Equity in isolation

A researcher awarded a rapid response grant to examine the equity and effectiveness of self-isolation and quarantine measures had to do some rapid responding of her own when New Zealand moved swiftly into COVID-19 Alert Levels 3 and 4 before she began her study.

Ms Lesley Gray, a senior lecturer in the Department of Primary Health Care and General Practice at the University of Otago, Wellington, and a public health specialist by background, was awarded a research grant in April to look at the effectiveness and equity impacts for people during the COVID-19 response.

The grant was awarded as part of a joint Ministry of Health and Health Research Council (HRC) request for proposals for COVID-19 research – and had been aimed at investigating the impact on those requested or required to self-isolate and quarantine during February and March. This rapidly expanded to include physical distancing and requirements associated with the government's Alert Levels 1 to 4, ironically coming full circle with returning residents and citizens mandated to quarantine in hotels.

“The day we submitted our HRC proposal was the day that we rapidly moved into Alert Level 3 and then 48 hours later into Level 4, so pretty much everything we put in the original proposal was surpassed. Effectively the whole population was in isolation at that point. Thankfully the research team had indicated we could adapt the proposal to this evolving pandemic.”

The research team, including Professor Michael Baker, Dr Amanda Kvalsvig and Associate Professor James Stanley (Public Health, Wellington), arranged to add an extension survey on to the Ministry of Health's COVID-19 Health and Wellbeing Survey to capture the experiences of New Zealanders in lockdown, and continue to follow them as the alert levels have changed.

“We often hear people say disasters are great levellers. Well, of course, that's not true because we don't have a level playing field or equal resources to start with. People's available resources and social situations make a massive, massive difference to people's ability to sustain their own health and well-being, for example, if they are living in very crowded houses, or face job insecurity, or are unable to work from home, or are faced by a situation that impacts on tikanga.”

Gray says the information from the surveys will be linked to anonymised demographic information from the Ministry of Health's New Zealand Health Survey, so the results can be broken down by ethnicity, age, gender, occupation, and health status.

“We often hear people say disasters are great levellers. Well, of course, that's not true…”

Her team will also conduct a series of qualitative interviews and focus groups with people to ask them about their experiences during the COVID-19 pandemic.

“This will look in real detail at the equity questions, and what has proved doable and/or improved for people, and what have been real issues that perhaps we are only just starting to see the ramifications of.”

The research is a collaborative project between the University of Otago, Wellington, the Joint Centre for Disaster Research and the School of Psychology at Massey University, and is supported by science communicator Dr Siouxsie Wiles from the University of Auckland.

Gray is pleased to be working with Māori investigator Dr Natasha Tassell-Matamua, the deputy head of the School of Psychology at Massey University. Tassell-Matamua says there are likely to have been many unintended social, emotional and cultural consequences of self-isolation and quarantine measures.

“This project provides a very timely and important opportunity to examine factors that might impede or promote self-isolation and distancing for Māori, as well as providing an opportunity that empowers Māori voices to actively contribute to the ongoing management of COVID-19.”

The researchers also asked New Zealanders about their attitudes to wearing face masks and the use of apps or contact cards for contact tracing.

Gray says the first snapshots of research findings have already been sent to the Ministry of Health to help guide current and future pandemic responses.

As a disaster risk researcher, it has been a unique time in which to conduct research, she says. “It is very unusual to be able to research during an event and be able to collect the data while the global pandemic is still happening and have a feedback loop to the Ministry of Health.”