Young woman wearing disposable medical mask shopping in supermarket during coronavirus pneumonia outbreak. Protection and prevent measures while epidemic time.

Next steps as COVID-19 returns – Expert Reaction

New Zealanders have been briefed with new information about how the Government is handling new cases of community transmission.

The SMC asked experts to comment on the following:

  1. Mask wearing
  2. Contact tracing tech
  3. Legal powers
  4. Mental health & coping

Associate Professor Arindam Basu, College of Education, Health & Human Development, University of Canterbury, comments:

“Masks are excellent for source control, i.e., not passing infection to others. Not so much for prevention of ‘getting’ diseases, hence masks should be on whenever people are out and about.

“There is evidence of airborne transmission, so putting on masks is essential in public spaces

“Any mask is good, EXCEPT for those with valves on them. The clue is to wear them properly covering  nose, and take care not to overlap with glasses to avoid fogging.

“Mask wearing needs to be with all other precautions (hand wash/cough-sneeze hygiene).

“Turn off face-recognition algorithms on phone if wearing masks as they do not work, prompting to take off masks for some people.”

No conflict of interest declared.

Dr Andrew Chen, Research Fellow, Koi Tū – Centre for Informed Futures, University of Auckland, comments:

“While there are other technologies available, such as Bluetooth-based methods like those we have seen overseas, it is important that we focus on the tools that are available to us right now.

“Manual contact tracing (i.e. public health officials interviewing active cases and making phone calls to contacts) is still the primary mechanism through which we are conducting contact tracing.

“The NZ COVID Tracer app is a useful tool to provide a bit more information to contact tracers, and importantly can help notify you if they identify an exposure risk and there is an overlap with your location logs.

“Keeping your own records through other means is also helpful, and it is worth spending the time to retrace your steps over the last two weeks, just in case it is needed by contact tracers.

“Bluetooth-based methods (including the Apple/Google protocol and CovidCard) are being actively investigated and developed by the government, but I expect that this will still take a few months to be rolled out and we should not rush this process – it is more important to get it right.

“These other technologies are not silver bullets and we have seen limited effectiveness overseas, so we need to think of these technologies as augmentations/support for the manual contact tracing system.

“Under the recently released COVID-19 Public Health Response (Alert Levels 3 and 2) Order 2020, s16(2)(d) requires that businesses at level 2 (and level 3) must ‘display a copy of the QR code for the business or service in a prominent place at or near the main entrances to the workplace’, where the ‘QR Code’ is defined earlier as ‘a unique identifying code issued by the Government for the purpose of supporting contact tracing’.

“I expect that this refers to the NZ COVID Tracer QR codes – increasing the availability and visibility of these posters will hopefully improve use of the app and help people keep records of their movements more easily. We have previously seen that more businesses making QR codes available leads to a corresponding increase in participation, so I hope that this new requirement will lift the participation rate.

“Businesses can easily generate a QR code through the Ministry of Health using a self-service form.”

No conflict of interest declared.

Dr Simon McCallum, Senior Lecturer in Software Engineering, Victoria University of Wellington, comments:

“The identification of new cases highlights the issues we have with contact tracing and the potential for transmission. Manual contact tracing is vital, and everyone should register their details with the COVID Tracing app.

“However, for regular usage, the COVID Tracing app has problems. The first is that it requires people to actively engage with the app multiple times per day. This level of engagement is very difficult to maintain over time. There are some ways to increase engagement but these are challenging.

“The CovidCard solves part of the problem, but given we still do not know the transmission dynamics of SARS-CoV-2, having a fixed hardware approach may turn out to be worse than useless. It could miss transmissions and give people a false sense of security.

“New Zealand has diverse communities and we need multiple tracing solutions for different groups of people. There are at least three different types of communities that need to be different solutions.  There are many of us who use Facebook and Google/Apple maps. For many of these people, a GPS tracking system that records our location on our phones would be fine. We can already do this by turning on location services in Google maps, or using OpenStreamMaps (OSMAnd and turning on local tracking).

“For those who are more concerned about privacy, we need something like the COVID Tracing App, or the CovidCard. The CovidCard has a significant problem in that it cannot detect if the virus is on a surface or has been transmitted by airborne spread. The CovidCard could also create a false sense of security so that people feel that they do not need to worry as much about recording where they were.

“These technology solutions also do not address the most concerning aspect of community transmission, the potential for a reservoir of cases in communities that are not well connected to the health system, or do not trust government organisations. For this community, we need systems that connect with people through organisations they trust. These may be Churches, Marae, gangs, or sports groups. This requires working with communities and finding solutions, rather than mandating some technological solution. There are ways to use business-style QR codes that allow people to anonymously check in and provide a way to contact them through their trusted organisation. This will require careful interaction and building of trust with organisations with a focus on protecting public health.”

