In the latest edition of the COVID-19 wrap, public health researcher Alison Barrett reports on some recent research findings and releases, including the World Health Organization’s manifesto for a healthy recovery.
New Zealand’s COVID-19 elimination strategy
Baker, M, et al, Medical Journal of Australia, Preprint, 19 May 2020
Different methods of managing and containing the COVID-19 pandemic have been implemented around the world in attempts to flatten the curve and reduce the burden on health services.
The authors, from University of Otago in New Zealand (NZ), describe the four main strategies used in infectious disease control and NZ’s commitment to an elimination strategy from 23 March, after seeing early evidence of the approach in Taiwan.
An elimination strategy is based on the idea that, through very strict measures including full border closures, an infectious disease is eliminated from a country or region. While the main goal is for absence of the disease, occasional outbreaks may occur but they will be able to be contained easily and quickly as health systems will not be overwhelmed.
Baker and colleagues write that “the health impact of a poorly contained pandemic had been modelled using a range of scenarios, demonstrating clear health gains if a widespread pandemic could be prevented in NZ”, and therefore they followed an elimination approach.
Minimising negative impacts from the virus for Maori and neighbouring Pacific Island populations, who are more likely to experience disproportionate outcomes, was another catalyst for this approach.
The three other approaches used to manage infectious diseases are:
- Mitigation, where the aim is to slow entry of the disease into a country, prevent an initial spread and then implement physical distancing measures to flatten the curve
- Suppression, a stricter version of a mitigation approach that also involves travel restrictions, lockdowns and strong physical distancing measures, the approach that Australia has followed
- ‘Herd immunity,’ where countries aim for the majority of their population becoming immune to an infection, either by being vaccinated or being infected by the disease and recovered.
Most western European countries and the United States followed a mitigation approach initially, until it became evident that health services were overwhelmed, as seen in Italy, Spain, and United States; they then implemented stricter measures and aimed to suppress the virus.
Between the infectious disease management approaches, “the main difference is the intensity and timing with which they are applied”.
For an elimination strategy to be effective, early implementation of strict border controls are required, combined with efficient surveillance, testing, response planning, political will and a strong public health system.
Baker and colleagues write that while elimination status may take some time to achieve, “New Zealand had passed the acute phase of the pandemic response, and could be considered to be in a pre-elimination stage”.
It was now in a position to carefully come out of lockdown (which they began on 28 April) and move on from managing pandemic transmission of COVID-19 to making informed decisions about further prevention options such as treatments and vaccinations as they become available.
Singing away the social distancing blues: art therapy in a time of coronavirus
Gupta, N, Journal of Humanistic Psychology, 22 May 2020
Art is being used throughout the world in people’s response to loneliness, fear and uncertainty arising from the pandemic. Assistant Professor Nisha Gupta from University of West Georgia, wrote this essay to honour these therapeutic expressions of art.
“Art empowers us to participate, having faith in our ability to make a difference,” she writes.
Historically, music has been used by people throughout the world as a form of bonding, to help people remain motivated, united and resilient in the face of shared adversity.
Throughout COVID-19, many examples of therapeutic music-making have been witnessed, from Italians singing, playing musical instruments and clapping together from their balconies, to the many celebrities performing for Global Citizen and WHO’s One World Together at Home performance on 18 April.
“Musical solidarity has the therapeutic ability to puncture the isolation of social distancing,” Gupta writes, and can lift a collective spirit.
One of the most challenging aspects to motivating people to understand the seriousness of COVID-19 and the importance of physical distancing is that the virus is invisible; it is difficult for people to comprehend or act on things they can’t really see.
Visual art helps people share knowledge with others, helps to connect human experiences, view things from different perspectives and provide a way to document history.
Gupta writes: “As a therapeutic vehicle, the visual arts help make the unconscious conscious.”
