Dr Rawiri Taonui Covid Maori | The Bungled Covid Communications to the Papatoetoe Community
|08 Mar 2021 18:27 PM|
A War of Words
A war of words broke out last week between Prime Minister Jacinda Ardern and Case L (from Family 3) in the Papatoetoe cluster. The Prime Minister slated Case L for going to work at KFC on 22 and 23 February and her sibling Case J for going to work at Kmart Botany on 19 and 20 February. The Prime Minister said as the household of a casual-plus contact they were meant to be getting tested and isolating at home.
Ardern did not pull punches, saying ‘It is not appropriate, and it is not okay for members of the team of five million to let the rest of us down’ and ‘Those individuals are facing the full judgement of the entire nation’ and ‘There are consequences, undoubtedly’, and possible ‘legal’ ‘repercussions’.
The Response from Case L
Case L accused the Prime Minister of pillorying her family and asked for an apology. She said she was not instructed to self-isolate and referred to a letter and a text sent to her sister on 14 February advising that the families of casual-plus contacts did not need to self-isolate.
Supported by Chris Hipkins, the Covid-19 Response Minister, the Director-General of Health Dr Ashley Bloomfield, Ardern said she would not apologise. The ternary pandemic leadership did try to ameliorate the comments saying that there was no place for bullying or harassing those who make mistakes. Nevertheless, there was a strong social media backlash, some racist, against the families and the South Auckland community.
Working with Cultural Communities
Community leaders, health experts and the media felt the Prime Minister’s comments went too far. Community leaders said there were shortcomings in the way the Ministry of Health and the Auckland Regional Public Health Services (ARPHS) communicated with non-European South Auckland cultural communities. The Ministry and ARPHS responded that this was not the case and highlighted their work translating tailored Covid-19 communications into more than 20 languages. Auckland City Councillor, Fa’anana Efeso Collins, countered that working with cultural communities was a lot more than simply translating and distributing information saying, ‘We need messengers, people on the ground in Papatoetoe who can speak Cantonese, Punjabi, Hindi, Samoan and Tongan’.
The Ministry also pointed to its work with community leaders. This was met with cynicism on the basis that while there were improvements this was recent. Others pointed to weeks of under-testing of Māori, Pacific and Asian communities during the first wave and the absent of random testing in South Auckland in July last year before the August Auckland OutBreak.
National Party Leader Judith Collins accused the Prime Minister of trying to shift blame to the rule-breakers to cover her 17 February decision to move Auckland from Level 3 to Level 2. She also said, ‘looking back now, you can see what an absolute gamble the Prime Minster took bringing us out of Level 3. On the very day, the Prime Minister announced it, there were two new cases in the community. She and her cabinet must have known there were kids at Papatoetoe high school who were not tested yet and were not answering their phones, so could not be relied on to be keeping to the rules’.
On Friday, after five consecutive days without any new community cases, the Prime Minister moved Auckland to Level 2 yesterday. Dr Bloomfield congratulated ARPHS and PHS for the quality of their communications bringing the cluster to this point. Many questioned that compliment. Efeso Collins said health officials overestimated how well-informed people have been during the outbreak. Others described the Ministry of Health information as confusing, contradictory, and complex.
COMMUNICATIONS 14-16 FEBRUARY - ALERT LEVEL 3
Instructions to the Families of Casual Plus Contacts
Communications lie at the heart of the issue at Papatoetoe. During an outbreak, Ministry of Health communications to those at the core of the affected can be understood as operating to a six-category framework, including close contacts, their families, casual contacts-plus, their families, and casual contacts and their families.
During the Papatoetoe event, Ministry of Health instructions written by ARPHS were sent to PHS who, after frequently adding further comments ,emailed the material to four groups requiring each to adhere to different instructions: 1) Close contact teachers and students who shared a classroom with Case A; 2) their families; 3) Casual-plus contact all other staff and students; 4) and their families.
The following timeline analyses the communications to casual-plus contacts and their families on the first day of the outbreak 14 February.
Dr Bloomfield announced that all communications to the staff/students and families would be sent from PHS.
A PHS email sent later in the afternoon to a group of parents and forwarded in sequence to others, advised that emails, Facebook posts and texts from the school would be ‘the only factual sources’ parents should follow. This signalled that communications would be sent from APHS to the school then to families. Without appropriate checks and balances, this process caused significant confusion.
ARPHS Press Release
The afternoon press release advised that all close contact and casual contact [actually casual-plus contact] staff and students and all family members of close contacts would be tested. The release omitted to explain what the status of the families of casual-plus staff/students.
