{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T19:18:32Z","timestamp":1790709512548,"version":"4.1.0"},"reference-count":44,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2022,5,26]],"date-time":"2022-05-26T00:00:00Z","timestamp":1653523200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100007364","name":"Fondazione CRT","doi-asserted-by":"publisher","award":["Lagrange project"],"award-info":[{"award-number":["Lagrange project"]}],"id":[{"id":"10.13039\/100007364","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosdigitalhealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Digit Health"],"abstract":"<jats:p>Despite the availability of effective vaccines against SARS-CoV-2, non-pharmaceutical interventions remain an important part of the effort to reduce viral circulation caused by emerging variants with the capability of evading vaccine-induced immunity. With the aim of striking a balance between effective mitigation and long-term sustainability, several governments worldwide have adopted systems of tiered interventions, of increasing stringency, that are calibrated according to periodic risk assessments. A key challenge remains in quantifying temporal changes in adherence to interventions, which can decrease over time due to pandemic fatigue, under such kind of multilevel strategies. Here, we examine whether there was a reduction in adherence to tiered restrictions that were imposed in Italy from November 2020 through May 2021, and in particular we assess whether temporal trends in adherence depended on the intensity of the restrictions adopted. We analyzed daily changes in movements and in residential time, combining mobility data with the restriction tier enforced in the Italian regions. Through mixed-effects regression models, we identified a general trend of reduction in adherence and an additional effect of faster waning associated with the most stringent tier. We estimated both effects being of the same order of magnitude, suggesting that adherence decreased twice as fast during the strictest tier as in the least stringent one. Our results provide a quantitative measure of behavioral responses to tiered interventions\u2014a metric of pandemic fatigue\u2014that can be integrated into mathematical models to evaluate future epidemic scenarios.<\/jats:p>","DOI":"10.1371\/journal.pdig.0000035","type":"journal-article","created":{"date-parts":[[2022,5,26]],"date-time":"2022-05-26T17:25:41Z","timestamp":1653585941000},"page":"e0000035","update-policy":"https:\/\/doi.org\/10.1371\/journal.pdig.corrections_policy","source":"Crossref","is-referenced-by-count":54,"title":["Evidence of pandemic fatigue associated with stricter tiered COVID-19 restrictions"],"prefix":"10.1371","volume":"1","author":[{"given":"Federico","family":"Delussu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7246-2341","authenticated-orcid":true,"given":"Michele","family":"Tizzoni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3085-8641","authenticated-orcid":true,"given":"Laetitia","family":"Gauvin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,5,26]]},"reference":[{"issue":"4570","key":"pdig.0000035.ref001","article-title":"Impact of tiered restrictions on human activities and the epidemiology of the second wave of COVID-19 in Italy","volume":"12","author":"M Manica","year":"2021","journal-title":"Nature Communications"},{"issue":"9","key":"pdig.0000035.ref002","doi-asserted-by":"crossref","first-page":"1145","DOI":"10.1038\/s41562-021-01181-x","article-title":"A worldwide assessment of changes in adherence to COVID-19 protective behaviours and hypothesized pandemic fatigue","volume":"5","author":"A Petherick","year":"2021","journal-title":"Nature Human Behaviour"},{"key":"pdig.0000035.ref003","article-title":"The concept of \u201cfatigue\u201d in tackling covid-19","volume":"371","author":"S Michie","year":"2020","journal-title":"BMJ"},{"key":"pdig.0000035.ref004","unstructured":"WHO. Pandemic Fatigue. Reinvigorating the Public to Prevent COVID-19. Policy framework for supporting pandemic prevention and management. 2020."},{"issue":"m3093","key":"pdig.0000035.ref005","article-title":"Behavioural fatigue: a flawed idea central to a flawed pandemic response","volume":"370","author":"K Abbasi","year":"2020","journal-title":"BMJ"},{"key":"pdig.0000035.ref006","doi-asserted-by":"crossref","first-page":"2960","DOI":"10.3389\/fpsyg.2020.589892","article-title":"Behavioral fatigue: real phenomenon, na\u00efve construct, or policy contrivance?","volume":"11","author":"N Harvey","year":"2020","journal-title":"Frontiers in Psychology"},{"issue":"3","key":"pdig.0000035.ref007","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1136\/jech-2021-216876","article-title":"Patterns of compliance with COVID-19 preventive behaviours: a latent class analysis of 20 000 UK adults","volume":"76","author":"L Wright","year":"2022","journal-title":"J Epidemiol Community Health"},{"key":"pdig.0000035.ref008","doi-asserted-by":"crossref","unstructured":"Lilleholt L, Zettler I, Betsch C, B\u00f6hm R. Pandemic Fatigue: Measurement, Correlates, and Consequences. Preprint at PsyArxiv. 