Where in the world is the NHS COVID contact tracing app? Apps rolling out globally, but will they roll out before it’s treatable ?

It does seem that the NHS contact tracing app, debuted after various tests on 5 May in the Isle of Wight, has vanished from the radar screen. A scan of recent news indicates that the app is further delayed in favor of a manual track and trace system with 25,000 contact tracers, starting 28-29 May A Telegraph article indicates that the app had the Bluetooth blues, with further detail from Wired UK around emerging worries within NHSX about BTE’s ability to accurately calculate the distance between two users.

Folks in the Isle of Wight, who enthusiastically adopted the app (Week 1’s 52,000 downloads), would like to know how they’re doin’, in the immortal words of a real NYC Mayor, Edward Koch. That data about contacts and alarms seems to not be forthcoming from the NHS–as well as an updated app with more questions about symptoms and test requests and results integrated into the process, according to BBC News today 16 June. Yes, it was an odd choice, but often beta tests take place in relatively small and isolated places, not big cities where factors can’t be controlled. But the app appears not to be moving forward in favor of the manual system. Nevertheless, the sound of crickets is deafening.

Some articles like Wired’s blame the NHS’ centralized approach, where a report of COVID goes straight to the NHS server, with outbound messages going to those with whom the person was in contact, defined by BTE tracing within 6 feet for 15 minutes +. Observers like our own Editor Emeritus Steve Hards noted in comments on the 29 May article that “It will only take a few well-publicised malware or phishing incidents to make the job of the genuine trackers unworkable and for any trust in the app to evaporate.”

A great deal of fuss has been made of other countries adopting contact tracing apps that actually work. Most of these are built on a platform developed by Apple and Google. These have been used in Italy, Switzerland, Latvia, and Poland. Austria is in test, Germany just launched. Japan’s is on a Microsoft platform. Countries that launched earlier have had their wrinkles. Italy is feuding over issues of data privacy. Norway’s Smittestopp app, which used both GPS and BTE to advise those contacted to self-isolate, was stopped by the Norwegian Data Protection Authority on disproportionate intrusion into users’ privacy. A bug in the programming affects Australia’s CovidSafe iPhone users in logging matches when the other iPhone is locked. Singapore, after seeing only one-quarter of the population adopting the app,  is going the wearable dongle route that you hand over if you test positive. BBC News

By the time the apps are developed, debugged, and rolled out, the lockdowns will have ended, and the virus will have abated or mutated for next season. Meanwhile, progress has been made on treatment protocols. HCQ, zinc, azithromycin, vitamins C and A in early-stage treatment are already well known, like Tamiflu for the first few days of the flu. In later treatment, nasal oxygen (not ventilators), high dose vitamin C, heparin (a common blood thinner to prevent lung clotting), methylprednisolone (a steroid) and also HCQ were published by the Front Line COVID-19 Critical Care Consortium as early as 6 April. Now another BBC News report reveals that the University of Oxford’s RECOVERY Trial is mass-testing several approaches, including an inexpensive steroid, dexamethasone ($1 a dose). Sadly, they estimate that 5,000 lives in the UK could have been saved. Between cheap and common HCQ, heparin, steroids like dexamethasone and methylprednisolone, and high dose vitamins like A, C, and zinc, let’s hope that the spread in Africa and Latin America, especially Brazil, can be quelled.

NHS’ COVID contact tracing service started today–but where’s the app? Australia? (with comments)

To paraphrase the burger chain Wendy’s long-past spokeswoman, Clara Peller, ‘Where’s The App?’. The NHS debuted a contact tracing scheme for COVID, but it is a manual system dependent upon–people. If you test positive for the virus, you will receive a call from the NHS’ test and trace system. The person will ask for information about your recent contacts with others, and then asked to self-isolate for 14 days. Those names you provide will be contacted as well.

The NHSX-developed Bluetooth LE app remains in beta test on the Isle of Wight, which started on 5 May [TTA 5 May]. Reportedly there were 52,000 downloads in week one, which for an island with only 80,000 households is pretty impressive. 

