On 18 June, after several promised launch dates had been embarrassingly breached, the government finally abandoned its attempt to get an NHS Track and Trace app operational this side of any second Covid-19 wave. The app was supposed to use Bluetooth signals between smartphones to enable contacts of coronavirus-positive people to be tracked, traced and isolated (TTI).
Will it matter, the loss of this high-tech guardian angel? Only marginally. The majority of a Covid-19 patient’s high-risk encounters – prolonged or close face-to-face contact – will be memorable if prompted by a skilled human contact tracer. The app might have helped with tracing in anonymous settings, such as on public transport, but there is little evidence globally that such apps actually much reduce overall Covid-19 transmission. We’re probably better off continuing to emphasise frequent hand hygiene, the observance of social distancing, and the use of face-coverings – all backed up by rigorous TTI performed in the traditional, labour-intensive way.
One of the unsurprising findings of the NHS app’s abortive pilot on the Isle of Wight was that patients much preferred news about potential exposure and the need to self-isolate to come from a human being with whom they could discuss the implications, rather than via an impersonal notification on their phone.
The UK is not the only country finding apps for TTI difficult to develop. The problems are threefold. Most fundamental is the determination of the big players, Apple and Google, to have nothing to do with any system that creates a centrally held database that has the potential for abuse – such data could reveal who was where, when, and with whom. Apple and Google have instead created a different system that passes ephemeral information solely between phones without compiling a central record.
Most other countries, including Germany and Italy, have built their apps on this Apple/Google platform, but a few – like the UK, Australia and Singapore – have tried to do their own thing. All three countries have run into major problems, but the UK is uniquely vulnerable to the tech failure because of our tardiness in establishing an effective human-operated TTI system. That raises another question for a future Covid-19 inquiry: how far did our Health Secretary Matt Hancock’s infamous obsession with technology – and its illusory simple solutions to complex health problems – impede the creation of a traditional TTI system in the UK?
Even with apps built on the Apple/Google platform, there are problems with phones not detecting each other reliably. And there are formidable difficulties with accurately extrapolating proximity of contact – so important for knowing the risk of virus transmission – from Bluetooth signal strength. Hancock tried to save face when announcing the abandonment of the NHS app, suggesting the UK had at least developed a better solution to this problem than the tech giants have achieved thus far. We shall see.
The tribulations surrounding contact tracing apps are in stark contrast to some other applications of technology in the battle against the pandemic. The most noteworthy is the Covid Symptom Study (CSS), undertaken by King’s College London in association with health science data company ZOE. Their app collects daily health reports from participants around the UK.
With more than three million volunteers, the CSS is the largest public science project of its kind in the world. And the data it has been gathering is ground-breaking. The CSS identified loss of smell and taste (anosmia) as a hallmark symptom of Covid-19 as long ago as late March. Volunteers have also described a dozen other Covid-19 symptoms beyond the “classic” triad of cough, fever and shortness of breath that defined the UK’s criteria for access to swab testing.
The CSS has corroborated the existence of a gastrointestinal variant of the disease, characterised by nausea and diarrhoea, as well as another worrying phenomenon I am seeing among my patients – a relapsing/remitted Covid-19 variant in which patients suffer recurrent bouts of symptoms for months. The CSS estimates this disease pattern affects about 5 per cent of patients, almost always people who were never sick enough to require hospitalisation, but who seem to struggle either to clear the virus or to switch off their immune response.
Such innovative and effective research is a UK success story. The project has been supported and promoted by the devolved administrations. Yet, study leaders report UK government pressure to desist in their efforts, apparently on the grounds that the CSS app would detract from the NHS one. Anosmia was grudgingly added to the official UK Covid-19 case definition as late as mid-May, and there is still no sign of the gastrointestinal variant being incorporated.
The CSS now provides the government with a daily picture of Covid-19 case numbers and locations across the country, which identifies regional variations in infection rates – the very outcome it was hoped the NHS app’s centralised database would deliver. Yet the UK government continues conspicuously to fail to endorse the project officially, or to support the research.
From failure to harness domestic PPE manufacture and supply; through shunning of independent labs pleading to contribute to national testing capacity; to regional public health and primary care being sidelined in favour of commercial outsourcing of testing and tracing: throughout the pandemic the UK has demonstrated a rigid, ideological instinct to centralise control. This might have been excusable had we been competent to deliver. As it is, it is yet one more dismal lesson to be learned from our disastrous response to the coronavirus crisis.
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This article appears in the 24 Jun 2020 issue of the New Statesman, Political football