8.3 Our assessment: testing, contact tracing and mask requirement­s Tā mātau arotake: ngā whakaritenga whakamātautau, whaiwhai i te pātanga, me te ārai kanohi

During the pandemic, routine COVID-19 testing, extensive contact tracing and widespread mask use were all important tools used to mitigate the spread of the virus. The combination of testing and contact tracing ensured that positive cases and their close contacts could be identified, then isolated or quarantined until they were no longer contagious or at risk. Mask use reduced the likelihood of a community outbreak from cases that had not been detected by these methods.

There is good international evidence that testing, contact tracing and mask wearing all reduce the risk of COVID-19 transmission.⁵² It is more difficult to quantify the benefit of making these measures mandatory, although cross-jurisdictional comparisons show that protection from infection is greater where mask wearing is compulsory (rather than voluntary).⁵³ Nevertheless, given the effectiveness of these measures depends on them being widely adopted, we are confident that making them compulsory contributed usefully to the success of the elimination strategy during 2020 and 2021. In our view, making testing, contact tracing and masking compulsory resulted in meaningful benefit that outweighed the ‘cost’ to New Zealanders (e.g. the discomfort of wearing masks and impingements on individual human rights and privacy).

While we are satisfied that these requirements were reasonable, we identified some practical issues with their implementation that provide useful learning opportunities for future pandemics.

Making testing, contact tracing and masking compulsory resulted in meaningful benefit that outweighed the ‘cost’ to New Zealanders.

8.3.1 Testing requirements

8.3.1.1 Compulsory border testing was useful for keeping COVID-19 out of the community

Mandatory testing for groups at higher risk of exposure made it more likely that cases would be detected and could be isolated. This was particularly relevant at the border and in MIQ, to reduce the risk of the virus spreading from overseas arrivals to border workers, their families and the wider community. It appears to have been effective. Between June 2020 and September 2021, a small but steady stream of positive COVID-19 cases were detected at the border. The vast majority of these cases did not result in, or coincide with, any community transmission.

8.3.1.2 Compulsory testing orders were challenging to implement

Operational realities at the border

While the mandatory testing system provided assurance, some government agencies were reluctant to implement mandatory testing for people working at the border and did not know how best to do so, as was noted in a 2020 review.⁵⁴ Further, there were practical issues in some cases with mandatory testing, especially when testing could not be performed onsite.⁵⁵

The 2020 review of the implementation of the COVID-19 surveillance strategy, including mandatory testing, found that there was ‘a lack of appreciation of operational implications of directives’, leading to border directives that were difficult to understand and implement.⁵⁶ The review also suggested that testing regimes were poorly targeted in terms of which workers were at highest risk of COVID-19 exposure, especially at the border.⁵⁷

The view that central government lacked operational awareness about how such requirements would work in practice was echoed by some stakeholders the Inquiry engaged with directly. One major port company criticised what they regarded as ‘unworkable instructions’ for testing of border workers:

“There was an order for immediate testing […] issued Friday 9am with a deadline for midnight the following Monday. Every person had to be tested in that time. It covered 5,500 people who worked at our port. MoH had no idea about the number of people and the practicalities of testing. […] People showed up at the testing facility which could not cope. The timeframe was eventually amended to focus on those with higher risk (720 workers) [...] It impacted workers locally – there were unworkable instructions with the threat that if they didn’t follow them, they were breaking the law.”

‘Testing fatigue’

Nasal swabbing – the principal method used in mandatory testing for COVID-19 – is an unpleasant and somewhat invasive procedure.⁵⁸ Some public submitters who were subject to frequent testing requirements found these intrusive and unpleasant.

“Expecting people to have their nasal passage scratched every day they worked is cruel and should be illegal.”

“Crossing the [Auckland] border I was subjected to regular PCR tests so I could cross the imaginary ‘border’ that separated my home from my work. I still feel sick in my stomach every time I come up to that bit of the road that marked the ‘border’.”

