COVID-19 and Workplace Fatigue: Lessons Learned and Mitigation StrategiesPosted on by
The declaration of coronavirus disease 2019 (COVID-19) as a US public health emergency on March 13, 2020, altered the way we work and live, intensified feelings of stress, and created uncertainty about the future for many people. The closure of many businesses led to financial instability and the highest unemployment rates since 1976 1. Exposure to an abundance of news coverage, some of which has been conflicting or has changed over time, has fueled feelings of mistrust and fear2-5. New routines and behaviors, such as wearing masks and social distancing, along with frequent messages about handwashing and cleaning, are chronic reminders of our “new normal” and have been shown to increase stress and anxiety6. Lessons learned from COVID-19 studies report that fatigue is linked to different factors, including changes in work schedules and routines and worries about economic stability and health. Effective employer-led strategies to mitigate fatigue include clear communication about safety policies and procedures and implementation of organizational safety measures (e.g., creating safe work spaces, developing sanitization routines, provision of employee assistance programs). Suggestions for workers include knowing about employer-based fatigue mitigation programs, keeping regular and healthy routines, and developing strong social networks (while protecting yourself and others). These unprecedented times require that employers collaborate with workers on a holistic approach and creative solutions to manage workplace fatigue.
Fatigue, Stress, and Sleep
Fatigue in the workplace is commonly associated with shift work, long work hours, and the resulting sleep impairment. However, many other factors—such as stress, health, and health behaviors —can cause fatigue7. Especially during these times, fatigue may also be a symptom of depression or other mental health challenges, and sleep impairment or reduced sleep quality can intensify existing mental health issues8. In times of stress, sleep problems are common, and sensitivity to sleep disruption increases the likelihood of chronic insomnia9,10. Insomnia is a risk factor for post‐traumatic stress disorder when people are exposed to major stressors. This, in turn, is associated with an increase of sleep disruption, which can create a spiral of stress, mental health issues, sleep impairment and fatigue11,12.
Fatigue can slow down reaction times, reduce attention or concentration, limit short-term memory, and impair judgment, thus increasing the risk for fatigue-related incidents, such as work injuries. However, worker fatigue can also affect others when mistakes are made, for example, when fatigued workers operate machinery at work, make family-related decisions at home, or drive while tired. Recognizing the sources of fatigue can allow for targeted, effective mitigation strategies to keep everyone healthy and safe.
COVID-19 and Changes in the Workplace
In response to the declaration of COVID-19 as a public health emergency, more than 55 million workers were in jobs considered essential to maintaining critical infrastructure12. While the pandemic has provided unprecedented challenges, some industries have established the infrastructure, plans, and training to navigate through emergencies. In other industries, employees who do not face emergency situations in their normal work (grocery clerks or delivery drivers for example) are not typically provided the training and resources to manage stress, longer work hours, increased work demands, and fatigue13.
Millions of healthcare personnel on the frontline for responding to the pandemic have been at the greatest risk for exposure to SARS-CoV-2, the virus that causes COVID-19 while working around the clock to care for the sharp increase in patients. A surge of new cases of depression, anxiety, and insomnia, plus worsening of existing mental health issues—particularly among nurses—has been attributed to limited resources, overwhelming workload, longer shifts, disruptions to sleep and work-life balance, process inefficiencies, occupational hazards, and concerns about health and financial instability14-16.
Demands for essential goods, such as cleaning supplies and toilet paper, put extreme pressures on our supply chain. To meet this sudden increased demand, the Federal Motor Carrier Safety Administration amended hours of service regulations to allow truck drivers more time to transport emergency or critical supplies and avoid situations in which drivers could be too fatigued to operate their rigs safely17. Drivers reported that transport routes were shortened to focus on regional deliveries, more time was needed to unload and load trailers due to additional COVID-19 mitigation practices, and the closure of many businesses and rest stops reduced the number of safe places to stop, eat, and rest18. Given that drivers are paid by the load and mileage, these conditions raised concerns that drivers would be pushed to operate longer, forgo rest breaks, and park in unsafe or unsecure locations if they ran out of available hours—all of which adds to worries about financial instability and fatigue among truck drivers who haul essential goods in our supply chain.