2020.","DOI":"10.31234\/osf.io\/2xvbr"},{"issue":"6","key":"pdig.0000035.ref009","doi-asserted-by":"crossref","first-page":"20210041","DOI":"10.1098\/rsfs.2021.0041","article-title":"A year of living distantly: global trends in the use of stay-at-home orders over the first 12 months of the COVID-19 pandemic","volume":"11","author":"T Phillips","year":"2021","journal-title":"Interface Focus"},{"key":"pdig.0000035.ref010","article-title":"Evaluating the impacts of tiered restrictions introduced in England, during October and December 2020 on COVID-19 cases: A synthetic control study","author":"X Zhang","year":"2020","journal-title":"medRxiv"},{"key":"pdig.0000035.ref011","doi-asserted-by":"crossref","first-page":"108484","DOI":"10.1016\/j.mbs.2020.108484","article-title":"Four-tier response system and spatial propagation of COVID-19 in China by a network model","volume":"330","author":"J Ge","year":"2020","journal-title":"Mathematical Biosciences"},{"key":"pdig.0000035.ref012","article-title":"The Role of the California Tier System in Controlling Population Mobility During the COVID-19 Pandemic","author":"EL Schwarz","year":"2021","journal-title":"Research Square"},{"issue":"6531","key":"pdig.0000035.ref013","doi-asserted-by":"crossref","DOI":"10.1126\/science.abd9338","article-title":"Inferring the effectiveness of government interventions against COVID-19","volume":"371","author":"JM Brauner","year":"2021","journal-title":"Science"},{"issue":"12","key":"pdig.0000035.ref014","doi-asserted-by":"crossref","first-page":"1303","DOI":"10.1038\/s41562-020-01009-0","article-title":"Ranking the effectiveness of worldwide COVID-19 government interventions","volume":"4","author":"N Haug","year":"2020","journal-title":"Nature Human Behaviour"},{"key":"pdig.0000035.ref015","doi-asserted-by":"crossref","unstructured":"Weill JA, Stigler M, Deschenes O, Springborn MR. Researchers\u2019 Degrees-of-Flexibility and the Credibility of Difference-in-Differences Estimates: Evidence From the Pandemic Policy Evaluations. National Bureau of Economic Research; 2021.","DOI":"10.3386\/w29550"},{"issue":"1","key":"pdig.0000035.ref016","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1038\/s41597-020-00575-2","article-title":"COVID-19 outbreak response, a dataset to assess mobility changes in Italy following national lockdown","volume":"7","author":"E Pepe","year":"2020","journal-title":"Scientific Data"},{"issue":"1","key":"pdig.0000035.ref017","doi-asserted-by":"crossref","first-page":"eabi5499","DOI":"10.1126\/sciadv.abi5499","article-title":"Impact of close interpersonal contact on COVID-19 incidence: Evidence from 1 year of mobile device data","volume":"8","author":"FW Crawford","year":"2022","journal-title":"Science Advances"},{"issue":"6","key":"pdig.0000035.ref018","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1038\/s41591-020-0895-3","article-title":"Modeling shield immunity to reduce COVID-19 epidemic spread","volume":"26","author":"JS Weitz","year":"2020","journal-title":"Nature Medicine"},{"issue":"57","key":"pdig.0000035.ref019","article-title":"Adherence and sustainability of interventions informing optimal control against COVID-19 pandemic","volume":"1","author":"L Di Domenico","year":"2021","journal-title":"Communications Medicine"},{"issue":"4","key":"pdig.0000035.ref020","doi-asserted-by":"crossref","first-page":"043115","DOI":"10.1063\/5.0041993","article-title":"How adherence to public health measures shapes epidemic spreading: A temporal network model","volume":"31","author":"BM Behring","year":"2021","journal-title":"Chaos: An Interdisciplinary Journal of Nonlinear Science"},{"key":"pdig.0000035.ref021","doi-asserted-by":"crossref","first-page":"044316","DOI":"10.1103\/PhysRevE.104.044316","article-title":"The effect of delayed awareness and fatigue on the efficacy of self-isolation in epidemic control","volume":"104","author":"G De Meijere","year":"2021","journal-title":"Physical Review E"},{"issue":"27","key":"pdig.0000035.ref022","doi-asserted-by":"crossref","first-page":"15530","DOI":"10.1073\/pnas.2007658117","article-title":"Economic and social consequences of human mobility restrictions under COVID-19","volume":"117","author":"G Bonaccorsi","year":"2020","journal-title":"Proceedings of the National Academy of Sciences"},{"issue":"8","key":"pdig.0000035.ref023","doi-asserted-by":"crossref","first-page":"800","DOI":"10.1038\/s41562-020-0875-0","article-title":"Mapping global variation in human mobility","volume":"4","author":"MU Kraemer","year":"2020","journal-title":"Nature Human Behaviour"},{"issue":"1","key":"pdig.0000035.ref024","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12942-021-00299-5","article-title":"Domestic and international mobility trends in the United Kingdom during the COVID-19 pandemic: An analysis of Facebook data","volume":"20","author":"HE Shepherd","year":"2021","journal-title":"International Journal of Health Geographics"},{"issue":"1","key":"pdig.0000035.ref025","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1038\/s41467-021-23404-5","article-title":"Impacts of social distancing policies on mobility and COVID-19 case growth in the US","volume":"12","author":"GA Wellenius","year":"2021","journal-title":"Nature Communications"},{"key":"pdig.0000035.ref026","article-title":"Evaluating the reliability of mobility metrics from aggregated mobile phone data as proxies for SARS-CoV-2 transmission in the USA: a population-based study","author":"N Kishore","year":"2021","journal-title":"The Lancet Digital Health"},{"key":"pdig.0000035.ref027","article-title":"Non-pharmaceutical interventions during the COVID-19 pandemic: A review","author":"N Perra","year":"2021","journal-title":"Physics Reports"},{"issue":"2","key":"pdig.0000035.ref028","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1111\/bjhp.12519","article-title":"Compliance without fear: Individual-level protective behaviour during the first wave of the COVID-19 pandemic","volume":"26","author":"F J\u00f8rgensen","year":"2021","journal-title":"British Journal of Health Psychology"},{"issue":"3-4","key":"pdig.0000035.ref029","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1080\/13669877.2021.1890637","article-title":"COVID-19 risk perception: a longitudinal analysis of its predictors and associations with health protective behaviours in the United Kingdom","volume":"24","author":"CR Schneider","year":"2021","journal-title":"Journal of Risk Research"},{"key":"pdig.0000035.ref030","unstructured":"Perrotta D, Del Fava E, Zagheni E. 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R: A Language and Environment for Statistical Computing; 2013. 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