Preparing to enter the Traffic Light system – Expert Reaction

How can New Zealanders make good decisions to lower risk and keep safe when we enter the new Traffic Light framework on Friday?

The SMC asked experts to share the latest on how public health measures can help to keep the coronavirus at bay, and to give practical tips for navigating the new landscape.

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

Note: Dr Kvalsvig was co-author on a recent editorial in the New Zealand Medical Journal, which includes discussion around the role of public health and social measures as part of NZ’s pandemic response. You can read the editorial here.

“Covid-19 vaccines are safe and effective, and they make a tremendous contribution to pandemic control, but the protection isn’t total and it’s possible to be vaccinated but infectious. The traffic light system puts a very high dependence on vaccination. That’s concerning because as we’ve seen repeatedly in other countries, vaccination alone isn’t enough to stop outbreaks when there are cases in the community. And of course, vaccine percentages aren’t quite as good as they appear. Children under 12 years aren’t eligible so they aren’t counted in the vaccine statistics, but they can develop Covid-19 infection and can pass the infection on.

“What this means is that we need a layered approach to protection that will keep people safe over the holidays. With a new variant on the horizon, this summer should be the one when New Zealanders start to take air quality seriously. Summer weather gives us so many opportunities to stay connected and stay safe. It would be good to see clear messaging from Government about exercising and meeting up outdoors, and when indoors, keeping doors and windows open as much as possible. Where that isn’t feasible, as is the case in many classrooms and workplaces, good ventilation systems and HEPA filters can help sustain air quality. Wearing masks adds another layer of protection both for the wearer and those around them. This NHS video is a great example of the kind of public health messaging that we could be using here.

“All of these measures work together to reduce the amount of virus that people are breathing in. Importantly, they’ll continue to work regardless of which Covid-19 variant is circulating.”

No conflict of interest.

Dr Joel Rindelaub, Aerosol Chemist, University of Auckland, comments:

“There is no doubt that our understanding of COVID-19 transmission has shifted since the beginning of the pandemic. We now know that transmission of the virus is dominated via inhalation of airborne aerosols rather than contact with surfaces (fomites). While fomite transmission is still believed to be possible, recent real-world investigations have not been able to conclusively identify surface contact as a route of transmission, meaning the occurrence is likely rare.

“With airborne transmission in mind, the current data suggest that both the use of face masks and physical distancing can help reduce community transmission of the virus while the benefit of hand washing is less certain. Importantly, there is currently limited rigorous data quantifying the exact impact of ventilation, which is expected to be one of – if not the most – important factors in reducing the spread of the virus. In well-ventilated outdoor locations, COVID-19 transmission occurs roughly 20 times less frequently than in indoor areas. Fresh air is vital to keeping us safe from respiratory viruses, yet the response to create better ventilated indoor environments has been behind that for other non-pharmaceutical interventions.

“The most important thing we’ve learned from this pandemic is that clean air is vital to keeping us healthy, and it should be the pandemic’s lasting lesson that helps inform future planning and policy.

“With COVID-19 in the community, limiting time indoors is a good way to reduce potential exposure to the virus. When visiting locations where the removal of masks is common, such as eating and drinking establishments, it is best to use outdoor seating areas whenever possible.”

No conflict of interest.

Dr Amanda Wallis, Research Lead, Umbrella Wellbeing Ltd, comments:

“The new traffic light system may create uncertainty for people around Aotearoa as we are forced to determine our own comfort levels with mingling with others, travelling and using public spaces. When socialising with loved ones, for example, choosing in the moment whether to mask up, physically distance, and meet inside or outdoors may be cognitively taxing, as well as potentially costly to our own wellbeing. Social norms inform our behaviour to a large extent, and research shows that navigating public health measures may contribute to feelings of social anxiety through fear of norm violation.

“To combat this, people could try to prepare for upcoming events by establishing their intentions and crafting social norms ahead of time. Consider messaging family members or friends a few days prior to the event and let them know you plan on wearing a mask, for example, and create a psychologically safe discussion around how you might keep each other safe. Try to centre the focus of this conversation on COVID-19 as the threat, rather than each other. For example, ‘I know this is new territory for all of us but I’m quite scared about catching COVID-19 – do you mind if we catch-up outside to play it safe?’”

