COVID19 — Making sense of contact tracing, part 2
COVID19 contact tracing is coming and will be part of the so-called new normal, whether we like it or not. The usage and goals of contact tracing seems to vary between countries. Countries where technology is part of like, like for example South Korea, opted early for tech-based contact tracing to be able to contain the spread of the lethal virus. In combination with large volumes of testing for infections and antibodies, South Korea used the data and triggers to break the chains of uncontrolled infections. An interesting mix of warning people for hotspots and using data to identify people who are at risk of being infected and infecting others was and is a key pillar of the South Korean coronavirus strategy.
Less tech-savvy countries like the United Kingdom seem to be opting more for a learning-by-doing approach for contact tracing, which matches most of their covid19 strategy so far. The pilot edition of the app shows several serious usability issues which are not ‘from this century’ as someone called it. Looking at the app, the data it attempts to collect and provide to the NHS, and the way the politicians are presenting the app, it appears that this app is designed to learn about the spread of the virus rather than be an instrument in preventing that same spread. After reviewing the app and the available information, one might get the impression that the UK Government under Boris Johnson still hasn’t really let go of their herd immunity concept.
For a contact tracing app to be valuable asset in containing COVID19 and avoiding its uncontrolled spread, it needs to fulfill a couple of requirements. The first requirement is of course the absolute and unconditional desire and commitment of the Government to contain the spread of the virus. Without that, you will end up with something like what is happening in the United Kingdom where Secretary of State for Health and Social Care Matt Hancock is encouraging people to drop measures to contain the spread of the virus during the trial of the NHS app on the Island of Man…
The next requirement for contact tracing to contribute to containing the spread is massive usage and acceptance of the app. At least a 50% share of the population but 60–70% and more are of course preferable. A lower participation rate would only provide data on a very limited part of the population, which might be interesting to study the spread of the virus but doesn’t provide any real warning and protecting about uncontrolled spread.
The third requirement is reliability of the data on infections and immunity of the people who use the contact tracing app. Reliability of COVID19 infection data is a major challenge which goes far beyond technology of an app. When someone tests negative for coronavirus, this provides just a snapshot in time. A person could get already infected while waiting for the test results. There are also many cases where contradicting test results occurred, and experts still challenge the reliability of some of the so-called quick tests. When we say ‘data is King’, we should say ‘valid data is King’ and that will continue to be a challenge for contact tracing apps in many ways.
There has to be a mechanism which ensures that everyone who is or was infected is registered as such within the app. There are 2 key enablers which decide on the success of this. Trust in the authority behind the app and the availability of testing for the coronavirus. Winning and maintaining trust in technology is important under all circumstances, and with something as brutal as COVID19 even more so. The users of the app must feel confident that their data will not be used against them. Not now and not in the future. The users must also clearly understand the purpose of the app and the data they provide and receive. This takes clear communication and transparency. And a lot of winning the hearts of the population to use the app and provide the personal data.
Even with the right technology and a massive acceptance and usage among the population, no contact tracing app will contribute to containing the spread of COVID19 without a massive coronavirus capacity to detect infections. Here is an example from effective contact tracing in Germany, even without app. A friend and his wife got infected with COVID19 during dinner with friends. My friends developed symptoms within 2 weeks, the couple that probably infected them didn’t. 4 people who tested positive for the coronavirus. German health authorities performed ‘analogue’ contact tracing by contacting everyone these 4 people had contact with in the past 2 weeks and invited them for COVID19 testing. The result of this proactive action to contain the spread of the virus is that over 500 people were tested, and 89 confirmed cases were found, 53 of which were asymptomatic.
Testing is key in any pandemic scenario and crucial to enable contact tracing apps to contribute to containing the spread of the virus. How else do you expect to provide adequate data on contacts with infected people or hotspots? Remember Steve Balmer’s famous ‘developers, developers, developers’ chant? The chant of every government should be ‘testing, testing, testing’ to provide the platform based on which contact tracing makes sense.
The United Kingdom and Australia are launching their contact tracing apps with a rather dangerous message. ‘Get notified when you come into contact with COVID19’ is the slogan of the Australian version. A very dangerous slogan because it leads people to believe that they did not come into contact with COVID19 when the app didn’t not give an alert… Only with massive usage and the ability to test, test, test and when you are done with that, test some more, the ambition of being able to warn the population about contact with COVID19 infected people seems realistic. And even then, the risk of transmission of the virus through asymptomatic people remains uncovered and creates an even bigger false sense of safety.
The United Kingdom is still opting for a learning by doing scenario for COVID19, including their pilot of the contact tracing app on the Island of Man. With a population of 84,000 people and 330 confirmed covid19 cases, the Population Infection Ratio is 0.4% compared to 0.3% in the United Kingdom. Although this might appear to be a small variation, it is an absolute variation of 33%! The Infection Mortality Rate for the Island of Man is with 7% much lower than in the United Kingdom where over 15% of the infected population has died from COVID19.
All in all, this pilot will not lead to representative data which could provide important lessons for the rollout throughout the United Kingdom and to analyze the effectiveness of the pilot on the Island of Man itself. Even more so while Secretary of State for Health and Social Care Matt Hancock instructed the population to drop social distancing during the pilot…