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Alert level update and mandatory masks on public transport – Expert Reaction

Auckland will stay in Alert Level 3 for the rest of the week.

Prime Minister Jacinda Ardern announced the city will move to Alert Level 2 on Sunday at 11.59pm, but gatherings will be limited to ten people. The rest of the country will remain at Alert Level 2 until Sunday 6 September, when restrictions will be reviewed.

Cabinet has also reviewed the evidence on masks, which will become mandatory on all public transport at Alert Level 2 and above, from Monday 31 August.

The SMC asked experts to comment on the announcement. 

Professor Shaun Hendy, Director of Te Pūnaha Matatini, comments:

“I am supportive of the move to extend Alert Level 3 in Auckland through to this coming Sunday. Although the public health response has been very effective since the first case was detected, there is still the need for population-wide measures to manage the risk around the edges of this current cluster. We need more time to be sure that we have stamped out any further chains of transmission that might still be active, despite the best efforts of our contact tracers. This is an elusive disease that is very hard to manage as we have seen through some of the infections that occurred before we went to Level 3. Even something as straightforward as sharing a bus ride or an elevator is a risk. Our modelling suggests that we need more time in Alert Level 3 in Auckland before we can be confident the spread is under control.

“This outbreak is different in several ways to the one we experienced in March and April. The virus is thought to spread more effectively in winter conditions. It has also affected Auckland’s Pasific population, who are likely more vulnerable to the disease. On the other hand, contact tracing has so far proved very effective and testing rates last week were phenomenal. There is much more judgement involved this time in making the call to move between Alert Levels. This judgement will need to be exercised again later in the week as our understanding of this cluster grows.

“We all still need to continue to take this seriously. Remember, if you feel ill, don’t go to work, and if you have any of the symptoms of COVID-19, seek a test. If you can, make sure you wear a mask when on public transport, as will be compulsory from this coming Monday, and consider doing so in any other situation where you are indoors in close contact with other people for an extended period. Download the app, enter your contact details, and make sure you scan those barcodes. If you don’t want to use the app, keep a diary of where you have been and how you travelled there.

Conflict of interest statement: Te Pūnaha Matatini is funded by the TEC, but is also currently working under an MBIE contract to supply COVID-19 modelling to government.

Associate Professor Siouxsie Wiles, Microbiologist, School of Biological Sciences, University of Auckland, comments:

“The Government has decided to keep Auckland at Alert Level 3 for a further four days. After this, the city will move to Alert Level 2. The rest of the country will remain at Alert Level 2. This is a pragmatic decision to ensure the current cluster is fully contained. The last thing we want is to miss some cases that then turn into further community transmission. Keeping the rest of the country at Alert Level 2 is an important trade-off that will allow Aucklander’s to travel around the country while still helping to slow down any transmission of the virus should someone who is infectious leave Auckland. This is our first resurgence so I am pleased to see the Government modify its response as needed while sticking to the elimination strategy.”

No conflicts of interest to declare.

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

“The decision to extend Auckland’s level 3 by four days until Sunday night is welcome news for New Zealand’s elimination strategy. There are signs the reproduction number is less than 1 at level 3, meaning cases are decreasing. But there are almost certainly still active, unidentified cases in the community with the potential to spark new outbreaks if we relax too soon.

“This has proved to be a large and complex cluster with transmission in a range of settings including multiple workplaces, families, shops, public transport and churches. We are still finding new cases every day, including some with no obvious link to the cluster. The cases we have seen as a result of contacts between strangers on bus journeys are an example of how quickly this outbreak could spread. Although contact tracers are trying to track down people who were on these buses, they may not be able to find everyone so there is a risk some will slip through the net.

“Provided the recent trend of cases continues, the extra four days at level 3 will give us a better chance of containing this cluster. We should also remember there is still a risk of the outbreak spreading outside Auckland. And this risk will rise with increased travel between regions. So it’s absolutely essential the rest of New Zealand stays at alert level 2 for the next couple of weeks and sticks to the level 2 rules.”

