Introduction by Croakey: Several Australian states moved to increasingly severe restrictions on movement and gatherings this week and the federal government began forcibly detaining all new arrivals to Australia for a fortnight under uniformed guard as the novel coronavirus outbreak intensifies.
Health Minister Greg Hunt and others cautiously expressed hope that Australia’s epidemic curve is starting to flatten, as state and federal governments began enforcing unprecedented population controls punishable by heavy fines and jail time in a bid to slow COVID-19 cases.
The debate has become polarised, with some arguing in favour of the crackdown and urging that governments go further — most prominently, advocating for the nationally mandated closure of schools — while others urge a greater emphasis on communicating the risks and on expanding other elements of the response, such as testing.
In this piece first published on his blog Bad Blood, and cross-posted here with permission, health promotion practitioner and PhD student Daniel Reeders explores how, in a vacuum of information and government transparency, emotions are overriding the evidence to the detriment of our discourse and response.
Daniel Reeders writes:
For the past three weeks I’ve been spending time on Twitter, monitoring the emerging response to the COVID-19 epidemic and, as we learn more, translating scientific ‘signals’ and policy responses into plain language.
In the past week, that role has become controversial.
I wrote in my last post about how our Prime Minister has politicised the reliability of communications. The government has taken to late night press conferences where it announces a laundry list of restrictions with no clearly apparent underlying principle. Journalists and health promotion people are united in agony at this spectacle.
The government’s ongoing failure to show its workings has important implications for adherence with recommendations. As I’ve argued, people don’t adhere to recommendations they don’t understand. This includes people (of all ages) going to cafés and pubs, for example, breaking recommendations of physical separation and avoiding mass gatherings.
But reactance against poorly-understood recommendations can go in the opposite direction as well — people being hyper-conscientious, and people being utterly convinced that current recommendations are totally inadequate.
The kids are alright
The public debate over how we are responding to COVID-19 is increasingly focused on demands for school closures. People are quite rightly observing that kids can get the virus and pass it on. Intuitively, that makes sense, right? Kids are little grot monsters and childcare is a swap meet for bugs of all kinds — every head cold going, flu, gastro, nits, hand foot and mouth, you name it.
All the same, AHPPC says there’s no evidence kids play a major role in epidemic transmission and it does not recommend school closures. That looks like a huge contradiction, and the failure to explain it has left a lot of people feeling severely mistrustful of the response.
Along with a small crew of co-authors on a recent Conversation piece, I’ve been active on Twitter trying to explain what Prof Tony Blakely calls the ‘missing rationale’ for Australia’s responses to the COVID-19 epidemic.
Some of the most bizarre inconsistencies, like weddings being capped at five people but fitness boot-camps being allowed ten, are a little easier to understand if you know that COVID-19 is most easily passed on via close, sustained contact. Sitting side-by-side in pews for 90 minutes affords a better chance of viral transmission than doing star jumps 2 metres apart, outside.
(Others, like allowing barbers to remain open, are just bizarre and inconsistent.)
So this past week on Twitter I’ve been making the point that school closures are not supported by evidence, and encountering increasingly caustic responses, along the lines of ‘you’re not an expert, you’re not an epidemiologist, you’re just a health communications guy.’ Somehow overlooking the fact our epidemic response is currently paralysed by our government’s inability to communicate effectively, and there’s an emerging political crisis about that.
The demand for school closure fits the pattern I described in my post on panic. Processing complex messages is much harder in high energy emotional states like alarm, distress, anger and panic. People in those states reject emotionally dissonant messages, e.g. if the tone isn’t suitably urgent, the speaker is seen as untrustworthy and the message is discounted.
School closure is simple, urgent, and decisive
So here’s the counter-argument:
- The WHO Joint China investigation found that in China, which had one hundred thousand cases and aggressive tracing of contacts, children were much more likely to be infected by their parents than the other way around.
- Other countries like Singapore have controlled the outbreak without closing schools, albeit with much higher collective adherence to social distancing (physical separation) recommendations;
- In Australia, data on cases and contact tracing shows very few infections in young people — at the time of writing, in New South Wales, only 27 out of 818 total cases were under 19 years.
- Modelling studies show that school closures won’t help, and a study published today from the University of Sydney shows they may lead to more children becoming infected via contact with higher risk adults.
But it seems nobody’s buying that. It is contradicted by the widespread belief that there is exponential community transmission that is not being picked up in our data.
These two beliefs — infectious kids, unobserved transmission — have formed what sociologist Erving Goffman called a strong discourse. Normally you validate a model against empirical data. In a strong discourse, if the empirical data doesn’t fit the model, it’s the data that is rejected.
We see that happening when we attempt to persuade anti-vaccination advocates and climate denialists with evidence. They reject empirical findings as logically inconsistent with prior beliefs, even though nothing about the universe obeys the laws of logic.
It’s happening now with COVID-19 control, and that is an extremely concerning development. It has the potential to compromise the ability of governments to communicate not just the rationale for action, if they ever felt like doing that, but what we need people to do.
It can also poison the political conversation.
We’ve spent a week on an increasingly heated argument about school closures. They have driven a split through the ‘national cabinet’ of state and territory and the Commonwealth governments, with Vic and NSW going their own way. And while that has dominated the news, we haven’t been talking about the devastating effects of the epidemic and control measures on people’s livelihoods.
This week we saw the modern-day equivalent of bread lines snaking around the block, as people tried to get their identity validated so they could complete online claims for social security payments. We have a huge population of temporary residents who are not eligible for those payments and therefore have to keep working, putting them at increased risk of exposure to SARS-CoV-2.
Some Twitter users have argued the government, in trying to minimise restrictions and their impact on employment, is putting dollars before lives. Others have demanded the government tell us all it knows.
But there’s no big secret there.
The government is sitting on epi modelling that predicts tens of thousands of deaths as hospitals are overwhelmed. That isn’t a secret; it’s the premise for flattening the curve, which many people now recognise, if not understand precisely. It is also sitting on economic modelling that predicts millions jobless and multiple years of recession. And it is trying to negotiate a way forward with both of those things happening simultaneously, knowing those predictions could spark widespread panic.
We need to be talking about that. We need to talk through what that means.
So let’s close the schools and move on with the public conversation.
Daniel Reeders has worked in health promotion for over a decade and been involved in research and practice in social marketing and communication strategy around health issues like HIV, cancer screening and sexual and reproductive health.
He is currently studying in the PhD program at the ANU School of Regulation and Global Governance (RegNet).