INTRODUCTION
Since the year 2020, the COVID pandemic has become the primary concern worldwide. The alarming rise in the number of people getting infected with COVID and subsequent deaths had a major impact on the healthcare system[1] and economies of majority of countries including India, leading to feelings of uncertainty, and apprehensions[2] among the common mass. As the first wave of the pandemic subsided by January 2021 in India, there was a phase of relief which was very short lived, as the second wave started within 2 months in March 2022. The discovery of the novel variants[3] of the COVID-19 virus, and repeated waves of the pandemic made almost everyone feel helpless and hopeless. The prolonged duration of the pandemic added to continued feelings of hopelessness among people paving the way to emotional instability and unsteadiness[4,5] Predicting the long-term impact of COVID, the World Health Organization coined the term Pandemic Fatigue[6] in the year 2020. It expressed concerns on the changes at behavioral level observed “through an increasing number of people not sufficiently following the safety recommendations and restrictions and decreasing their effort to keep themselves informed about the pandemic”.[7] Pandemic Fatigue is a concept where the initial excitement and feeling of crisis have been replaced by feelings of exhaustion and burnt out. From a physiological perspective, when acute stress persists and becomes chronic stress, the unremitted activation of the Hypothalamic-pituitary- adrenal (HPA) Axis and subsequent uncontrolled cortisol can influence and initiate the process of exhaustion and fatigue in individuals. On similar lines the Pandemic Fatigue is hypothesized to drain physical and cognitive strength of common population. Several studies suggest people experiencing changed biological functions in terms of sleep and appetite. Overall exhaustion associated with the COVID pandemic is also reported to cause emotional bluntness[8] in individuals. However, this exhaustion did not come all of sudden and took its own course. The perception of the general public towards the pandemic have undergone different phases, and possibly been proportional to the death rates and availability and adequacy of health services. The first wave of the pandemic could be termed as a phase of confusion, shock and fear as people tried to understand the nature of the pandemic amidst new insights about the COVID virus gained with every passing day. As nationwide lockdown was enforced, people tried to cope up with this unprecedented situation by engaging in their lost or newfound hobbies and sharing them on the social media. The volume of internet use by people of all ages at the same time peaked to never seen before numbers during the pandemic. However, people were gradually feeling suffocated with the COVID protocols, confined to their home and many struggled with dwindled income or even loss of job. As the first phase improved, complacent behavior in terms of precautions against the COVID virus were commonly observed. The second wave hit within 2 months of the first wave, and was very dreaded compared to the first wave due to very high death rates during this wave which almost crippled health services across many nations including India. People in general became apprehensive about the whole situation, as death in own or nearby family was becoming common and there was a constant sense of anxiety of getting infected. These waves of the pandemic happened over a period of more than a year, during which people depending on their own health beliefs tried to develop their own strategies to protect themselves from the risk of infection. As people got extra cautious about hygiene, there was also an increase in people’s engagement into fitness activities and better health practices. But as mentioned earlier, people’s perception towards the pandemic kept on changing and complacency in behavior continued. The pandemic maintained its presence even after 2 years in different strength through its different variants, while the loss of job, business, restrained social interaction in person, and hassles of work from home continued. Though people started to get adjusted with the restrained lifestyle during the pandemic, they were also being hopeless with passage of time[9] With development of the vaccines and mass vaccinations, the situation has improved than before and we are in a stage where COVID infection is not fatal unless someone has major comorbidities. However, several domains of physical and mental health of individuals appear to have been adversely impacted by the prolonged pandemic situation which need to be established through longitudinal and well controlled studies. There are probabilities of increased cognitive and mental health problems. Many studies suggest that the pandemic or lockdown fatigue can slow down cognitive abilities.[10,11]
Chronic stress and fatigue are known factors to affect cognitive functions. Also, COVID-19 infection has potential to trigger cognitive decline. Research shows that due to Pandemic Fatigue, changes in habitual responses to situation, capacity to concentrate, and certain deficits in memory can happen. Long term health outcomes including changes in cognitive functioning due to COVID pandemic is a cause of concern. Predicting changes in cognitive functions and how it is mediated by exhaustion during 2 long years of COVID pandemic is challenging because of constant alteration of situations.[12]
Studies show that, there are differences in peoples coping patterns, stress tolerance and problem-solving skills in comparison to 1st year of COVID pandemic.[13] As physical activities are known to have a direct and positive influence over the cognitive functions, pandemic idleness, and overtiredness due to restricted physical movement and involvement might have an adverse brunt on cognitive functions of individuals.
With the above background, the present study aimed to explore the probable association between Pandemic Fatigue and cognitive functioning in adults.
METHODS
Study design and sample
A group of 100 individuals were selected online for the study using survey based purposive sampling method during the period February to April 2022. It was a cross sectional and explorative study including healthy adults in the age range of 18–40 years of both sexes. Sample were selected online from across the country but were predominantly from the states of West Bengal, Jharkhand, Odisha (Eastern part of India), Karnataka (southern part of India), and Delhi (Northern part of the country).
Following inclusion and exclusion criteria were followed:
Inclusion criteria
- Healthy individuals in the age range of 18–40 years of both sexes, irrespective of previous COVID infection status
- Minimum education up to intermediate, with reading and comprehension abilities to respond to the assessment protocols.
Exclusion criteria
- Individuals having chronic medical, neurological, or psychiatric illness or currently infected with COVID.
