On the 7th May, residents of the Isle of Wight became the first UK citizens to trial a new contact-tracing app - a key component of the Government’s new ‘test, track and trace’ strategy to minimise the spread of COVID-19.
Systemic contact tracing, defined by the World Health Organisation as “the process of identifying, assessing, and managing people who have been exposed to a disease to prevent onward transmission”, is critical for controlling infectious-disease outbreaks. In the case of COVID19, adoption of digital solutions is necessary to keep pace with the rapid speed of transmission.
However, while mobile solutions such as smartphone proximity trackers are proving a popular approach with governments in every hemisphere, it is essential that these apps are not considered a ‘one-stop shop’ but rather one element of a larger contact-tracing strategy. In their latest guidance, the World health Organisation encouraged authorities to embed community engagement and localisation in their strategies, all supported by a workforce of trained contact tracers.
Putting concerns around data privacy, technical efficacy and parallel testing aside – these are widely debated elsewhere – a total emphasis on digital solutions can blind us to the effect on people and the role they can play:
Positive public attitudes and behaviour can ensure sufficient smartphone users download a proximity tracker for the programme to be effective.
Human contact-tracers can improve the efficacy and accuracy of smartphone proximity trackers by reinforcing key messages and providing personalised risk assessments.
Not all UK citizens have smart phones – alternative methods are required to ensure contact-tracing programmes extend to and protect everyone equally.
Recent research conducted by the University of Oxford suggests that 56 per cent of the UK population and 80 per cent of smartphone users would need to download (and use perfectly) one proximity tracking app for it to be effective at suppressing the epidemic. Unfortunately, uptake observed elsewhere suggests this may not be the case. In Singapore, only one-fifth of the population have reportedly downloaded the national application TraceTogether, with the result that in only 4 per cent of random encounters will both people have the app installed. Obtaining public buy-in and maintaining their trust is therefore as important an investment as technological development.
Another area where people can be the difference between a successful contract-tracing solution and failure is in the ability to communicate information to drive a change in public behaviour. In South Korea, often cited like the posterchild for electronic surveillance methods, contact-tracers contacted and interviewed those to collect additional data and issue instructions. Without such a dedicated workforce reinforcing key messages (“Stay home”) and assessing symptoms, it is unlikely all those who receive a warning will comply and stay home. This highlights the importance of the 18,000-strong contact-tracer workforce the UK government have committed to hiring by mid-May.
And finally there is the matter of reach. Approximately one-fifth of the UK adult population do not own a smartphone. Those at greatest risk of being missed by a digitally centric approach are the elderly and those with a poorer sociodemographic background. Insufficient investment in alternative methods of contact-tracing runs the risk of exacerbating inequalities in how different social groups experience the COVID19 epidemic.
This is not to say that digital solutions, and even proximity trackers once the bugs are worked out, are not important for contact tracing – indeed we have said they are essential – but there is a real danger in overreliance on these approaches which could cost lives. This may be the digital age, but personalisation and localisation are perhaps more essential now than ever.