The original rollout date set by Health Secretary Matt Hancock and NHSX chief Matthew Gould to the House of Commons’ science committee was mid-May, which has come and gone. The new date is now sometime in June. However, Baroness Dido Harding, the new director of NHS’s Test and Trace program, would not confirm that date–as we’d say, tap dancing quite hard. Digitalhealth.net, Telegraph

The US has been hiring contact tracers by state from Alaska to New York. A recent study in preprint in MedRxiv (PDF) by Farzid Mostashari of ACO management company Aledade and others found that in order to reduce the transmission rate by 10 percent, a contact tracing team would have to detect at least half of new symptomatic cases, and reach at least half the people with whom they were in close contact. MIT Technology Review 

Apps have been deployed in Australia (COVIDSafe) and Singapore (TraceTogether) and are in development in Switzerland and Germany. Most use BTE, but South Korea, India, Iceland, and some US states including North Dakota and Utah are using GPS phone location. China has been the most ruthless in using GPS data to monitor citizen locations and activity, to restrict their movements. Previously mentioned here [TTA 19 May] are UnitedHealth Group and Microsoft’s ProtectWell, PWC’s homegrown app–and Google and Apple announced in April a BTE app which hasn’t debuted yet. The Verge

Post-COVID back to work: for workplace screening, testing, contact tracing, there’s an app for that

If you’re looking forward to going back to the office without the children and the dog barking, and seeing people other than your family, don’t expect to go back to “The Office” Normal with kibitzing over the divider and in the kitchen/break room. Chances are the latter will be locked, and the nearest person over the divider will be six feet away. There will not only be serious physical changes to the office, starting with many fewer people there, but also apps to track your health and who you come in contact with. Your employer will be managing your potential risk for infection of yourself and others.

  • UnitedHealth Group and Microsoft’s ‘ProtectWell’ app will screen your health everyday (using Microsoft’s COVID-19 triaging Healthcare Bot and Azure. If there’s a risk of exposure or if you are exhibiting symptoms, it will direct you to a COVID-19 testing process that enables closed-loop ordering and reporting of test results directly back to employers, managed (of course) by UnitedHealth. The app will also provide guidelines and resources for a safer work environment, including physical distancing, personal hygiene, sanitation, and more. UHG and Microsoft are furnishing the app to employers at no charge. UHG has already implemented this ‘contact tracing lite’ for frontline workers and will roll out to its over 320,000 employees; Microsoft will do the same for its US-based workers. Release
  • Enterprise software company Appian released Workforce Safety and Readiness, an app to enable HR departments to plan and maintain a return to work for employees and to maintain a safer workplace. This ’employee re-entry’ app as their CEO Matt Calkins put it, is not for every company. The app will quiz employees on factors such as health data, possible virus exposures, and details about their jobs to determine when and how they should return, based on their jobs plus CDC and state guidance, both of which keep shifting; state and local guidance in particular is keeping more than one law firm quite busy. The app can then push information to workers about their new hours, area, and similar. When the employee is back to work, they can then use the app to provide feedback on crowding and lack supplies such as hand sanitizer or wipes. The app is built on a HIPAA-compliant system and originated with a self-reporting disease app. Appian is targeting larger companies with thousands of employees on a $5,000 per month subscription model. Appian page, The Protocol
  • Companies large and small have devised their own mass testing procedures for current workers and those returning, as early as the next two weeks. This next article from Protocol details several approaches, mostly around detecting the imminently ill.
  • PWC has already set up a contact tracing system for returning workers, an app that tracks contacts with the phones of others of a person who self-reports being ill. While the privacy seems pretty robust–it works on employee self-reporting and his or her AD ID on my phone, then all the other phones it had contact with over the past X days via Bluetooth. As PWC’s David Sapin of their connected solutions area put it, “But if you’re going to come back into the workplace, you need to accept having this type of app on your phone.”
  • For a really dystopian view, see this article in Bloomberg. You may be scanned thermally, have an elevator operator (back to the past!), and lots and lots of sensors monitoring your comings and goings. Facilities departments will be retrofitting for anti-microbial surfaces and plexiglass guards. Before you are allowed to return, if you are allowed to return, you may be pre-assessed for risk before you are allowed to, with bonus point for antibodies. And when you’re back in your ‘six feet office’, you’ll have many more rules governing daily desk coverings, how you interact with your colleagues, walk in the hall, go to the bathroom. Hint: buy acrylic polycarbonate manufacturer stock. ZDNet

Of course, one wonders if Unintended Consequences will be to very firmly establish a remote workforce, which is anathema to some companies, or encouraging further outsourcing of work to offshore entities.