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

Professor Michael Baker, Professor of Public Health, University of Otago, Wellington, comments:

“There were many positive messages in the outbreak response measures  described this afternoon.  The Prime Minister reinforced the Government’s commitment to the elimination strategy which is increasingly supported by positive health and economic outcomes.

“The move to requiring mask use in public transport is a very positive development.  The evidence base for this measure has been strong for several months with mass masking endorsed by the World Health Organisation in new guidelines released on 5 June 2020.

“The extension of alert level 3 in Auckland until next Sunday 30 August means that this lockdown will have lasted for just under three weeks before moving down to level 2.  This represents a huge advance on the measures needed to control our first outbreak, which started on 26 February, when we spent about seven weeks locked-down at levels 4 and 3.

“This new more targeted approach is making much greater use of mass testing and contact tracing, plus some contribution from mask use. The shorter period of lockdown is not without risk, and we will need to watch how case numbers hopefully decline in the coming week.

“This targeted approach hopefully signals the way of the future with managing any future COVID-19 outbreaks. There will be further opportunities to refine this approach with the use of innovations such as the CovidCard that has the potential to increase the speed and effectiveness of contact tracing.”

No conflict of interest 

Dr Dougal Sutherland, Clinical Psychologist, Victoria University of Wellington and Umbrella Wellbeing, comments:

The announcement today that New Zealand will remain at its current COVID-19 Alert Levels until Sunday and then everyone moving to Level 2 for another week may be disheartening for many. Whereas the first lockdown was accompanied by an increase in anxiety for some, the recent return to Level 3 seemed to bring with it a collective downturn in mood. “Oh no, I thought we had beaten this” was a common refrain. The Prime Minister acknowledged this in her press conference saying that she knows some people found it harder this time around. The government announcement today could further erode our collective sense of hope.

“We are at a turning point in how we view things as a nation: have we learned to be helpless in the face of adversity or can we learn to be hopeful? Positive psychology teaches us that we can learn to have a sense of realistic optimism. This doesn’t mean never acknowledging anything bad, nor taking a blindly saccharine-sweet positive view of the world. It does mean examining the attributions we make about adversity and positive events.

“Optimists externalize the causes of adversity, seeing them as due to causes that are nothing to do with them personally, and that are fleeting and specific to a situation. They credit good events to personal, permanent, and pervasive causes. Pessimists do the opposite. Pessimism is associated with hopelessness and depression. Optimism is linked to better coping, better relationships, and fewer negative thoughts.

“So although there may not yet be a vaccine for COVID19, there is a “vaccine” of sorts for our mental wellbeing. Perhaps the best thing we can do to mentally prepare for the future, whether that be with or without lockdown, is to begin learning how to think optimistically, albeit in a realistic way.”

No conflict of interest 

Jacqui Maguire, Registered Clinical Psychologist, comments:

“Imagine you are running a half marathon and the finish line is 200m within sight. You are aching, you are fatigued, but you have been committed. You’ve pushed through your first wind, enjoyed the high of your second wind and you are about to experience the great reward of victory…then the finish line is shifted out 1km. How do you respond?

“I imagine for many New Zealanders yesterday’s announcement may feel very similar to the scenario above. So how can we best respond in the face of shifting expectations?

“First: Take a moment to acknowledge your emotional response and just sit with it. Whatever you are feeling is ok. This is harder than it sounds, but is a critical component of emotion regulation. Emotion regulation enables you to calm your mind, and then make purposeful and helpful decisions.

“Second: Dig deep. When the expectation bar has been shifted out, reconnecting to your values/purpose can help increase your motivation.  Intrinsic motivation is powerful and effective.