No conflict of interest

Dr Melanie Woodfield, The Werry Centre, Department of Psychological Medicine, University of Auckland, comments:

“Holding child development in mind can help parents respond effectively this summer, when differing family norms and values will be busily intersecting with public health guidelines at the beach or the campground.

“For example, in terms of moral development, young children tend to determine whether someone is good or bad based solely on whether they follow the rules: for example, ‘Uncle Bob is bad because he’s not wearing his mask.’ As they develop, children increasingly understand that it’s possible to be a good person, and not follow a rule. Subtleties such as intentions come into play – there’s a difference between deliberately not washing your hands, versus carelessly forgetting.

“It can help parents to stay calm and effective if a child development lens is applied where possible –‘she’s just little, and didn’t know’ versus ‘how can she think that?’ or ‘she’s unkind’ if a child asserts that their cousin is naughty for not washing hands. Or the child seems confused that their lovely best friend (who is ‘good’) is not following the rules (which is ‘bad’). Steer clear of who is right, and emphasise that different people make different choices, and some people have fewer choices available to them. An opportunity to seed ideas that’ll serve them well as they grow – how to be respectful, while staying true to their own values. How to like someone yet disagree with their decisions.

“On another note, the UK government’s Behavioural Insights Team “EAST” acronym is a useful way of summarising how to nudge kids toward public health behaviours. Try to make the hand washing, or mask wearing:

  •     Easy (reduce the hassle, have lots of masks available),
  •     Attractive (scented bubbly soap),
  •     Social (model hand washing; kids can take a socially distanced friend to the tap at the campground)
  •     Timely (prompt at natural transition times, create new habits through daily rhythms).”

Conflict of interest statement: Dr Melanie Woodfield is employed part-time as a Clinical Psychologist in government-funded Child and Adolescent Mental Health Services. She receives research funding from the Health Research Council of New Zealand.

Dr Kirsty Ross, Senior Clinical Psychologist and Senior Lecturer in Clinical Psychology, Massey University, comments:

“This summer will have felt like a long time coming for many people; a chance to reconnect and have some normality after another period where things have felt quite unpredictable and uncertain. We will have to navigate a new set of rules and guidelines, which will take some getting used to. People may also be feeling a bit nervous about how to manage situations that may arise, such as when people around you are not socially distancing, wearing a mask or scanning in – all public health measures we know are important in keeping the SARS-CoV-2 virus at bay.

“Assertive communication is the boundary where you can take care of yourself and your needs, and care for others in the situation as well. When we sit back passively, we can often feel frustrated (and sometimes even guilty) that we haven’t spoken up, and anxious about the consequences of not doing so. When we speak too aggressively, this can harm the relationship we have with the person we are talking to, and may even mean getting into an argument, or having our message and needs lost as the other person defends their position as they feel under attack.

“Being assertive takes practice and often a good place to start is to place the relationship first. For example, if you are with your family and another group of friends, and someone is not wearing a mask, start by saying how much you enjoy their company, and that you are glad you are finally getting to spend some time together. Then move on to speaking about what is concerning you and what you would like to change: ‘I’m so glad we can finally meet up again as we have really missed seeing you and we have been looking forward to catching up. But when you are not wearing your mask, I feel uncomfortable and worried, as I really want to make sure that we keep well and safe. So, while I respect your right to make your own choices, when we are out together as a group, I would really appreciate it if you could wear your mask around me and my family. Then I will be able to relax and really enjoy myself.’

“Assertive communication is really valuable when you are wanting to preserve a relationship with someone you care about or need to have ongoing involvement with. If you are in a situation where someone you don’t really know well and don’t need to see again is not making choices that make you feel comfortable, then placing your own needs first and leaving the situation is totally understandable and okay! We cannot control what others do, and we are only responsible for our own choices; but we can control how we respond to people. We have a responsibility to ensure that we let them know our needs rather than hoping they can read our minds.

“If communicating assertively is hard for you, don’t worry – it can feel uncomfortable at first until we become skilled. It can help to practice with people you know well! But having tools and strategies to stand up for our needs (and those of people we love such as our children and family) can be empowering and help alleviate some anxiety as we enter this new phase of the pandemic. And what a wonderful model for our children about how to navigate difficult conversations!”

No conflict of interest.