The press release did include a web link to ‘Guidance for Casual-plus Contacts’ saying ‘household members do not need to stay at home or get tested, unless they are also casual-plus or close contacts, or they develop symptoms. While helpful, it is unlikely that many opened the link. Subsequent emails from PHS indicate that staff responsible for emailing the families had not opened and read the guideline.
4.00pm PHS Email
This email to a large group of parents and forwarded in sequence to other parents and families contradicted the casual-plus contacts guidelines, saying ‘all students and all families at PHS will be tested’.
5.00pm Letters to Casual-plus Contacts
Individual ARPHS letters are sent to the parents of close contacts and casual-plus contacts. Casual-plus contacts were told they needed to get a test and self-isolate at home. Repeating the omission from the earlier press release there are no instructions about whether the family members of casual-plus contacts were required to get a test or self-isolate at home. The letter includes the link to the casual-plus guideline. There is no confidence that many followed the link, and, if they did, they would be confused if they had also read the 4.00pm email.
5.20pm ARPHS Update
An update is sent clarifying that the family/households of casual contacts are no longer required to isolate and may continue their daily routine’. This corrects the omission in the earlier press release and the letters to casual-plus families. The information is clear without the need to follow the link. Had the earlier communiques followed this format, much confusion would have been avoided.
6.08pm PHS Email
A school email says, ‘All staff, students and their families (who live in the same household) need to stay home for the next 48 hours and get a Covid test’ [until 16 February]. This contradicts the update sent 50 minutes earlier. The 48-hours stipulation also contradicts letters to close contacts who have been asked to self-isolate until 24 February.
Equally concerning, the email says the parents of ‘close contact’ students will receive a ‘notification’ confirming whether their child or children are close contacts, and parents of ‘not close contacts’ will know their children are ‘not close contacts’ because they will not receive a ‘notification’. Both were already receiving letters. A further email makes a disconcerting comment about the first case.
This is a copy of the 5.20 pm update. It corrects the 6.00pm email by clarifying that ‘the family/households of casual contacts are no longer required to isolate and may continue their daily routine’.
6.43pm PHS Email
This email is sent to casual-plus contacts. It repeats the above ‘the family/households of casual contacts are no longer required to isolate and may continue their daily routine’. The media release, the update, and a link to the casual-plus information site are included. This finally clarifies that the whānau of casual-plus contacts do not need to be tested or self-isolate at home.
A text is sent saying ‘casual contacts to isolate and test - their families don't need to’.
15 February Facebook Post
This post informs the parent of a casual-plus student that families are not required to undertake a test.
The Government vs Case L
The Prime Minister and Chris Hipkins claimed Case L should have been getting tested and self-isolating at home. They also said that the family should have stayed home because another member of their family was a casual-plus contact. The Casual-Plus Contact Guidelines state that families of casual-plus contacts do not need to self-isolate at home or be tested. The communications between 14-16 February confirm the understanding of Case L that she did not need to seek a test or self-isolate at home.
Over a two-hour period, the families of PHS were inundated with a mini-tsunami of unorganised and complex communiques comprising a confused, inconsistent, and convoluted shambles of mistakes and mixed messaging. What went wrong?
The Ministry of Health and ARPHS employed a four-category contact framework via the school to communicate with the staff/students and families of the school (close contacts, their families, casual contacts-plus, and their families. They required each of the four groups to comply with different expectations. They wanted close contacts to get tested and stay at home until 24 February, their families to stay at home until the close contact returned a negative test, casual-plus contacts to stay at home until they returned a negative test, and their families to continue as normal.
This complexity led to mistakes and omissions. The correspondence was poorly written. It frequently used the wrong terms for casual-plus families (non-close contact, casual contact, and casual-plus contact) and/or omitted to provide advice, gave the wrong advice, or gave advice that was obtuse and confusing; errors that cascaded into the emails from the school.
If those composing correspondence could not clearly articulate the requirements for each group, whether because they did not understand them or were under too much pressure, they could not expect that their plurilingual audience would understand their correspondence either, especially if English was not their first language.
ARPHS and PHS entered an agreement without clear checks and balances. The relationship was well-intended. ARPHS wanted to work with the school, the school wanted to support the community. However, staff at the school staff were not health professionals. Too many authored too many emails with too many mistakes. The PHS communications required vetting via support from the ARPHS or Ministry.
Despite all good intent, neither the ARPHS nor PHS appreciated the impact their frenetic rush would have on a multi-cultural plurilingual community they were serving. The risk existed that individuals and families, particularly those less trusting of mainstream institutions, others who were simply afraid, and young people, would disengage from the process. This is possibly the case with Family 3. It is surprising and a credit to the community that more did not.