There was some concern that ‘testing fatigue’ could undermine the effectiveness of the regime. In April 2021, ministers were briefed about reports of increasing resistance to repeated nasal swab testing among border workers, noting:

“There is a risk that ongoing use of invasive testing methods could create testing reluctance or fatigue, and compliance with the testing regime could reduce given this.”⁵⁹

Border workers were subsequently given the option of saliva testing in recognition of the challenges of taking frequent nasal tests.⁶⁰

Record-keeping and assurance

The mandatory testing regime placed significant requirements on people running border-related businesses or activities to ensure staff were being tested as required.

An online register helped with record-keeping requirements, but had some significant limitations. It was not a real-time system; there was a lag between when swabs were taken and when results appeared in the register.⁶¹ There were also issues with duplicate health identification numbers, which meant the system might struggle to match border workers with their test results, exacerbated in cases where businesses were unable to correct errors in the system.⁶² A submission from an organisation working at the air border highlighted these challenges:

“Managing testing mandates was resource intensive and system poor… 14,000 records were uploaded into BWTR [the Border Worker Testing Register], every person who had ever worked in the facilities from inception. There was little consultation with PCBUs [persons conducting a business or undertaking], and current staffing lists were not sought. This created significant discrepancies in the records, names spelt wrong, incomplete, and incorrect records, multiple records for one person, and in one instance, a […] staff member had five records with five different NHI numbers. His tests were assigned to multiple records […] this created ongoing noncompliance [issues] for this staff member when in fact he was compliant.”

From February 2021, the Ministry of Business, Innovation and Employment rolled out a visitor management system for staff at MIQ facilities that improved and automated the register and addressed some of these issues. Despite this, concerns remained about the quality of data the system generated,⁶³ as well as more general concerns about the level of compliance with the border testing regime.⁶⁴

8.3.2 Contact-tracing requirements

8.3.2.1 Mandatory contact tracing was an important element of Aotearoa New Zealand’s COVID-19 response

Requiring people to comply with contact tracing is a key element of infection control, particularly during a pandemic. International evidence shows that contact tracing reduces the risk of COVID-19 transmission.⁶⁵ As noted in Chapter 3, contact tracing in Taiwan was so effective in identifying cases that – together with isolation and widespread masking – it enabled Taiwan to successfully eliminate COVID-19 transmission in 2020 without the need for lockdowns.⁶⁶

Details of contact tracing and how this was carried out are discussed in more detail in Chapter 5. Mandatory contact tracing was an important component of Aotearoa New Zealand’s COVID-19 response – particularly during the early stages of the elimination strategy, when it successfully enabled chains of COVID-19 transmission to be identified and closed down (through quarantine of people with infection and isolation of their close contacts).

While the discussion here focuses on implementation challenges with the NZ COVID Tracer app, the Inquiry is confident that contact tracing more broadly was an important and necessary part of Aotearoa New Zealand’s COVID-19 response.

8.3.2.2 The NZ COVID Tracer app made contact tracing easier, but it was not as effective as hoped at identifying contacts of cases

During COVID-19, many countries introduced digital technology to supplement ‘manual’ (person-based) contact tracing. Digital apps allowed people to record or scan their location while out and about, creating a database that could be used to inform people if it became apparent they had been in proximity to someone who was subsequently diagnosed with COVID-19.

User experiences with the NZ COVID Tracer app

Some people found the NZ COVID Tracer app useful and reassuring. There were positive comments about the app in our public submissions, generally expressing views that it was easy to use and had a beneficial impact.

“The use of the Covid app was fantastic and provided a degree of comfort knowing your potential exposure would be notified to you.”

“I think the app was a great idea – allowing people to scan into various locations and it meant you got a warning when you might have been in contact with someone else. This information allowed people to make informed decisions e.g. not visiting a newborn baby or grandparent if there is risk of covid. The main goal should be keeping people safe.”

However, others found the app inaccessible or confusing, as the following quotes indicate. It may have been particularly challenging for older or disabled people.

