How community mask mandates started in New Zealand
A short history into the ever-changing mask advice during 2020 & how behavioral nudging influenced government to start mask mandates to maintain public acceptance of Covid zero restrictions
In an October 2020 interview shortly before the US election, White House Coronavirus Task Force advisor Scott Atlas called the public health advice on masks “garbage science” and compared wearing a mask to “bordering on wearing a copper bracelet.”
Atlas didn’t see strong evidence to justify community mask mandates and pointed to places that had mandates yet no reduction in community levels of transmission. Tweets from Atlas on this subject were removed by Twitter yet the views Atlas held on masks were mainstream at the start of the pandemic and echoed in New Zealand.
January & February 2020 - when masks don’t work
In January 2020 then Director-General of Health Ashley Bloomfield stated that masks were “...not really any protection.” The same news article quotes an Auckland University academic, Simon Swift urging caution over masks and a virologist calling surgical masks “rubbish.”
This didn’t stop people from panic buying masks. In February 2020 Bloomfield’s mask advice was "If you do not have these [Covid] symptoms, you do not have to wear masks because there is no evidence that they protect people who are not sick."
Bloomfield was almost exactly repeating the words of another member of the White House Coronavirus Task Force, Anthony Fauci, who said the same month “Masks are really for infected people to prevent them from spreading infection to people who are not infected rather than protecting uninfected people from acquiring infection.”
An early March 2020 Time magazine article devoted itself to wondering why the public kept buying masks in the US when experts, including the Centers for Disease Control and Prevention (CDC) were saying masks don’t work.
April & May 2020 - masks still don’t work
In April 2020 during the 1st New Zealand lockdown, masks were a hot topic in the media - a campaign to make your own cloth mask started up and mainstream news was now saying there was no clear consensus on mask use.
On the 6th of May 2020 the Ministry of Health’s Chief Science Advisor Ian Town produced a rapid review which found no conclusive evidence in favor of masks and pointedly mentioned the CDC had now flipped its advice to recommend masks but “…it cannot find any data to quantify the risk reduction from wearing masks.” The review did note the precautionary principle would suggest if there was any possible benefit to masks, then they could be used as Covid presented “a serious threat.” The review included the risks and harms of masks.
Bloomfield presented an oral item on the use of face masks to Ministers at the 13th of May meeting of the Cabinet Social Wellbeing Committee (SWC).
It seems reasonable to assume the mask review was discussed yet the following week’s SWC meeting shows an investigation on the supply chain and availability of masks had begun. They were considering mask mandates on public transport to help ease social distancing requirements - which effectively meant empty seats between passengers to adhere to the 2 meter or 1 meter rules according to Alert Levels:
How did they go from an inconclusive rapid review on masks to suggesting their use solely on public transport? And specifically for physical distancing requirements?
An 11th of May blog post from the standard Otago University group of self-called public health experts could be the missing clue. Published 2 days before the SWC meeting Bloomfield spoke at, their blog post is devoted to why masks absolutely must be implemented on public transport. With little direct evidence for this conclusion the post grasps for benefits - going so far as make the insane claim that mandating masks in a single instance within a Covid zero environment would benefit…climate change:
In the comments on this post, 1 of the authors Ling Chan admits to lobbying the government on mask use for public transport:
Chan says there is a lack of appropriate evidence but “…in the face of a deadly pandemic, we should apply the precautionary principle and use every tool we can for any potential benefit that can be ascertained from that intervention, even if the evidence is indirect, or insufficient.”
This group’s many, many blog posts lobbying for masks during the pandemic often came with references. I read them and I suspect no one else has as once you start reading the science (and this isn’t restricted to just masks) - you realise how poor the science behind something can be.
Among the observational studies on influenza and health-care worker use that made up the references - my favorite is a study of 4 hospitalised patients in South Korea. It’s strange they reference it as 4 patients in hospital isn’t great data but even so the study comes to both the opposite conclusion than they claim and it was retracted.
Media covered their blog post the day it was published but tempered it with the Ministry’s rapid review finding inconclusive evidence.
A 15th of May 2020 memo on the mask supply chain to the Health Minister again states it’s unclear if masks are effective and there may be harms:
The memo ends that physical distancing on public transport would still be required even if masks were mandated and lists what other countries were doing. Most countries either required them indoors or not - the memo’s authors couldn’t find specific instances of only requiring masks on public transport.
At a press conference on the 27th of May 2020 Bloomfield announces they were seeking advice on the Ministry’s rapid review on masks with the Covid Technical Advisory Group (CTAG):
Another co-author of the 11th of May blog post was Michael Baker - who had been a member of CTAG since its formation in January 2020. But CTAG had already discussed the mask review at their 8th of May meeting (chaired by the Ministry of Health’s mask review author Ian Town).
The minutes list what can surely only be Baker’s comments that masks should be considered for public transport despite the discussion being summarised as “There is not currently a good evidence base for mass public masking.”
Official Information Act (OIA) requests released more rapid reviews done in May and June 2020 on in-flight transmission and the use of masks on planes. The reviews say “…the use of face masks offers a theoretical potential benefit in reducing….modes of transmission.” The review also ends with a round-up of what other countries were doing. Bloomfield followed the reviews by emailing airline lobby group BARNZ on the 19th of June, stating passengers on international flights should be offered masks but they were not mandatory to wear.
During May and June mask reviews and evidence were clearly not overly convincing.
August 2020 - now masks work
Which makes it noteworthy that the next official document that pops up on masks was again from the Cabinet Social Wellbeing Committee. At their 5th of August 2020 meeting the new Health Minister, Chris Hipkins had talking points announcing a mask u-turn.