COMMUNICATIONS 17-19 FEBRUARY - ALERT LEVEL 2
Auckland moved to Alert level 2 on 17 February. ARPHS sent out three letters between 17-19 February.
This letter continues the practice of different requirements for the four groups while adding over-arching expectations for all staff, students, and families.
17 February Email from PHS
The school advises that there are two new cases but that the school will re-open on 22 February. It also announces that 24% of school contacts (over 364 people) have not been tested. This suggests a headlong and ill-considered rush to open the school.
18 February PHS Facebook
On 18 February, the school posts a reminder on Facebook that all students require a negative test before they can return to school. This is the only message translated into multiple languages. This would have been more helpful had it also said that all family members are required to be tested and stay at home.
19 February ARPHS Letter
This letter reinforces that school students cannot return to school unless they have had a negative test. This too should have included a requirement that all families needed to be tested and stay at home.
18 February ARPHS Letter to Whānau Māori
This letter to whānau Māori is the best thus far of all the correspondence to families. Using short sentence bullet points, the communique is comprehensive, succinct, and clear. It gives the best situational update of all correspondence to families. The transparency and clarity build confidence and generate trust in the leadership of the response. The letter dispenses with the four-category approach. This simplifies two clear messages, ‘Testing is important and our students, staff and whānau are asked to get a test’ and ‘We are asking everyone in your whānau or people who spend a lot of time at your whare to stay home’.
This is the only letter in the train of communication thus far that is readily understood without re-reading. Most likely this is because it is written by a person focussed on communicating with the community rather than the policy and levers in play at the top of the Ministry and ARPHS.
19 February PHS Email
This email advises the school will re-open on 22 February. It reminds that students need to return a negative test before they can go back to school. Parents are told students will not need masks. The tone is celebratory. Parents express concern about sending their children back to school when there are still many more students yet to complete second tests. It says nothing about families needing to stay at home and get tested.
21 February PHS Email
This email confirms that the school will re-open on 22 February.
The Government vs Case L
The government and Ministry claim the letters of 17 and 19 February required Case L and her family to get tested, stay home, and not go to work.
The 17 February letter conveys the expectation that everyone in the family should get tested. Family 3 is disengaged and chooses not to comply. Family 3 is also ‘encouraged to stay at home’ and told ‘they should work at home’. They are not ‘required’ to do so. Because the Alert Level 2 guidelines allow people to go to work if adequate social distancing is in place, and the letter does not explicitly change that, Case L can interpret that she can go to work.
The letter of 19 February does not say anything about the family needing to stay at home or get tested. It merely reminds students to get tested.
During this period, 20 texts and phone calls are made to contact the family. The writer does not accept the government and Ministry view that the texts and phone messages included direct instructions to the family of Case L to get tested, stay at home and/or not go to work. That would be inconsistent with reported practice during other events. The Ministry had time to send a team to visit the family. They did not avail themselves of this opportunity. That was a significant failing.
The government and Ministry’s strategy was changing but not its communications. The government was intent on re-opening the school on 22 February. At one level, they were treating all staff, students, and families as one distinct group. They wanted everyone to get tested and stay home. At a second level, they retained the four-category format, for example, different isolation end-dates were ascribed for casual-plus contacts (22 February) to get them ready or the reopening and for the lower number of close contacts (24 February) to keep them away when the school reopened. The result was another poorly written, imprecise, and rambling 17 February communication.
By contrast, the 18 February letter to whānau Māori is better suited to the multi-cultural plurilingual PHS context because it reduces everything to one simple message, everyone should get tested and stay at home.
Case I began showing symptoms on 19 February. Case J went to work on 19 and 20 February. Case L went to work on 22 and 23 February. Case I got tested on 22 February. The result was declared positive on 23 February. The family was transferred to MIQ where Case J and Case K also tested positive. Case L initially tested negative, then tested positive on 26 February. On 26 February, the Prime Minister tells the family off on national television.
The Government vs Case L
Chris Hipkins said that Case L should not have gone to work when their sibling Case I was showing symptoms on 19 February. While the government position seems rational, the situation is not that straight forward.
The Casual-Plus Contact Guide, which advises that ‘household members’ do not need to self-isolate at home, does say they should stay home if they ‘develop symptoms. In a glaring oversight, the guide does not say household members should stay at home if the primary casual-plus contact has symptoms. Some might say, as Chris Hipkins did, that ‘staying at home when a casual-plus contact is exhibiting symptoms is simply common sense’. But that is not straight forward either.
