UK health authorities are turning to mobile applications to help try and slow the spread of COVID-19 across Britain.
According to an April 6 research report by Gartner the ongoing pandemic is pushing global healthcare systems beyond their limits, prompting “the need to rapidly develop new capabilities such as contact tracing and mass temperature screening….”
Of the more than 148,000 global deaths so far, more than 14,000 have been reported in the UK. However, whilst the UK government has followed World Health Organisation advice around instigating a country-wide lockdown and introducing social distancing measures, it has faced criticism around the lack of available testing for both front line workers and the public.
Launched in late March, the COVID-19 Symptom Tracker App was developed by King’s College London (KCL), alongside Guys & St Thomas' hospitals and London and Boston-based startup ZOE, a nutritional science company co-founded by KCL Professor of Genetic Epidemiology, Tim Spector.
ZOE was originally founded to combine data from Spector’s research into twins with machine learning to develop a consumer product that can predict a person’s response to what they eat. As the coronavirus pandemic spread, Spector decided to use ZOE to track the symptoms of volunteers in his studies, then opted to roll the app out to the entire UK population.
The application was released on March 24 and within a day had been downloaded more than a million times. Users who choose to input data into the app are asked to provide information that includes age, sex at birth, height, weight, postcode of residence, pre-existing health conditions, and habits such as smoking. Then, they’re asked daily to report any symptom that could be associated with COVID-19. The data is shared with researchers at King’s College and at the Guys and St Thomas' Hospitals, to get a better sense of how the pandemic is spreading through the UK.
Data is key to stopping virus transmission
As the virus continues to spread globally, Mike Jones, vice president, team manager and research director for healthcare at Gartner, said collecting data at a population level is critical to help manage the epidemic nationally and support government efforts to supply appropriate resources geographically.
He said that while the government has been doing its best with the information it has already, getting data on an individual level is vital for strengthening any scientific modelling.
“It's very important to have the right data on the individual, what co-morbidities have they got, their age and sex and if there’s any underlying health conditions,” Jones said.
Although the British public has so far shown a willingness to hand over data to the app, a lack of widely available testing in the UK means the majority of people inputting information has essentially been self-diagnosing – raising questions about the accuracy and validity of the data set.
Furthermore, whilst some symptoms – such as a persistent cough and high fever – are felt by the majority of those who contract the disease, some symptoms, like the loss of taste, have been less well publicised, meaning many people could have contracted the illness without knowing it. The lack of testing also means that those who are asymptomatic, but may have still unknowingly passed on the disease, will be missing from the data set.
Though mass-testing is seen by many as the most effective way to reduce the spread of coronavirus, Jones said such an approach is much more complex in practice.
“At a population level, if you can imagine the scale of rollout [that] rolling out testing for individuals to a point where it was accurate enough in size, you’d have to open testing centres, putting people potentially at an increased infection risk,” he said. “I think [current UK government policy] is the right thing to be doing at the moment, which is to focus on testing those people that are in contact with other colleagues and with the workforce.”
He agreed that an app that collects data at the population level would still need to confirm the self-reporting status of users.
“What governments are trying to do is get a really good handle on things like hospitalisation rates and death rates and understanding what these numbers mean – for example, knowing that reported deaths may only include hospital deaths, and it doesn't include deaths in the community.”
Jones also noted that countries will need accurate and reliable data to model what an exit plan or a return to “normal” might look like; that allows officials to explore various scenarios such as removing all restrictions or enacting a phased return, an approach Italy is currently undertaking.
Privacy concerns grow
The independently developed Covid-19 Symptom Tracker App stresses that the data it collects in the UK will only be shared with researchers at the institutes associated with its development. However, this week it emerged that NHSX, an arm of the National Health Service (NHS) set up to drive digital transformation within the UK health service, is looking to launch its own mobile application for contract tracing.
"If you become unwell with the symptoms of coronavirus, you can securely tell this new NHS app," said Matt Hancock, secretary of state for health and social care, speaking at Number 10's daily coronavirus press conference. "And the app will then send an alert anonymously to other app users that you've been in significant contact with over the past few days, even before you had symptoms, so that they know and can act accordingly.”
That idea, while welcomed, immediately raised concerns around privacy after a draft government memo was leaked to the Guardian that said ministers might be given the ability to order “de-anonymisation” to identify people from their smartphones.
The Guardian further revealed yesterday that the NHS is also engaged in a standoff with Apple and Google over their new proposed app. The two companies are refusing to support the development of the NHS contract-tracing app because it would result in the UK government creating a centralised database of contacts, explicitly violating Google and Apple’s policies that all contact-tracing apps must operate in a decentralised way.
Jones says that collecting such information has proven to be vitally important to understanding how the virus is spreading in other countries.
“[We need to be collecting] information about who people have been in contact with over the last 14 days to 21 days so they can understand the exposure that they’ve had to certain individuals who might have been infectious,” he said.
Currently, Jones said, there’s only a few countries that moved quickly on contract-tracing, using apps to able to track individuals and the people they’ve been near.
“Israel has taken an approach where they've pushed through emergency legislation to access what you and I might consider to be very private data about our location through our mobile phones. They're using special measures to collect data on people's movements and their locations through their mobile phones to get information about who you may have come into contact with in the past 14 to 21 days, which has raised a few eyebrows around the use of data and privacy laws.
“Singapore is taking a different approach with an app that's been freely available to download,” Jones said, “so the people self-report symptoms and their status and also track the people that you come into contact with as well.”
The NHSX app, which was inspired by Singapore’s TraceTogether, uses Bluetooth technology to perform contract tracing, a further cause of controversy as it will require Bluetooth features to be switched on constantly, potentially exposing unique device IDs.
Furthermore, because the app is a voluntary download, unless 60% of the UK’s population – around 40 million people – opt to use it, the data collected won’t make a meaning difference to the government’s ability to conduct proper contract-tracing. In Singapore, around 12% of the population have signed up to TraceTogether, a statistic that doesn’t bode well for the UK government’s plans.
“That's where we’ve probably got some lessons to learn, globally, about having applications that can be quickly rolled out in an epidemic, that are transparent when it comes to privacy and consent and how the data is used so we avoid having to put in things like emergency legislation that people might not always trust,” Jones said. “If [the general public] don't trust [the application], they might not want to use it. They might switch off their phones. You want you want to have solutions that are transparent abut can also do the job as well.”