Mask use rises but social distancing guidelines are being ignored as pandemic fatigue sets in

More people are now having visitors over or leaving their homes unnecessarily, a USC study finds, opening up gaps in the ‘Swiss cheese’ model of COVID-19 defense.

January 27, 2021 Leigh Hopper

Though mask-wearing is up, other protective behaviors like avoiding close contact with non-household members are waning in the face of COVID-19 “fatigue,” a USC survey shows.

The findings are worrisome, given the importance of the “Swiss cheese” model of pandemic defense in which multiple layers of protection block the spread of the new coronavirus. Protective behaviors will remain important until a large percentage of the population is vaccinated, researchers say.

“There has been a lot of talk about ‘pandemic fatigue,’ and this study clearly shows that people are less willing to take precautions to limit the risk of infection and slow the spread of the virus,” said John Romley, lead researcher on the study and senior fellow at the USC Schaeffer Center for Health Policy & Economics.

The study was published on Friday in JAMA, the Journal of the American Medical Association.

The research team used data from the Understanding America Study, an ongoing survey of 7,705 U.S. residents by the Center for Economic and Social Research at the USC Dornsife College of Letters, Arts and Sciences. They analyzed 16 waves of survey responses to the Coronavirus Tracking Survey between April 1 and Nov. 24, 2020. The survey was sent every two weeks to U.S. residents.

The researchers found that:

  • Mask-wearing increased from 39.2% in early April to 88.6% in late November.
  • Staying at home, except for essential activities or exercise, decreased from 79.6% to 41.4%.
  • Avoiding close contact with non-household members decreased from 63.5% to 37.8%.
  • Not having visitors over decreased from 80.3% to 57.6%.
  • Avoiding eating in restaurants decreased from 87.3% to 65.8%.

Vaccines are here, but vaccination takes time,” Romley said. “In the meantime, we need to stay focused on protecting one another. We should target behaviors that are most effective and least disruptive. We also need to recognize that people may be tempted to let down their guards after a first dose of vaccine.”

Pandemic fatigue may become a larger concern as COVID-19 variants spread

The researchers developed an “adherence index” to 16 evidence-based protective measures to measure apathy and resistance toward interventions. Responses were adjusted for age, sex, race/ethnicity, education, household income and the seven-day mean of daily new cases in the respondent’s state.

They found that overall adherence on the index decreased substantially from 70.0, out of a possible 100, in early April to the high 50s in June before increasing to 60.1 by late November. The trends occurred in all regions of the U.S.

“The general decrease we see in protective behaviors matches anecdotal reports, but the difference we find between behaviors is a very new and important addition to the conversation,” said co-author Matthew Crane, a medical student at Johns Hopkins University School of Medicine and a visiting scholar at the USC Schaeffer Center. “Attention to pandemic fatigue is especially relevant given rising concerns about new variants of the virus, which may require even greater physical distancing measures to curb transmission.”

In addition to Romley and Crane, authors on this study include Kenneth Shermock of Johns Hopkins University and Saad Omer of the Yale Institute for Global Health.

The Coronavirus Tracking Survey has been supported by the Bill and Melinda Gates Foundation, the National Institute on Aging (grant 5U01AG054580-03) and the National Science Foundation (grant 2028683).

Information about the survey and the Understanding America Study panel — including methodology, question wording and results — is available upon request to and will be posted online when the survey is complete.