Ethical approval for the study was obtained from Departmental Research Committee of the Amity Institute of Psychology and Allied Sciences, Amity University Kolkata. Informed consent was taken from each participant before administration of the following assessment tools:
- Pandemic Fatigue Scale (PFS)[14]: The PFS is a six-item scale which models Pandemic Fatigue with sub-factors of “information fatigue” i.e., being tired of hearing about COVID-19 and “behaviour fatigue” i.e., feeling demotivated and strained from fighting COVID. Scoring system was following the mean and percentile range obtained from the specific sample
- Perceived change in Cognitive Functioning Questionnaire: The Perceived change in cognitive functioning questionnaire is a tailor-made survey-based questionnaire which includes 5 items. The items estimate the areas of cognitive functioning i.e., memory, attention and concentration, flexibility, planning and decision making.
Statistical analysis
Socio-demographic data were analysed by calculating frequency and percentage. Descriptive statistics was applied to calculate mean and standard deviation. Student’s t-test was used to compare cognitive functions of the sample and Pearson’s correlation was used to see the relationship of Pandemic Fatigue with cognitive functions of the sample. IBM SPSS Statistics for Windows, version 25 (IBM Corp., Armonk, N.Y., USA) was used to analyse the data.
RESULTS
Socio demographic details showed that the mean age of the sample was 27.26 ± 6.64 years, with females in majority. Sixty percent of the sample was never affected with COVID [Table 1]. Pandemic Fatigue was present predominantly in whole sample as mean score of the sample on the PFS was 22.38 ± 7.09 with most of the sample having Pandemic Fatigue features “about half of the time”.
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Table 1: Sociodemographic details of the sample
Pandemic fatigue was found significantly correlated with perceived changes in cognitive function of the sample in Attention and Concentration domain; though relationship in other domains of memory, planning and decision making was statistically not significant [Table 2]. Upon further comparison of individuals with history of COVID infection and noninfected individuals in the sample, no significant difference was found in terms of Pandemic Fatigue; however, individuals with history of COVID infection in past perceived significant changes in their attention and concentration, and flexibility [Table 3].
Table 2: Relationship between age, pandemic fatigue, and changes in cognitive functioning
Table 3: Comparison of pandemic fatigue and perceived changes in cognitive functioning between individuals with history of COVID-19 infection and noninfected individuals
DISCUSSION
The notion of Pandemic Fatigue is about being unable to maintain the motivation for safety protocols and health behaviour due to prolonged and stressing nature of the COVID pandemic. The present study was aimed to explore the extent of Pandemic Fatigue associated with the COVID pandemic situation and its relationship with cognitive functioning of adult individuals. The persistent and prolonged nature of the pandemic and constant anxiety and apprehension appear to have influenced individuals impacting their motivation and feeling hopeless about the pandemic situation.[15,16]
Table 2 showed the correlation of age with Pandemic Fatigue and changes in cognitive functioning. It has been stated and examined in various studies that, ageing has a general impact over physical, emotional, and cognitive wellbeing and supports present study findings suggesting significant relationship of age with changes in attention and concentration in studied sample. Present study findings suggest that Pandemic Fatigue had a significant association with perceived changes in attention and concentration [Table 2] of the sample and find support from studies that suggest Pandemic Fatigue or exhaustion itself has unpleasing and unfavourable impact over overall cognition.[17] Though there was no significant relationship found between memory functions, planning and decision-making capabilities of the studied sample. The changed lifestyle and being unsure about everyday life appear to have an effect over selective and focused attention.
The impact of COVID pandemic appear to have turned out to be an additional perpetuating factor for every age group to have affected cognitive abilities even when the person has not been infected by the virus. While the findings are cross sectional in nature, it would be interesting to explore these changes in long term, as with growing age changes in concentration, being less vigilant or attentive are more frequent.[18]
Studies do suggest that corona virus is capable of affecting physical and psychological health[19] of infected individuals who might have cognitive deficits and altered neuropsychological functioning. Comparing the Pandemic Fatigue and perceived changes in cognitive functioning between infected and noninfected individuals, the present study findings suggest no difference in fatigue status of infected and noninfected people [Table 3]. While fatigue in itself was found related with attention and concentration function only, interestingly infected and noninfected people differed significantly on domains of attention, concentration and flexibility. Previous studies too have mentioned that recovered COVID patients are known to have exhibited cognitive dysfunction due to inflammatory cytokine and consistent viral clearance.[20] Studies show that, recovered infected individuals might also have mild cognitive impairment.[21] In the domains of sustained attention[22] and cognitive flexibility, the changes are more prominent and visible, supporting present study findings.
Implication and limitation of the study
The present study suggests the adverse impact of the prolonged COVID pandemic, and its related stress and fatigue on cognitive state of the healthy individuals. The assessment of cognitive functions could have been more structured, and the results could be indicative only. Future studies in longitudinal course using stringent measures, with bigger sample size and better gender distribution may give better insight in the domain.
CONCLUSIONS
The concept of Pandemic Fatigue has been used in accordance to describe how people have become disinterested and de-motivated to gather or listen any information about the pandemic or maintain their compliance with health protocols and finally also trying to get adjusted with the situation in their own way.
The adverse effects of COVID is surpassing the domain of physical health. Along with physical health, psychological and cognitive wellbeing of individuals is also getting affected. Irrespective of being infected with the virus or not, the Pandemic Fatigue is impacting people both physiologically and psychologically. Overall, the present study is an indicative of how Pandemic Fatigue related to COVID pandemic is having a bearing on cognitive functions particularly attention and concentration of healthy adults. Individuals with history of COVID infection are more at risk of these changes. Present study findings can be used as preliminary evidence to identify the specific impact of Pandemic Fatigue and to mediate the pandemic exhaustion and cognitive function in affected individuals. Further an emerging awareness of the Pandemic Fatigue concept can improve the health outcome of common mass.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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