The government’s frequently changing policies have risked people breaking rules they are unaware of or subjectively interpreting rules they are unclear on, write Simon Williams and Kimberly Dienes
From its initial decision to delay the UK entering lockdown in March 2020, to recent coverage of lockdown house parties, the UK government has tended to over-emphasise the prevalence of covid-19 rule breaking and its association with “pandemic fatigue” (“behavioural fatigue”).1,2 This “narrative of blame” on rule breakers3 is part of a wider displacement of responsibility by the government onto the public that, as one of us argued in The BMJ, occurred from the very start of the pandemic.4
A number of academics, including some contributors to The BMJ, have rightly critiqued this use of the term “fatigue,” arguing that it is a misrepresentation of the public’s response, and a poorly defined concept unsupported by empirical evidence.3,5 In the UK, there is good evidence that adherence, particularly “majority adherence,” has remained consistently high throughout the pandemic.6 However, a recent large international study concluded that “pandemic policy fatigue” was widespread.7 Covid-19 behavioural science is evolving as rapidly as covid-19 biomedical science, and so our understanding of the role of “fatigue” may yet change as new evidence emerges.
Based on our research—a longitudinal study of public perceptions and experiences of covid-19 policy in the UK8,9,10—we argue that a very specific type of fatigue is increasingly prevalent, one quite different from general behavioural fatigue: alert fatigue. Alert fatigue, we argue, does not stem from a lack of motivation to adhere to rules per se, but to a lack of capacity to understand rules that are frequently changing across place and time. The public aren’t complacent, they’re confused; and many people’s lack of understanding is understandable.
Alert fatigue, a concept derived from research on clinical decision making support, is understood as the mental state (“cognitive overload” or “desensitization”) that comes from receiving too many “alerts” that consume time and energy. This state can cause important alerts to be ignored along with clinically unimportant ones.11,12 Cognitive overload has frequently been reported during the pandemic as a response to increased work and childcare demands, and as a biological response to chronic stress.13,14 People are already working at a cognitive deficit because of existing cognitive burden, which makes it even more difficult to understand confusing and frequently changing policy. For example, hearing about four distinct national guidelines, as well as local or tier guidelines, interferes with trying to learn and follow the rules for an individual’s particular area, and increases alert fatigue.8,10
Although well intentioned, the government’s at one point daily and still frequent press conferences and briefings have been cited as confusing or excessive, leading people to intentionally “switch off” from official announcements.9,10 Alert fatigue is important because it might be leading to inadvertent non-adherence: where people are breaking rules they are unaware of or subjectively interpreting rules they are unclear on.10
Alert fatigue has increased over the course of the pandemic as more rule changes have created more “noise” in people’s heads. In March last year, we had no precedent and so we were learning how to behave in this new way for the first time. Now we have to unlearn more relaxed behaviours and relearn stricter behaviours around distancing and socialising. It is hard to make such rapid and frequent behavioural adaptations. Many politicians have claimed that these behaviours are common sense, whereas we argue that there is no such thing as “common sense” in a pandemic.15
What might have been simple behavioural guidelines are no longer simple. The example of outdoor exercise is a case in point, where rules have varied nationally at various times, with what is permitted changing from exercising alone once daily, to unlimited exercise including group exercise and other various permutations, and back to once daily (but with one other person).16 This confusion leads to a type of “rule blending,” whereby some people are mixing and matching rules from different phases of the pandemic.
The UK government and devolved administrations need to take alert fatigue into consideration when we come out of the current lockdown. We suggest that they should follow three basic principles. Firstly, policy should seek to be as consistent as possible geographically both within and across the four nations. With infection rates decreasing significantly across the UK, the current lockdown presents a “reset” opportunity, where a unified approach that is more understandable to the public can be taken. Secondly, rather than implementing frequent minor and incremental policy changes, less frequent but more substantial policy changes could be universally implemented. We are already seeing examples of inconsistent and incremental policy change: for example, differing approaches and timelines to reopening schools.17
Finally, the government needs to consider how it can better communicate policy changes. Trust in the UK government is extremely low and predictive of lower adherence18; restoring it may be an insurmountable task, but public perception of the vaccine rollout’s success may help. Governments should learn from past experience by not making overly frequent official announcements (particularly where they do not pertain to significant rule changes), by providing adequate notice about significant rule changes, and by ensuring the communication is as clear as possible.