Is a COVID-19 ‘immunity passport’ next for the UK to get back to work?

The Guardian is reporting that UK ministers are in talks with Onfido, a UK company which uses facial biometrics for identity verification. An ‘immunity passport’ would combine identity verification with a medical history on whether that person has had COVID-19. The government could use antigen tests, which show current infections, or a test that detects IgM antibodies. For past infections, the test would need to detect IgG antibodies. This passport would be several months in the future.

The question is if the tests work especially for past infections and access to reliable testing. For instance, the earliest instances of COVID-19 may have occurred in the US starting in late November. Will the IgG antibody still be present? These tests are still developing and are not widespread yet, despite many companies’ claims. Both Roche in the US and Quotient in Edinburgh have new lab-based tests that apparently have superior accuracy. Roche received emergency use approval from the US Food and Drug Administration (FDA) for their test, while Quotient is claiming 99.8 accuracy for 36,000 antibody tests a day in 35 minutes.

The process that Onfido outlined works like this:

  1. Use an app to take a facial picture that you match to your government-issued id. The app matches the two to verify your identity and can also detect if the ID is fake.
  2. Get a test to determine whether you have had the coronavirus
  3. At work, you open the app at reception and take a picture of your face that generates a QR code. This is scanned by the receptionist and confirms whether you have immunity or not.
  4. If you have a match, you can enter the workplace.

Of course this discriminates against those with smartphones, and if your facial appearance has changed. Example: if your government ID was taken with a beard and you’re now clean-shaven, in this Editor’s estimation you will have a problem. Most government IDs also look like the pictures of missing appearing on milk cartons, so what your app takes could very well not match.

It’s also unknown whether the antibodies even confer immunity–and for how long.

Contact tracing in the UK: the biggest digital health test yet?

Is uncertainty over risk of data breaches and violation of data privacy in the NHS contract tracing app the real barrier to adoption? Or is the risk more complicated–the user perception of  app reliability for them to upend their life? A person might not want to have the government on record as telling them that they were “sufficiently near” a person diagnosed with coronavirus–and also believe that the app does not provide reliable information. The person receiving the alert very well may not be infected, but the risk is that they may be compelled to self-isolate and even test with repeated alerts that may or may not be accurate.

In other words, the ‘false positive’ alert syndrome. We go back to this syndrome to understand that the real test of confidence is the perception that the algorithms will, with a good deal of confidence, screen for the number and duration of contacts of other people with symptoms, and that the complex algorithms will create a correct evaluation.

With a system that relies on about 80 percent of adoption, according to a University of Oxford team, the real factor in a successful contract tracing app may be Human Behavior– how users with smartphones perceive the app as reliable in alerting them for enough risk to self-isolate, with privacy and security lesser concerns.  UKAuthority  Hat tip to reader Alistair Appleby

Contact tracing app ready for Isle of Wight trial this week: Hancock. But is it ready for rollout? (updated)

Announced today was what in normal times we’d call a beta test of the contact tracing app [TTA 25 April] developed by NHSX on the Isle of Wight. Transport Secretary Grant Shapps announced it Sunday to Sky News. BBC News detailed today that council and healthcare workers will be first to try the contact-tracing app starting Tuesday at 4pm, with the rest of the island able to download it starting Thursday. Gov.UK  The Isle of Wight has approximately 80,000 households.