Correspondence since 14 February regularly reminded families to watch for symptoms. However, the list of symptoms families received was that for earlier strains of Covid-19 not the B117 variant afflicting the Papatoetoe cases. An update of the characteristic B117 symptoms was not sent until 28 February.
On 27 February, Dr Bloomfield said that the new list had been drawn from Ministry observations of what unfolded as the cluster grew. He also said this was different from what had been observed overseas. That is not the case. The Ministry regularly monitors and updates itself with the latest overseas research. On 27 January, the Office of National Statistics in Britain released data showing that the symptoms of B117 were significantly different to those of earlier strains of Covid-19, with more muscle aches, fatigue and headaches and less loss of sense of smell and taste. The list being sent to the Papatoetoe families included only one of the main four symptoms for B117.
This is another area where the Ministry possibly fell short. On 20 December, last year, the New and Emerging Respiratory Virus Threats advisory group (NervTag) in Britain reported that the B117 variant appeared to infect more younger people than earlier strains. Israel and Italy reported the same phenomena on 9 February, research the Ministry claims they regularly monitor.
Had the communications been simpler, clarified the correct symptoms and raised the possible vulnerability of young people, the government would have seen more engagement from students and their siblings.
23 February Letter
In response to Case I and J testing positive, ARPHS sent a further letter to the staff/students and families at PHS. This had the same format as the letter to whānau Māori on 18 February. It stated that the ‘Ministry of Health required everyone in the school community â€“ students, staff, brothers and sisters and all household members â€“ to stay home. The letter also said that ‘everyone in the school community must stay away from work or any other school or educational facility until all students and staff members in their household have had a negative test result’.
At this point, Case L and her family are for the first time clearly required to get a test and stay at home. They were already on their way to MIQ.
23 February Unite Covid-19 Post
A Unite Covid-19 Facebook post in response to the backlash against Case L and her family confirmed that they were not required to stay at home before 23 February.
From the outset, the government was working on a timetable to re-open the school on 22 February. Communications were rushed. The four-category framework meant they were complicated, confusing, and contradictory. There were mistakes and key elements omitted. The Ministry and ARPHS also failed to pass necessary information about the B117 symptoms and the potential threat of the variant to young people.
Simpler two-tier message messaging addressing contacts as one group and families as another and both on one timeline were needed. The only communications to meet that standard was the ARPHS letter to whānau Māori on 18 February and the letter to all families on 23 February.
The decision to go from Alert level 3 to Alert level 2 on 17 February was premature. The decision was internally logical, there had been widespread testing, there was a single train of transmission and wastewater testing indicated this was not a large outbreak. However, the government and Ministry forgot that they were dealing with human beings and thousands of them in families around the school, and other people in workplaces, and locations of interest, including hundreds of young people in a school with a 97% non-European demographic where English is often not the first language.
If the messages in English were shambolic, then no amount of translation would render them sensible to those who received them. Many would have been completely mystified. Young people would have been inclined to disengage.
When it became apparent that some people did not understand or were not complying with the requirements, the Prime Minister took this personally. The Prime Minister has been our best leader in decades. She has been magnificent during Covid-19. Her reaction indicates the toll that successive emergencies like Christchurch, White Island and one-year of Covid-19 can take on our best.
There was a backlash against the families and South Auckland. Thankfully, Case L, community leaders and health experts pushed back. One positive has been the emergence of substantial support for the South Auckland community. There is greater awareness that the region’s ethnic health and social-economic profile, the location of Auckland Airport and six MIQ facilities, and repeated border/MIQ failures in the area make South Auckland vulnerable.
There is also more recognition that South Aucklanders contributed a significant percentage of Auckland essential workers during the first wave and comprise a substantial proportion of the current border workforce. Judith Collins said the government and the country took South Auckland for granted. ‘We might be a team of five million, but we’re relying on about 400,000 South Aucklanders who are carrying most of the load’.
In a concession of sorts, the Prime Minister announced that the June vaccine public rollout would begin in South Auckland.
Efeso Collins cautioned that any crackdown on those who do not comply with covid rules will only be counterproductive, particularly when so much has already been asked of his region in response to the pandemic. Dr Bloomfield has announced that the government will be taking a tougher approach under section 70 of the Health Act toward those who do not comply with the rules. That approach only adds value if the government and Ministry revisit their policies and communications.
The communications were chaotic. It is inappropriate and not okay to let down New Zealand. One hopes that the team of five million do not judge those responsible too harshly and that there are not disproportionate legal or other repercussions.
Noho haumaru - stay safe and self-sovereign.
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