In late-2020, many countries around the world faced another surge in number of confirmed cases of COVID-19, including United Kingdom, Canada, Brazil, United States, etc., which resulted in a large nationwide and even worldwide wave. While there have been indications that precaution fatigue could be a key factor, no scientific evidence has been provided so far. We used a stochastic metapopulation model with a hierarchical structure and fitted the model to the positive cases in the US from the start of outbreak to the end of 2020. We incorporated non-pharmaceutical interventions (NPIs) into this model by assuming that the precaution strength grows with positive cases and studied two types of pandemic fatigue. We found that people in most states and in the whole US respond to the outbreak in a sublinear manner (with exponent k=0.5), while only three states (Massachusetts, New York and New Jersey) have linear reaction (k=1). Case fatigue (decline in peoples vigilance to positive cases) is responsible for 58% of cases, while precaution fatigue (decay of maximal fraction of vigilant group) accounts for 26% cases. If there were no pandemic fatigue (no case fatigue and no precaution fatigue), total positive cases would have reduced by 68% on average. Our study shows that pandemic fatigue is the major cause of the worsening situation of COVID-19 in United States. Reduced vigilance is responsible for most positive cases, and higher mortality rate tends to push local people to react to the outbreak faster and maintain vigilant for longer time.
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