Al Johnson
nzcovidresponse.substack.com
This week the seven-day isolation and mask mandates in healthcare were extended.
When we started getting hammered by Covid in 2022 (ah, the memories of those 20k+ cases a day), it was after existing community mask mandates were ‘strengthened’ to beat the spread back in the red traffic-light setting. How did we know those mask mandates were doing what was said – reducing infections?
DPMC has been proactively releasing content (it’s a gold mine and I’m covering it on nzcovidresponse.substack.com). One of the documents, which was done prior to the dropping of community mask mandates in 2022, noted modelling showed if community mask mandates were dropped, infections and hospitalisation would rise by 22 per cent to 25 per cent. Yikes.
I asked through an OIA to the Ministry of Health what success metrics, or tracking or assessment was done on whether mask mandates were working. I also asked did the actual statistics reflect the modelling – that is, did infections and hospitalisations rise after the mask mandates were dropped?
They weaseled out of the statistics question stating “Outside of modelling, it is difficult to isolate the impact of masks on transmission…” The question that crops up is then, naturally, how can it be modelled?
After some tussling they did provide me with the public health briefing on masks to Covid-19 Minister Verrall prior to the community mask mandates being dropped and transferred the rest of my request to DPMC because Cabinet is responsible for mandates.
Before I tell you what I got back – I want to share a bit of the documents I’ve been going through. The 2020 Cabinet paper recommending expanding mask mandates to all public transport across the country at any alert level (ie no evidence of any community transmission) explicitly references The Research Agency (TRA) research on compliance. Which found getting people to wear a mask was hard when there was no community transmission. A head scratcher!
The Cabinet paper stated: “… the behaviour change rationale for wearing masks when on public transport in Auckland is stronger than the public health rationale at this time”. And “It also serves as a useful visual reminder of ongoing Covid-19 risk.”
You might have heard about the UK Government’s Behavioral Insights team aka the Nudge Unit. Smaller and less-organised examples existed within government agencies here prior to Covid – largely out of co-design based government service improvements – often through DIA. In May 2020 the all-of-government Joint Insights group took advantage of one of those, a Ministry of Justice unit called Behavioral Science Aotearoa – was set up and funded to provide behavioral science to the justice sector. Up till then their work had mostly concerned minor tweaks like the best ways to remind people of court dates.
When Covid-19 hit in 2020 they moved their focus to specific behavioral research which could be “fed directly into decisions around settings under the Covid19 Alert Levels and the accompanying public communications”. Reports over several months noted things like “Visibility of Covid prevention behaviors serves as an important reminder and reinforcer of social norms… this exerts a special pressure to comply.” Another laid out that if “People no longer see the disease as much of a threat… [it] would undermine the government strategy.”
The 231 social media listening reports done by Annalect made news in April 2022 when some were released in an OIA to RNZ. After their release then Labour Minister David Parker was quoted as saying “… the Government didn’t form policy based on the comments.”
Are you sure? Under the Alert Level framework operating at the time, there were nine factors that Cabinet had to consider when reviewing the Alert Level restrictions in place. One of these factors was “public attitude towards the measures and the extent to which people and businesses understand, accept and abide by them”.
At the same time DPMC and the Ministry of Health were also commissioning dozens of surveys and in-depth research – including focus groups – on behavior and sentiments (comments!) to monitor attitudes and compliance on Alert Level restrictions and later vaccination intent. Key companies included TRA, Horizon, Colmar Brunton, Ipsos and Moana Research.
TRA were contracted initially for reporting and pulse checks and rapid reviews on attitudes and compliance with Alert Levels. They later followed it up with specific focus groups on issues to tweak and influence – nudge – public perceptions through campaign messaging.
And all these reports fed up to and were incorporated into Cabinet papers and Ministerial briefings – including the 2020 mask mandate Cabinet paper I mentioned above. It looks like then Covid-19 Minister Chris Hipkins even received specific briefings on the research from DPMC every two to three months.
Back to how they tracked community mask mandates.
A briefing by the Ministry of Health in August 2022 on whether community mask mandates should stay from a public health perspective to Minister Verrall noted that the mandate was only useful if the research showed it:
(The campaign ‘masks matter’ was clearly behavioral nudging as compliance dropped.)
DPMC further confirmed via their part of the OIA – that they did not have or use actual metrics or an assessment framework that masks were actually reducing spread – they relied on surveys of people’s attitudes “DPMC and MoH monitor compliance with mask mandates to inform public health settings.”
They went on to reference in the OIA those surveys commissioned with TRA and Horizon which showed as the months wore on compliance with mask mandates dropped and negative comments rose.
Self-reported compliance (and comments) was what was tracked – not actual effectiveness.
By the way, the day the community mask mandates were dropped in September 2022 – there had been a reported 1.7 million infections – a significant under-reporting of actual cases. How are the healthcare mask mandates are working? Well…