Stay-at-home orders and social distancing recommendations prompted many businesses to adopt work-from-home options for their employees where feasible. For many of these workers, lack of physical and temporal work boundaries between work and home life resulted in longer work hours and fragmented focus time, leading to stress, burnout, and fatigue19-21. Many are also juggling increased caregiving responsibilities in response to changing school arrangements and work, and research suggests mothers may be more affected than fathers based on differences in childcare duties19,22.
Returning to “Business as Usual”
Following the lowest level of employment during the pandemic, employment has been rising.* However, much of the increase in new jobs has been among part-time workers who would have preferred full-time employment, but either their hours were reduced or they were unable to find full-time jobs23,23a. Because of this, there may now be more workers employed in multiple jobs to make ends meet. While their overall hours of work per day may not change substantially, it may mean more scheduling demands from multiple part-time jobs and coordinating childcare (including dealing with school closures or remote learning). All this results in more time awake and added stress, leading to fatigue.
The addition of overnight shifts in workplaces to accommodate the physical distancing requirements, while keeping up productivity, may increase the risk for fatigue-related incidents, particularly among those who are unaccustomed to working non-standard schedules24. Organizations may be operating with reduced staff, which may lead to greater work intensity for individual workers.
A Holistic Approach for Employers and Workers to Manage Fatigue
The causes of worker fatigue can stem from a number of sources such as changes in work routines and schedules, varying degrees of stress due to adversities related to COVID-19 and concerns about exposure to SARS-CoV-2 at work. A holistic approach to worker safety, health, and wellbeing is critical for an effective and efficient return to our routines. For employers, it is important to use several strategies, learned from the impacts of public health emergencies, to manage stress and fatigue. Some strategies include structured training on large-scale disasters, increased staffing, collaborative efforts and modified human resources, such as alternate paid time off options where possible (e.g., to care for a family member with COVID-19)22. Messaging should be tailored to the workforce with considerations for literacy levels, translations, and delivery methods (e.g., infographics, online training). In times of crises, a clear plan and communications (based on risk-communications principles) from leaders, to set expectations, adjust resources, and help workers feel connected and involved can alleviate stress and fatigue. In addition, organizational measures such as social distancing, good ventilation, and psychological support systems (e.g., Employee Assistance Programs) are also effective measures 25,26. Considerations should be extended to all workers, including those working part-time or on contract. Creative solutions such as redesigning or shifting workloads may need to be considered.
Workers can consider workplace strategies like developing a buddy system or knowing employer safety protocols to help reduce the risk for fatigue-related incidents. Outside of the workplace, strategies to improve sleep include maintaining a regular routine and healthy habits. In times of common stress, it is normal for people to feel a greater need to communicate with each other. Studies from Wuhan, China, found good social support (while maintaining social distancing), creating strong social networks, and a sense of belonging reduced anxiety and fostered better sleep and self-efficacy during COVID-19 and return to work27. Health behaviors such as enhanced personal hygiene (such as wearing masks and handwashing) and using psychological support systems among coworkers, family, and friends have also been shown to decrease workers’ anxiety, depression, stress, and insomnia27,28.
More information and strategies to manage fatigue during COVID-19 is available on the CDC website and additional information about protecting and advancing worker safety, health, and well-being has been published in prior NIOSH Science Blogs and on the CDC website addressing strategies to build mental resilience, the importance of healthy work design and well-being solutions in mitigating stress among workers, sleep tips during difficult times, and the role of organizational support and healthy work design to support worker well-being. This blog is based on a larger article published in the November 2020 issue of The Synergist, the magazine of American Industrial Hygiene Association.
Imelda Wong, PhD, is the Coordinator for the Center for Work and Fatigue Research and an Industrial Hygienist/Epidemiologist in the NIOSH Division of Science Integration.
Mary B. O’Connor, MS, is an Occupational Safety and Health Specialist in the NIOSH Western States Division.
* Section edited to reflect trends in the data vs. monthly numbers that are quickly outdated.
For more Information
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