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November quarantine cluster – Expert Reaction

The Ministry of Health has provided an update on the new cluster of COVID-19 cases which emerged in NZ over the weekend.

The new cluster started when a quarantine worker at Auckland’s Jet Park facility tested positive for COVID-19 on Friday. A close contact of that person later tested positive for the virus after travelling from Auckland to Wellington. No new cases in the community were reported today, but several close and casual contacts are undergoing testing.

The SMC asked experts to comment on this cluster, and the ongoing risk of community transmission. 

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

As the recent events illustrate, there is obvious value in making mask use mandatory on flights and other transport settings. It is hard to see why the Government has held back from taking this potentially life-saving prevention measure. In the interests of transparent decision-making from Government, New Zealanders need to know the reasoning behind this decision.

“It’s good to hear that the latest border system failure is being reviewed. In particular, I hope that there will be epidemiologists’ eyes on the review of risks for border workers, both in their workplaces and in their communities. Workers in border-associated occupations are different from the rest of us in terms of risk because of how much exposure they have: even if they’re feeling well, their risk of being infectious remains substantial. A systematic analysis of how to protect these vulnerable workers and their contacts (and eventually, of course, everyone) would be time well spent.”

No conflict of interest

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

“Old habits die hard. You can’t teach an old dog new tricks. These proverbs ring true for us as we encounter a new community cluster of COVID-19. Put simply, Kiwis aren’t in the habit of wearing face-masks or scanning-into restaurants and shops we visit. We have seen some spikes in these behaviours but they appear to be temporary changes in our behaviour promoted by a change in how real we perceive the threat of the virus.

“The government is faced with the challenge of how to ramp up its threat message to the public quickly and effectively enough for us to start doing something new, such as using the COVID app. Under-emphasising the threat has obvious implications. But over-emphasising the threat could lead to people distrusting government communications, which could also lead to reduced app and face-mask use.

“Some have asked why the government simply doesn’t legislate for us to use the tracing app. Again, making this behaviour mandatory could erode trust in the government and could also produce psychological reactance, which is where people do the opposite of what they’re being told to do precisely because they are being told to do it.

“Tapping into people’s intrinsic motivation to do something new is the most likely path to get results. During our first Level 4 lockdown the government appealed to our sense of community and compassion for others. Staying at home was as much about keeping others safe as it was about keeping ourselves safe. No doubt there are a large number of government officials currently racking their brains of what’s the next psychological lever they can pull to make us want to wear masks and scan in. And perhaps this is the best we can hope for, at least in the short-term, as trying to establish new norms in public behaviour can be a lengthy process taking months if not years to embed.”

No conflict of interest

Dr Mike Lee, Associate Professor of Marketing, University of Auckland Business School, comments:

“Using the Covid-19 tracer app has never been a part of our routine, so it’s easy to become complacent when we are not at a higher Alert Level. One thing to reduce complacency would be to remind everyone of what’s at stake. In particular, businesses have the most to lose from the freedoms offered by Level One restrictions. And so, businesses should be doing a lot more to encourage and remind the customers to use their app.

“However, using the app is not top of mind for customers. Their usual routine is to walk through the door and begin shopping. The ‘user experience’ of using the Covid tracer app, as simple as it may seem, actually involves a number of steps. Adding these additional steps to our ritual of entering a business can be made more user friendly by firstly offering multiple areas for scanning, so that people do not feel like they are holding up the queue to enter a business. Secondly, offer multiple areas within the store for customers to scan the app in the event that they did not want to scan before entering, or simply forgot. Finally, the best place to remind people to scan the app is at the register when they’re paying for the transaction – all we have to do is ask the staff of businesses to gently ask customers whether they’ve had a chance to scan the QR code yet.

“We need to make it easy for people to do the right thing. Remember when we banned single use plastics, and people forgot to bring bags with them into the store? Businesses rallied around that pro-environmental cause in a way we need them to do now. They reminded people in the parking lot to bring bags from the car, or they provided the opportunity to purchase reusable bags at the cash register. We’ve done it before, we’ve learnt to change our behaviour, so we can do it again.

“Having businesses nudge people to do the right thing is the easiest way to change that sort of behaviour because businesses have the most to lose if we were to go back into a higher Alert Level or lockdown. Other more costly marketing strategies could involve incentivising use of the Covid tracer app by intermittently rewarding people for using it.

“Intermittent reinforcement is the most successful way of encouraging the behaviour you want to see happening. Casinos, pokie machines and addictive video games use it all the time. Intermittent reinforcement involves rewarding people for certain behaviour some of the time randomly so they never know quite when they will receive the reward for committing the behaviour you want them to do.

“Within the database of the Covid tracer app are all the registered businesses as well as where customers have been. If the government really wants to incentivise people to use the app they could have random giveaways that reward customers intermittently. For example, they could subsidise vouchers for the businesses which were scanned. That would encourage repeat visitation from those customers back to the businesses, as well as rewarding customers for scanning in the first place. Instead of getting a push notification saying that you are a contact of a positive case, maybe you could get push notifications every now and then for a 20% discount at your local café. Of course promotions like these would cost a lot more money, however it would help incentivise a percentage of people who are more extrinsically driven.”

No conflict of interest

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

“In New Zealand we have extremely low rates of community transmission and no restrictions on day to day activities. Under these circumstances, it’s easy to forget that the pandemic is continuing to rage out of control around the world. We need to continually monitor and improve our border systems. But as long as the global pandemic continues, there will always be a risk of border breaches.

“The virus won’t be taking a summer holiday, so if we want to have one we all need to play our part. The three biggest things we can do to stop the virus are:

1. Always use the Covid tracer app
2. Physical distancing where possible or use a mask
3. Get tested if you feel unwell

“Remember that whichever part of New Zealand you are in, you can get tested for free anytime.”

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

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

“We hope that the risks of an outbreak will decrease over summer, but it is important to remember that the prevalence of the disease is growing rapidly overseas and this will put more pressure on our border.

“Over the summer we will spend more time outdoors in conditions where the virus spreads less easily. The virus also seems to survive for longer in winter conditions, so risks of a large outbreak reduce during the summer. Regular coughs and colds also become less common. This should make it easier to detect any spread of COVID-19 at an earlier stage, because the symptoms associated with the disease should become less common. This still relies on people getting a test if they do develop any of the symptoms.

“However, the good news must be tempered by what is happening in the northern hemisphere. As northern countries enter their winter, many of them are experiencing uncontrolled outbreaks and case numbers are rising very rapidly. Kiwis returning from the northern hemisphere will be much more likely to be carrying the virus, which in turn will put much more pressure on our MIQ system.

“While summer conditions will work in our favour, this doesn’t mean we can relax. The risks of further outbreaks are still high and we all need to stay vigilant, use the app and get a test if we have any symptoms.”

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.