Conflict of interest statement: “I unsuccessfully stood for selection as a candidate for the Labour Party in the Taieri Electorate.”

Professor Michael Plank, Te Pūnaha Matatini and University of Canterbury, comments:

“Contact tracing can be time-consuming because it requires getting hold of someone on the phone and then interviewing them about their movements and contacts over the last two weeks. This might involve people looking at their diaries, bank records, phone location tracking history and potentially a lot of memory jogging by the contact tracer.

“We can all help speed this process up by having this information on hand: try making a list of everywhere you’ve been and who’ve seen in the last 14 days and see how long it takes you. The NZ COVID Tracer app can help here – you can now add manual entries so this provides a way of keeping all this information in one place, and in a format that will be easy for public health officials to process.

“We now know that one of the cases travelled to Rotorua last weekend. People who may have come into contact with this person should get tested. But remembering that there will be other cases we don’t know about, it’s quite likely infectious people may have travelled to other parts of the country. So wherever you are, it’s best to be cautious, at least until the contact tracing investigation reveals the true extent of the outbreak.

“There is no need to panic, but it would be sensible to act as if you have COVID-19 and act as if other people in your community have COVID-19.”

Conflict of interest statement: “I am partly funded by MBIE for research on mathematical modelling of COVID-19.”

Professor John Hopkins, Professor of Law specialising in Law and Disasters, University of Canterbury:

“The unhelpful confusion caused by the weak legal tools which the police and other enforcement bodies had under the first lockdown has been removed by the CoVID-19 Public Health Response Act 2020.

“This provides a much stronger mandate for such powers. While far from perfect, this act, with its clear authority under Section 11 will hopefully balance any reluctance by some individuals to follow the rules second time around (particularly given those earlier rules are current being challenged before the High Court).

“Although, as ever, the legal system which provides the framework for the CoVID-19 response will only achieve its purpose if the Community self-enforces its requirements. Maintaining that support through strong, clear and fair decision making will remain crucial in retaining the legitimacy of the response that this will require.”

No conflict of interest.

Dr Hiran Thabrew, Child Psychiatrist and Paediatrician, University of Auckland and Auckland District Health Board:

“Going back to lockdown, albeit half expected, is likely to be anxiety, disappointment and even a sense of grief.

“Anxiety is likely to be related to worries about one’s own safety and the safety of loved-ones and may lead to avoidance of people and public spaces. This may not be a bad thing. It may also lead to a resumption of searching social media for COVID-related stories, which is likely to be less useful.

“Disappointment is the psychological reaction to an outcome that does not match up to expectations (i.e. you are in an uncertain situation, you hope for a positive outcome, you feel you deserve the positive outcome and then you are surprised that you dd not achieve the positive outcome). The greater the disparity between your expectations and the outcome, the greater the disappointment.

“Grief can manifest in different ways/stages (although these don’t always happen in a set sequence):

  • denial (this isn’t really happening)
  • anger (acting out/breaking the rules)
  • sadness (feeling down about what’s going on).
  • acceptance (coming to terms with what’s happening and doing what’s needed)

“Those who break the rules are likely to channel the anger and risk exclusion by the rest of the ‘team of 5 million’ who are trying to survive the situation together.  Multiple cases could also lead to people doubting the Government’s strategy of stamping out the virus and pose a political risk during this election year. Therefore, public vigilance is essential, not merely reliance on a limited number of regulatory authorities such as the Police.

“Healthy ways to manage anxiety, disappointment and grief include:

  • Revising one’s expectations (again).
  • Focussing on what you can control, and trying to accept what you can’t
  • Continuing to do all the things you did during the previous lockdown to maintain your mental health and care for others, including:
    • Creating a new daily/weekly routine
    • Not trying to do too much (aim to achieve 70% of what you’d like, not 100%)
    • Talking about your feelings with others
    • Actively using relaxation strategies, including regular exercise, mindfulness via apps like CALM/Headspace, online yoga, etc.
    • Practicing gratitude by thinking of three things for which you are still grateful each day
    • Limiting use of social media to read stories about COVID or keep up with the latest case numbers
    • Checking in and staying connected with others, especially those who may be more afraid or more vulnerable to either the virus or the effects of isolation
    • Remembering that this too will pass

“Note that children may have different responses, depending on their ages. See my previous statements (here and here) for more information.

“However, the most important determinant of how they fare is likely to be how their parents react to the situation. So, providing age-appropriate explanations of what’s going on, staying calm and modelling self-care strategies will help them get through this period.

“Following this phase, the public is likely to be open to greater protection measures.  More organised or mandatory use of the COVID tracker app or other tracking technology may be one valuable strategy.”

No conflict of interest.