychosocial resources and assets. Communicable disease will obviously continue; times of great emotional upheaval will be re-experienced, and the continuum of vulnerability will be present.
The mental health profession is on the brink of large-scale disruption. And while communicable diseases, natural and man-made disasters or catastrophic events will never be completely eliminated, the ability to identify large population behavioral health issues earlier, intervene proactively, and better understand its progression in communities will allow us to address trends, and challenges during pandemics. COVID-19 will shape the way we deliver care forevermore. The future will need to be focused not only on the individual, but also on the unknown and unknowable population.
Greg Bankoff, Georg Frerks, Dorothea Hilhorst (2004) Mapping Vulnerability: Disasters, Development and People, London: Earthscan.
Dr. Kesling is a licensed mental health professional in Texas. He is a consultant for behavioral health strategies in communities.