Many Australians believe symptoms such as fever, aches and chills do not make them contagious – pointing to a chink in our pandemic-fighting armour.

Macquarie University research into Australians’ understanding of infectious disease has revealed how ingrained beliefs about contagion may be a factor in the spread of COVID-19.

In preliminary findings of the Australian Research Council-funded study, 96 per cent of the Australians surveyed said they would wear a mask if they had a cough.

By contrast, a significant minority – 21 per cent – said they would not wear a mask if they had a fever, one of the most common symptoms of COVID-19.

More than 30 per cent said they would not wear a mask if they had muscle aches and pains, and 50 per cent if they were experiencing chills.

Wrong beliefs persist despite public messaging

Chief investigator Dr Lisa Wynn, Associate Professor in Anthropology at Macquarie University, said the findings showed that despite clear public health messaging, people wrongly believed symptoms that they felt in their bodies or that other people could not see – such as fever, muscle aches and chills – did not render them contagious.

People need reminding that they can be contagious even if asymptomatic. Photo: Getty

This was opposed to symptoms such as coughing, runny nose and sneezing, which they understood as expelling contagions from the body.

Dr Wynn said: “What we are seeing from this current, apparently unstoppable wave of COVID spread is that the government efforts so far don’t seem to be stopping the outbreak.

“For sure they are limiting the spread and things would be much worse if they were not doing what they are doing – but we have to ask, what’s wrong? What’s missing here?

“I think in that case it becomes important to start looking at cultural beliefs about contagion, about infectious disease and how it spreads – and those cultural beliefs often do not coincide with what medical science knows or believes about contagion.”

Internal cultural ideas can override education

Preliminary findings were mostly based on interviews before the third  wave of community infections, so responses did not “necessarily represent current decision making”.

However, in interviews conducted since the lockdown began, some people were still reporting they would not wear a mask if they had fever, even though they knew it was a symptom of COVID-19.

“It just shows how powerful our internalised cultural ideas about contagion are … that they can override our education and be resistant to public health messaging, and powerfully shape our behaviour,” Dr Wynn said.

“There is clear messaging that fever is a sign of COVID, and to wear a mask and that’s how you stop the spread.

“But there is a significant minority of people who believe symptoms that they just feel in their body, and that aren’t respiratory, means that the contagion stays in the body in the same way as the symptoms.”

More worried about perceptions than symptoms

The study, when completed, will have involved 1000 online survey respondents and Zoom interviews with 100 people.

Of the 84 interviewed so far, the average age was 45 and 66 per cent were women.

Many people said they would still go to work with at least some symptoms. Photo: Getty

Among other key preliminary findings, some people were more worried about visibility of symptoms than infectivity, particularly if they were afraid to lose income by missing work.

They were more likely to keep their kids home from school if they were ill, with the exception of runny noses, than miss work themselves.

People were, however, more likely to stay home from work since COVID-19, seeing it as a sign that they cared for others and not a sign they were slacking. They were also acutely aware that others were watching them for signs of sickness.

Nevertheless, many people reported they would still go to work with at least some symptoms of infectious disease because they believed those symptoms were not contagious, and were afraid of losing work, salary or felt they were irreplaceable.

They also thought it unlikely that they had COVID-19 and weren’t too worried about spreading other illnesses, such as a cold or gastro.

“We know people sometimes don’t always wear a mask – or they will pull it down to talk, or have it under their nose,” Dr Wynn said.

“What it shows is people are not good at assessing risk of infectivity. Nobody goes out thinking they are going to spread COVID; they think that whatever they are doing is safe.”

Pandemics to come

The study recommends that public health messaging during COVID-19 should inform people that they can be contagious if they have a fever, aches and pains or chills, and that mask wearing reduces transmission even if symptoms are not respiratory.

In fact, Dr Wynn said, given that people are not good at predicting risk of contagion, it may be best to remove the question of symptoms from people’s minds and keep reminding them that they can be contagious even if asymptomatic.

Dr Wynn also underlined an urgency to tackle these ingrained beliefs given the spectre of ongoing pandemics.

“We have had more pandemics in the past 20 years than we did in the past century,” she said.

“It is a combination of increased air travel, increased urbanisation where people live closer and closer together, and it also has to do with battery farming and other intensive agricultural practices raising the risk of zoonotic diseases.

“Pandemics are not going to end, even when COVID ends; that is why it is so important to pay attention to these cultural ideas about contagion because they are going to be of enduring significance.”

This article was previously published at The Lighthouse and has been lightly edited for style and length.