“For example: You are motivated to follow the COVID-19 alert rules so the country can step down to level 1 as soon as possible.  This has been fueled by your values of:

  1. Community: You want your local economy to thrive. You know a swift return to level 1 will enable your local coffee shop stay in business; Aucklander’s regaining national travel will support tourism operators; children will be able to return to school; people’s wellbeing will improve.
  2. Family: Nan has an autoimmune disease and you want the risk of community transmission eliminated
  3. Honesty and Trust: You hold a firm view that honesty and trust are essential characteristics for society to possess. Therefore you believe it is imperative your role model these values.

“As such, when you feel like you can’t continue and the temptation to rule break is high, enable your values to keep you on course.

“Third: Foster flexibility in your thinking. Mindset is a powerful tool. An open and adaptive mindset is linked to enhanced resilience, whereas negative thoughts increase stress and fear-induced behaviour. One proven strategy is to hold ‘realistic optimism’. Realistic optimism can be defined as thinking about a difficult situation as:

  1. Temporary: This lockdown will end. We will get to level 1 again, we’ve done it before we can do it again. One day we will even have an accessible globe again – I can’t wait for that day.
  2. Specific: This alert level has restricted by physical movement. I am still able to connect with people I care about, appreciate nature, work (if possible) it may just look different.
  3. External: It’s not just me that’s finding it tough this time round. Lots of people are. I’m not weak, humans are just not made to flourish in isolation.

“Fourth: Reward yourself for all that we have achieved to date. A movie on a week night, a night off cooking, a book in the bubble bath. Whatever floats your boat!

“Dig deep and stay flexible. We’ll get through this; we’ll cross that finish line together. That doesn’t mean there won’t be hard moments, but hope will get us there.  I know it will.”

No conflict of interest.

Dr Sarb Johal, clinical psychologist, comments:

Full comment available here

“Mandatory wearing of face-masks for public transport across the country when on public transport is a new policy which comes into force next week. Although this may be challenging for some people, it is good that there is clear instructions and expectations about this. This will help to address some of the ambiguity or lack of clarity that has been reported by some about what behaviours they are being asked to do at each Alert Level. The requirement for people to wear face-masks on public transport at Alert Levels 2 or higher couldn’t be clearer.

“The decision to stay at Alert Level 3 in Auckland and Level 2 in the rest of the country may be disappointing for some, and it may also be reassuring for others. What is certain is that it is in keeping with a precautionary approach, informed by the evidence, trying to strike the balance between protecting people’s health and allowing them to move around and go about their business as much as is safely possible according to the risk assessment at the time.

“It’s going to be really important that people adhere with the Alert Level advice as much as possible to make sure we can get down to lower Alert Levels as soon as possibly. And mandatory mask-wearing in public transport will hopefully contribute to the efforts in not having to escalate up Alert Levels again.”

No conflict of interest.

Dr Amanda Kvalsvig, Senior Research Fellow, Department of Public Health, University of Otago, Wellington, comments:

“Although the decision to move to mandated mask use on public transport is welcome and much-needed, this change doesn’t go far enough. There are several other public settings that carry similar infection risks to public transport because they bring people together in closed environments. GP waiting rooms and emergency departments are a particular concern, because people attending are highly likely to be unwell and potentially infectious. Other settings where COVID-19 transmission has occurred include churches, shops, and secondary schools. I hope the Government will now give consideration to the contribution that masks can make to prevent COVID-19 transmission in settings beyond public transport.

“As described by the Prime Minister this afternoon, the new measures place a heavy reliance on individuals to own and carry a mask. There will be practical and cost barriers for many. At all times during Alert Level 2, masks need to be made freely available on public transport to ensure that no-one is disadvantaged.

“Finally, increased mask use in public places will make life very difficult for those who can’t wear a mask, and those who can’t hear speech and need to lip read. A badge or lanyard should be made available to anyone in that situation to avoid unpleasant confrontations or being unfairly denied access to public transport.”

No conflict of interest.