Examples of visual artwork seen throughout the pandemic include a mural on a street corner in London featuring PM Boris Johnson urging people to stop panic buying, and a mural of the Simpsons family wearing face masks with the message ‘stay home’ spray painted over it.
The author included one of her own paintings that she shared on social media with the message: “even though the virus looks pretty from afar, don’t trust it! Stay at home, folks!”
Australian artists including Ben Quilty and Reg Mombassa have recently shared some of the art they have created during lockdown.
Cinema and filmmaking are another way in which art can be therapeutic, whether it be by viewing or making films. In viewing films, the viewer may find comfort in relatable stories, especially if the film is about an experience similar to their own.
At the beginning of the pandemic, the Hollywood movie, Contagion, became one of the most-watched movies at that time; Gupta surmises this is because it “offers audiences a cathartic container for our panic, a sense of control to combat uncertainty, and hope for what’s to come.”
In making films, ordinary people may be empowered to control their own narrative and gain control. In another example from Italy, a film showed Italians talking to their former selves from the past, sharing things they now know about the virus. This type of film provides an opportunity for people to express feelings of regret while also helping others as a warning of what may be about to come.
In conclusion, Gupta says:
It is still early in the game, but if I am learning anything about the meaning of this time from the artists among us, it is that there is a profound desire to protect each other, sacrifice for each other, and be together-in-solidarity as an interconnected, global community when faced with this grave threat to the human species.
Our lives depend quite literally on our ability to love each other – across borders, balconies, and computer screens.”
Fast and frugal innovations in response to the COVID-19 pandemic
Harris, M, et al, Nature Medicine, 11 May 2020
“Necessity is the mother of invention,” the authors quote, in discussing the many ‘frugal innovations’ that have been developed around the world in response to the rapid pace of the COVID-19 pandemic.
‘Frugal innovation’ means “doing more, with less, for the many, and being creative, innovative and resourceful in the face of institutional voids and resource constraints,” Harris and colleagues write.
Examples of frugal innovations resulting from the pandemic include the building of a hospital in ten days in China; conversion of trains to hospitals in India and Pakistan; and distilleries pivoting to produce hand sanitiser.
The authors provide more examples of frugal innovations in response to the pandemic in the article, saying that many are developed by repurposing or reusing existing technologies, medications, or materials; and rapid deployment.
Frugal innovations are developed quickly and often without following traditional processes; this does not mean that they lack quality, just that healthcare was able to be provided in the best way possible in the current situation. This is especially important in low- and middle- income countries where access to healthcare is limited.
Challenges exist with rapid innovations as many are developed without being tested or evaluated rigorously.
However, the authors argue that “it is sometimes necessary to forego high regulatory standards in order to rapidly address new demands at low cost” and that this is an opportunity to share results, learn from others and continue improving inventions so that as many people affected by COVID-19 as possible can benefit.
Harnessing behavioural science in public health campaigns to maintain ‘social distancing’ in response to the COVID-19 pandemic: key principles
Bonell, C, et al, Journal of Epidemiology and Community Health, May 2020
Various methods – including “education, persuasion, incentivisation, coercion, environmental restructuring, restriction and enablement” – have been used around the world to encourage people to adhere to physical distancing measures to minimise the spread of COVID-19.
Due to the rapid spread of the pandemic, many of these techniques have been implemented without being informed by current evidence.
As countries begin to relax restrictions, without a vaccine, it is still important for people to follow physical distancing measures.
Through the study of other infectious diseases, like MERS and SARS, a body of behavioural science exists that can inform current interventions and ensure they are more likely to achieve their intended outcomes.
The key principles developed by the authors, behavioural and social scientists in the UK, are outlined below:
- Clear and specific guidance – while not sufficient to effect whole population behaviour change, provision of clear and specific information is important.
- ‘Protect each other’ – messages that promote changing behaviour to help others have more impact than ‘protect yourself’
- ‘Stand together’ – messages that emphasise community, a sense of duty and solidarity.