Simon Williams is senior lecturer in people and organisation in the School of Management in Swansea University, and adjunct assistant professor in the Department of Medical Social Sciences in the Feinberg School of Medicine at Northwestern University, Chicago. Twitter @s_n_williams
Kimberly Dienes is lecturer in clinical and health psychology in the Department of Psychology in the School of Human and Health Sciences at Swansea University, and honorary lecturer at the Manchester Centre for Health Psychology in the Division of Psychology and Mental Health at the University of Manchester. Twitter @KimberlyDienes
Competing interests: None declared.
Role of funding source: The research on which this opinion is based is funded by Swansea University’s Greatest Need Fund and Manchester Centre for Health Psychology based at the University of Manchester. The views expressed are those of the authors and not necessarily those of any organisation they are affiliated with. The funders played no role in the writing of the manuscript or the decision to submit it for publication.
- Mahase E. Covid-19: Was the decision to delay the UK’s lockdown over fears of “behavioural fatigue” based on evidence? BMJ 2020;370:m3166
- Dodd V. Shed parties and illegal races: UK police crack down on Covid-19 rulebreakers. The Guardian 18 Jan 2021. https://www.theguardian.com/world/2021/jan/17/uk-police-crack-down-covid-rule-breakers
- Reicher S, Drury J. Pandemic fatigue? How adherence to covid-19 regulations has been misrepresented and why it matters. BMJ 2021;372:n137.
- Williams SN. UK’s coronavirus policy places too much responsibility in the hands of the public. BMJ Opinion. March 2020. https://blogs.bmj.com/bmj/2020/03/17/uks-coronavirus-policy-places-too-much-responsibility-in-the-hands-of-the-public/.
- Michie S, West R, Harvey N. The concept of “fatigue” in tackling covid-19. BMJ Opinion. October 2020. https://blogs.bmj.com/bmj/2020/10/26/the-concept-of-fatigue-in-tackling-covid-19.
- Fancourt D, Bu F, Mak HW, Steptoe A. Covid-19 social study results release 29. 28 Jan 2021. https://b6bdcb03-332c-4ff9-8b9d-28f9c957493a.filesusr.com/ugd/3d9db5_59d1b940054440bbb52a72b6bd0b0a06.pdf
- Petherick A, Goldszmidt R, Andrade E, Furst R, Pott A et al. A Worldwide Assessment of COVID-19 Pandemic-Policy Fatigue, SSRN 2021. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3774252
- Williams SN, Armitage CJ, Tampe T, Dienes KD. Public perceptions and experiences of social distancing and social isolation during the COVID-19 pandemic: a UK-based focus group study. BMJ Open 2020a;10:e039334.
- Williams, SN, Armitage, CJ, Tampe, T, Dienes KD. Public attitudes towards COVID-19 contact tracing apps: A UK-based focus group study. Health Expectations 2020 (online first) https://doi.org/10.1111/hex.13179.
- Williams SN, Armitage CJ, Tampe T, Dienes KD. Public perceptions of non-adherence to COVID-19 measures by self and others in the United Kingdom. medRxiv 2020.11.17.20233486; doi: https://doi.org/10.1101/2020.11.17.20233486
- Ancker JS, Edwards, A, Nosal S. et al. Effects of workload, work complexity, and repeated alerts on alert fatigue in a clinical decision support system. BMC Med Inform Decis Mak 2017;17, 36.
- Baseman, JG, Revere D, Painter I. et al. Public health communications and alert fatigue. BMC Health Serv Res 2013;13, 295.
- Pfefferbaum B., & North CS.. Mental Health and the Covid-19 Pandemic. NEJM 2020;383,510–512.
- McEwen BS, Wingfield JC. The concept of allostasis in biology and biomedicine. Hormones and Behavior 2003 43,2–15.
- Can common sense guide us out of the coronavirus pandemic? BBC Newsnight. December 2020. https://www.bbc.co.uk/programmes/p091q34n
- UK Government. Guidance: National lockdown: Stay at Home https://www.gov.uk/guidance/national-lockdown-stay-at-home#:~:text=You%20may%20exercise%20on%20your,unless%20for%20a%20permitted%20reason.
- Covid in Wales: Youngest to return to primary schools from 22 February. BBC News. 5 February 2021 https://www.bbc.co.uk/news/uk-wales-55919366.
- Wright L, Steptoe A, Fancourt D. What predicts adherence to COVID-19 government guidelines? Longitudinal analyses of 51,000 UK adults. medRxiv 2020.10.19.20215376; doi: https://doi.org/10.1101/2020.10.19.20215376.