“Many elderly or those without smartphones couldn’t use COVID tracing app. Businesses often didn’t have log in sheets.”

“I wanted to follow the rules but wasn’t able to do so. How could they help? Could they design alternative systems and still ensure privacy? They tried but I don’t think they succeeded.”

These concerns were later reinforced in academic research exploring barriers to digital contact tracing in Aotearoa New Zealand. Focus group participants pointed out how older people, lower socio-economic groups, and some disabled people encountered barriers in using or accessing smartphones. Disability sector participants pointed out that the app could have been improved by following smartphone accessibility guidelines and noted many issues that prevented disabled people from scanning in (for example, QR posters located too high for people in wheelchairs).⁶⁷

Privacy concerns

Some people held strong privacy concerns about the NZ COVID Tracer app, despite the Privacy Commissioner’s supportive assessments.⁶⁸ Discomfort about the Government’s ability to ‘track’ people’s movements via the app was one of the main objections to its use expressed by public submitters to our Inquiry. Some felt this was government overreach – or worse, a ‘hidden agenda’ to gather and exploit data about individual citizens’ movements.

An academic study of barriers to the uptake of digital contact tracing also identified privacy as a common concern. Such concerns were particularly evident in population groups with low historical trust in government, the study found. Māori participants expressed distrust of the Government’s motivation for gathering data about people’s contacts and movements, reflecting Aotearoa New Zealand’s history of colonisation, and in particular, the disproportionate number of tamariki Māori^vii being taken into state care.⁶⁹ Similarly, a Pacific community participant noted that:

“Some of our community don’t have permanent residency … [They] weren’t comfortable in disclosing or downloading anything like that [app] as much as they wanted to, because they’re scared for their immigration status.”⁷⁰

Some of the stakeholders we engaged with reflected on the impact of such privacy concerns. One senior official involved with commissioning and rolling out the app told us that a key lesson from the pandemic was to think carefully about privacy concerns and keep data from contact tracing separate from other parts of the health system:

“People generally don’t trust the government, or are not comfortable with tracing functionality … when we talked to people, understood what’s worrying people in the community… this [lack of trust] was a big lesson. So I think it [tracing function] needs to be kept separate from apps that are used in peacetime, but be kept ready.”

Impact of mandatory QR codes on uptake of the app

Use of the NZ COVID Tracer app rose considerably in August and September 2020 following the re-emergence of community transmission and the Government’s decision to make the display of official QR code posters mandatory.⁷¹ After this decision, the number of users grew from about 600,000 to 2.2 million, while the number of posters displayed rose from 87,000 to 381,000 by late September 2020. A later review of the NZ COVID Tracer app’s effectiveness suggested around 45 percent of the population used it to scan their locations (considered a high rate of uptake for a tool of this nature).⁷²

Effectiveness of the app at identifying contacts of cases

Unfortunately, the app wasn’t as effective as hoped as a public health tool. The same review that found uptake to be ‘high’ at 45 percent also found that the QR function of the app was not effective in detecting close contacts of cases (though it was good at identifying casual contacts). The authors concluded that the app ‘likely made a negligible impact on the COVID-19 response in relation to isolating or testing potential contacts of cases’.⁷³

Challenges with enforcement

Evidence suggests it was challenging to ensure that members of the public participated in record-keeping activities (such as QR scanning) without placing impossible or unworkable requirements on business owners or enforcement agencies. An internal report indicates the New Zealand Police saw their role as one of supporting businesses to implement record-keeping rather than attempting to enforce compliance.

8.3.3 Mask requirements

8.3.3.1 Mask requirements provided actual and perceived protection from COVID-19

The evidence that mask wearing decreases the rate of transmission of COVID-19 (and other airborne respiratory viruses) is substantial (see Chapter 5).⁷⁴ However, for masks to have a significant impact on community transmission, they need to be both worn correctly, and used by most people. Making masks compulsory in a wide range of public and high-risk settings at different stages of the pandemic was an effective – if blunt – tool to encourage their use at the scale required.