- ‘This is who we are’ – messages that reflect social norms and group culture are more beneficial than those that imply people are doing the wrong thing (for example, ‘don’t panic buy’)
- Avoid messages based on fear or disgust in relation to other people as likely to be counterproductive and stigmatising.
- Avoid authoritarian messages – coercive and authoritarian messages may result in short-term changes, but difficult to maintain long-term.
- ‘Make a plan and review it regularly’ – helping people to make plans on how to stick to physical distancing may help them think about possible barriers and enablers to adherence. As circumstances change, it is important to review plans and adjust accordingly.
- ‘Make it possible’ – rewards, incentives and enabling physical distancing behaviour tends to be more effective than punishment. Reducing physical barriers will also help to increase adherence.
- Style of messaging – messages should be appealing, professionally designed and promoted by trusted spokespeople.
- Theory of change – each messaging campaign should be treated as an intervention following a defined behavioural aim, message, message source/voice, target group, expected objectives/outcomes; and should plan for unintended consequences using existing theoretical frameworks.
- Co-design – the authors emphasise that co-designing, piloting and evaluating interventions with the relevant audiences using a variety of methods is important; and will help to inform future interventions.
Australia’s public health messages have been criticised for being confusing, inconsistent, and implemented too slowly; as restrictions are lifted and situations change, it is imperative that communication is clear and reviewed regularly.
In summary, the authors have developed this set of key principles to inform development of interventions in response to COVID-19, to increase their likelihood of achieving desired outcomes.
World Health Organization manifesto for a healthy recovery from COVID-19
WHO, 26 May 2020
According to the WHO, decisions made by national governments in coming months in the recovery phase of COVID-19 can do either of two things:
- “lock in” economic development patterns that will do permanent and escalating damage to the ecological systems that sustain all human health and livelihoods, or
- promote a healthier, fairer, and greener world.
On 26 May, 350 organisations representing health professionals from around the world wrote an open letter to G20 leaders asking for a healthy, green recovery from COVID-19.
This article describes some ways in which governments can invest in a healthy recovery:
Protect and preserve the source of human health by reducing our impact on the environment and, thus, reducing risk of disease originating from animals.
Invest in essential services, from water and sanitation to clean energy in healthcare facilities.
Ensure a quick healthy energy transition by including plans to commit to clean energy in COVID-19 recovery strategies.
Promote healthy, sustainable food systems to reduce dietary-caused diseases such as diabetes and obesity.
Build healthy, liveable cities by enabling physical distancing through pedestrianising more streets and including more bike lanes.
Stop using taxpayer’s money to fund pollution. WHO writes that approximately “US$400 billion every year of taxpayer’s money is spent directly subsidising the fossil fuels that are driving climate change and causing air pollution.” As economic reform will be required post-COVID-19, WHO recommends governments start with addressing fossil fuel subsidies.
A global movement for health and the environment. The WHO says the COVID-19 crisis has shown that people will support even difficult policies if decision-making is transparent, evidence-based, and inclusive, and has the clear aim of protecting their health, their families and their livelihoods – rather than serving special interests,” and needs to be reflected in the way recovery policies are made.
Challenges and opportunities in the Post-COVID-19
World Economic Forum: Insight Report, May 2020
In this collection of essays, experts from around the world provide their views on how the world could look beyond the COVID-19 crisis and how leaders might “use this moment to build a more prosperous, equitable and sustainable world”.
Topics discussed include:
- Global, regional and urban governance
- Resilient and sustainable globalisation
- Technology in the post-COVID era
- Trade and connectivity
- Work and employment after the “pandemic that stopped the world”
- Free health for all, everywhere
- Long-term social-psychological effects.
Read the full collection of essays here.
Alison Barrett is a Masters by Research candidate and research assistant at University of South Australia, with interests in public health, rural health and health inequities. Follow on Twitter: @AlisonSBarrett. Croakey thanks her for providing this column as a probono service to our readers.
See previous editions of the COVID wrap.