Professor Nick Wilson, Department of Public Health, University of Otago, comments:

“The mandating of masks on public transport is a smart move by the Government for Alert Level Two and above. This makes the New Zealand response more consistent with international best practice and fits with expert advice from the World Health Organization and public health experts within New Zealand (as per this NZ Medical Journal article we wrote). It is however disappointing that mandated mask use is not being extended to indoor public settings where transmission risk is highest such as bars and nightclubs. These settings have been the source of outbreaks in jurisdictions which were otherwise making good progress eg, Japan, South Korea and Hong Kong. Indeed, New Zealand still fails to learn all the lessons it can from the island jurisdiction that has managed COVID-19 the best: Taiwan (where there has always been high levels of mask use from early this year).

“There are also positive signs that the Government is taking a more nuanced approach to the Alert Levels and keeping the size of events constrained. This will help with allowing successful contact tracing if there is further spread at such events. But here again it would be good to put more focus on restricting the really high hazard settings eg, by keeping bars and nightclubs closed in Level 2.

“More generally the Government has reiterated its commitment to the elimination strategy – which makes the best health and economic sense for island nations like New Zealand. But New Zealand also needs to further improve its border controls – possibly looking at shifting quarantine facilities outside of cities and onto military bases eg, Ōhakea air base which can take international flights. A number of experts (eg, here and here) have stated that hotel facilities are just not built for quarantine purposes and the risks of having outbreaks in major cities where these hotels are located is probably too high.”

No conflict of interest.

Lesley Gray, Senior Lecturer, Department of Primary Health Care & General Practice, University of Otago, comments:

“Aotearoa has gone from “whoa to go” on mask wearing in just a few short weeks.  It is understandable that people are nervous about masking up in public.

“I think the evidence for masking is becoming better understood and I think the right decision was made today about mandating mask wearing on public transport for Level 2 and above, especially as we all want to see Auckland move out of level 3 as soon as appropriate. Some research we are currently conducting has found associations between ‘belief in effectiveness’ with reported mask wearing – so basically if we believe there is a good reason to wear masks and that masks will help reduce the spread of COVID-19 we are more likely to report intentions to/or having worn a mask.

“Fabric three layer masks with an outer payer of non-absorbent material such as polyester, a  middle layer of cotton and an inner layer of cotton or cotton blend are great. As we become more comfortable and socialised to wearing masks we can show our individuality by the designs we choose. We need to get over our embarrassment and start appreciating everyone’s unique mask identity.

“One thing to be aware of – a number of my own relatives are deaf or hard or hearing and mask wearing by others can significantly hamper day to day communications.  If you know you work in an environment with deaf or hard of hearing people who might lip read – what mask designs can you come up with that will allow you to incorporate a clear mouth panel? Is it possible for the transport companies to come up with masks for their staff that include a clear central section?

“People with pre-existing respiratory conditions should check with their health professional about when/where to wear a mask/for how long. Will there be any exemptions for people and how can we ensure people who cannot wear a mask for health reasons are not vilified by society going forward?

“But remember – a mask alone is not enough protection. We still need to maintain good hand hygiene, physical distancing, cough or sneeze into your elbow, and keeping track of where we have been. If you have any symptoms – seek a test and stay home from work.”

No conflict of interest.

Associate Professor Elspeth Tilley, School of English and Media Studies, Massey University, comments:

This comment is an extract from The Conversation. Read the original article.

“While mask sales have skyrocketed in New Zealand since COVID-19 reemerged, public mask wearing (even in Auckland) is still the exception.

“This is where understanding ethical decision making can be useful. Scholars divide the study of ethics into three main branches: virtue, deontological and consequential. All three can us help think about wearing a mask.

“Asking a range of questions from all three ethical angles helps me arrive at an ethically measured decision: that I should be consistently wearing a mask when I go out. And a careful decision is much easier to stick to, even if it means I still get the odd funny look.The Conversation

Conflict of interest statement: “I have previously been part of research teams that have received funding from MoH and HRC on health communication topics.”