Hipkins was planning to update the Covid-19 Public Health Response Act 2020 to make masking encouraged at Alert Level 2 and mandated at Alert Level 3 when physical distancing wasn’t possible, and at Alert Level 4 when outside a work or home bubble (not just on public transport).
The sole reference in the talking points was to updated World Health Organisation (WHO) mask advice. WHO began to lukewarmly change their advice in June (and then December of 2020). The advice for community use is cautionary and nuanced and it even says community masking isn’t well supported by evidence but that it may be beneficial - in areas of widespread community transmission. It also lists potential harms of masks. The talking points also mentioned an Italian study (they didn’t include a reference) that claims wearing masks may act as a reminder to people to physically distance.
A media article covered the next day’s press conference where Hipkins encouraged masks, and said their use was justified in a Covid zero environment as it would “…merely provide…an extra line of defence.” The article also claims Hipkins “said the evidence had changed.” The media didn’t appear curious as to what evidence. There’s no explicit evidence that the evidence changed in any document proactively released. WHO didn’t supply new evidence per se it “merely” gave advice for places with widespread community transmission. Ling Chan was quoted in that same article saying mask mandates would prevent lockdowns.
OIA requests to the Ministry of Health from later in 2020 say it was the June WHO advice which prompted this change in mask guidance. The Ministry of Health refused to answer questions on harms as they stated they had no information to release - curious as various official documents do discuss harms.
On the 11th of August 2020 4 Covid cases in Auckland led to a rise in Alert Levels.
The following day on the 12th of August out comes another mask review, very firmly titled ‘masks prevent the spread of Covid-19’ from the Office of the Prime Minister’s Chief Science Advisor. The PM’s Science Advisor Juliet Gerrard was in regular meetings with the White House at the start of the pandemic and there’s a clear similarity of where Fauci and White House Coronavirus Task Force Coordinator Deborah Birx went - so too did New Zealand. But again, the content of the mask review wasn’t quite as firm as the title with frequent disclaimers and very conveniently the 2 page review finds there is now “…no evidence that the appropriate use of masks causes any health issues.”
An amendment Order was hastily drafted that put in place mandatory face coverings on public transport in Alert Levels 2 and 3 and 4 from midnight on the 30th of August 2020 (and encouraged in other indoor spaces). The term face covering was used as it could be well, anything - a scarf, a bandana, a cloth mask, a surgical mask or an N95 to ensure people could comply in the name of equity.
Auckland moved from Alert Level 3 to 2 on the day masks became mandatory - so Auckland became subject to the mask mandate, while the rest of the country in Alert Level 1 was not. Accompanying the Order was infringements for non-compliance of $300 rising to $1,000 if imposed by the courts.
Another OIA into the public transport decision highlighted this lengthy Cabinet Paper from Hipkins in his new role of Covid-19 Response Minister. A small cluster of 5 cases in November from an Auckland MIQ facility sparked looking at increasing public health restrictions at Alert Level 1 (this level was the prime dream of Covid zero - there was no known chance of Covid in the community).
The Cabinet paper discusses making mask use mandatory at all Alert Levels including Alert Level 1 on public transport in Auckland and all flights within New Zealand:
It goes on to justify masks:
Reviewing the development of mask mandates could be more a lesson in cynicism than public health. In May 2020 a Ministry of Justice unit called Behavioral Science Aotearoa pivoted from working on text reminders to get people to show up at court to specific behavioral nudging research that would be “…fed directly into decisions around settings under the COVID19 Alert Levels and the accompanying public communications.”
Over several months the unit spun out reports for the All of Government Joint Insights Group leading the Covid response on how messaging could be crafted to achieve and maintain compliance and acceptance of the government’s Covid restrictions.
An early report noted “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 reports frequently say the feeling of both risk and worry makes restrictions more accepted (albeit 1 report reviewed a global study that found avoidance behaviors such as wearing a mask predicted higher levels of anxiety).
Public health uses the precautionary principle and benefits must outweigh harms. But time moves quickly in a pandemic - as perhaps does the political need, with no Covid, to maintain public support through ‘visible reminders of risk.’
And the Cabinet paper confirms that “Adherence to public health measures is very strongly correlated with perceptions of risk.”
The existing public transport mask mandate excluded Alert Level 1 - which was problematic as it could also mean there was no visual reminder to embrace government policy. Commissioned research within the Cabinet paper claimed when Alert Levels dropped and masks weren’t required on public transport, only 5% of people surveyed faithfully continued masking all the time, and Covid tracer app scans fell from 2 million per day to 700,000 per week. The worry and risk was absent.
The paper recommended that masks be allowed to be removed for eating, drinking and taking medications on journeys but that this exemption “significantly undermines the effectiveness” and still maintains wearing a mask didn’t mean social distancing could be relaxed:
The Cabinet paper ends with Bloomfield’s words for mandating masks was not based on public health need:
The mask rationale was also focussed on cities with MIQ facilities and for short-term use only but from a “communications perspective” this was seen as confusing.
The press release announcing this new mask mandate turns away from those original statements by Bloomfield and Fauci that masks may be helpful for symptomatic people to expanding it to healthy people with no symptoms, and baldly (honestly?) announcing a key reason is to remind people of risk via signalling:
At the press conference after Cabinet made the decision, then Prime Minster Jacinda Ardern says:
Ardern goes to to re-confirm that they disregarded public health advice to make this short term when it was needed as it would be “confusing” so the political response was to take a “different position than they have recommended.”
The Order that came into effect on midnight the 18th of November 2020 applied to all domestic flights across the country and public transport in Auckland at all Alert Levels (excluding school transport and children under 12).
Note to readers: this was originally published in March of 2023 (in case it seems familiar to anyone) and if it caught your interest, there’s also a specific post on behavioral nudging as well as a post on mask use in schools.