Many of our public submitters supported the use of masks as a protective measure. We heard that they made people feel safe, by providing a perceived added layer of protection for themselves, their family, or for others who were immunocompromised. Some told us that they have continued to use masks, and expressed a view that they should be used more as a tool for general health management.

“The lockdowns, mask usage and vaccine passes made me and my family feel as safe as we could do under the circumstances, especially with immune compromised family members.”

“That masking does work and should be practised when sick regardless of pandemics and encouraged. This should be normalised so it isn’t pushed against so hard.”

Some submitters who were immunocompromised or had other medical vulnerabilities described feeling ‘relieved’ that mask measures were enforced to help them feel safe.

“As someone with chronic medical conditions, I was grateful for the mask and vaccine mandates as the pandemic progressed, as this meant I felt more safe as I carried out my daily living.”

Some submitters expressed the view that mask mandates should have been introduced earlier.

“My only concern, being a nurse was how long it took the MOH to realize that masks should be mandated. In the beginning they even said they weren’t required.”

8.3.3.2 But mask mandates were challenging for some

Mask requirements were also criticised by a substantial number of submitters, many of whom questioned the rationale for mask mandates. These submitters tended to cite the changing evidence about mask use over the course of the pandemic as proof that masks ‘did not work’ against COVID-19 and found the evolving guidance about mask use confusing.

Particular frustrations were expressed about the perceived illogic of mask requirements in enclosed spaces such as cafes, restaurants, on flights and in cars.

“The idiocy of having to wear a mask into a cafe and then take it off when you sat to eat was nonsensical.”

“Why did we have to wear masks on a plane but then it was ok to take them off to eat. Did the COVID hide in the toilet while we were eating?”

Some submitters shared negative personal experiences of wearing masks, and expressed concerns that masks caused social harms, including fear, isolation, impeding socialising and making it difficult to read facial expressions.

“This has caused damage to those wearing them.”

“The mask mandates making you feel trapped and silenced, a useless piece of cloth covering your mouth to keep you quiet, to stop you speaking out, giving people anxiety and [making them] feel like they couldn’t reach out at the risk of being disowned by family and friends.”

The compulsory use of masks may have created difficulty for some disabled people, including deaf and hard of hearing people, who rely on lip reading to communicate. A 2021 report on the impact of the COVID-19 response on disabled people’s rights outlined the negative experiences of some disabled people who rely on lip-reading to communicate. Some reported that health workers refused to remove their masks, even at a distance, and refused to try alternative ways of communicating (such as writing) to convey important information.⁷⁵

We also heard that mask requirements were difficult to carry out in practice in some settings, particularly in schools. While some public submitters expressed distress about children having to be masked at school, we heard in direct engagements that obtaining sufficient masks to uphold these requirements was also difficult. An education union told us that it took ‘far too long for masks to arrive, and when they did, they were no longer needed’.

Issues with exemptions

Mask exemptions caused ongoing issues for some members of the disability community. We heard in direct engagements that the process for issuing mask exemptions was poorly managed, and that some of the disability organisations contracted to issue mask exemption certificates had minimal notice about taking on this function and were overwhelmed with requests.

We also heard that many businesses did not trust the integrity of mask exemption certificates, and that the purpose and criteria for these were not well-communicated to the general public. This led to some disabled people who could not wear masks feeling subjected to discrimination and abuse.

“We had calls from people who were being arrested for trespass in their local supermarket because the police were refusing to acknowledge the exemption tool that had been provided by the Ministry of Health. The situation was denying disabled people access to essential services and food, and our reputation was negatively impacted.”

Some retail workers and members of the public found it difficult to distinguish between people who were legitimately exempt from mask requirements, and people who refused to wear a mask for other reasons, including as a point of protest. In attempting to verify whether people were genuinely exempt, some workers, especially in retail settings such as supermarkets, experienced escalating and unsafe behaviour from some customers.

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