Update: How the Isle of Wight residents reacted to the app. BBC News

How the app works: if someone reports COVID-19 symptoms through the app, that information goes to the NHS server and the server downloads that tracking information. The app then notifies the other app users that the person has been in contact with over the past few days, contact being defined as within 6 feet for 15 minutes. This can include someone a person has sat next to on public transport. The tracking in the app is via Bluetooth LE to other mobile phones. The app then alerts contacts with the app and gives advice, including how to get a test to confirm whether or not they do have COVID-19. Users will be able order tests through the app shortly.

Use of the app is voluntary and personal data is limited to postal code and what the user opts in to. So the intent of the app is to warn and test to reduce future outbreaks, as full lockdown is not and cannot be a permanent state. Mr. Shapps stated to Sky that the goal is 50 to 60 percent of the country using the app.

Unfortunately, many of the most vulnerable–older, sicker, and poorer adults–won’t have the smartphone, much less the app, and even with the smartphone, won’t be able to download the app or use it. It’s dependent on self-reporting, which may or may not be reliable. Phones can turn off Bluetooth LE. Another consideration, and one this Editor hopes has been tested, are extremes: extreme density in population and contact areas, and extreme distance, as in rural areas. Additional from BBC News, including a short Matt Hancock clip from the Monday briefing with an almost-touch of his nose or mouth right at the start (!)

The Guardian brings up privacy concerns as well as a Health Service Journal (HSJ) report that the app was ‘wobbly’ and had cybersecurity concerns which would exclude it from the NHS’ own app store. The HSJ story quoted their source stating that the government is “going about it in a kind of a hamfisted way. They haven’t got clear versions, so it’s been impossible to get fixed code base from them for NHS Digital to test. They keep changing it all over the place”.  The reporting data also will reside on NHS servers, not individual phones, but pushes out the alert from the server.

Worldometer gives the current UK statistic as total of 190,584 with 28,734 deaths. While case diagnosis continues to increase, fatalities have been steeply declining. There is concern that COVID is yet to spike in rural areas, as cases have concentrated in Greater London, the Midlands, and the North West. New York and New Jersey alone in the US have over 456,000 cases with just under 32,900 fatalities attributed to COVID-19, 3/4 of which have been in NY–almost as much as the entire UK. (However, the fatality statistic is widely questioned as not screened for contributing causes, since there are certain incentives for attribution.)

In other NHS news, NHS Digital, the information and tech side of NHS (not the innovation unit) has named a new deputy chief executive. Pete Rose will also take on the role of chief information security officer for the Health and Care System, including live services, cybersecurity, solutions assurance, infrastructure, and sustainability.

NHSX announces TechForce19 challenge awards (updated), COVID-19 contact tracing app in test for mid-May launch (UK)

NHSX, the group within the NHS responsible for digital technology and data/data sharing, made two significant announcements yesterday.

TechForce19 Challenge Awarded

NHSX, with the Department of Health and Social Care (DHSC) and the Ministry for Housing Communities and Local Government (MHCLG), yesterday announced the 18 finalists in the TechForce19 challenge. This challenge was set up quickly to support the problem of vulnerable, elderly, and self-isolating people during this COVID-19 quarantine to reduce actual and feelings of loneliness and lack of safety.

Like most everything around coronavirus, this was fast tracked: the challenge announcement in late March, submissions closing on 1 April, and the selection announced on 24 April. Each finalist is being awarded up to £25,000 for further development of their technology systems.

The 18 finalists include a number of familiar names to our Readers (who also may be part of these organizations): Feebris, Neurolove, Peppy, Vinehealth, Beam, TeamKinetic, Alcuris MemoHub, Ampersand Health, Aparido, Birdie, Buddi Connect, Just Checking, Peopletoo/Novoville, RIX Research & Media (University of East London), SimplyDo, SureCert, VideoVisit, and Virti. Their systems include checking for the most vulnerable, volunteering apps, mental health support, remote monitoring, home care management, and in-home sensor-based behavioral tracking. Details on each are in the NHSX release on their website. NHSX partners with PUBLIC and the AHSN Network (15 academic health science networks). Hat tip to reader Adrian Scaife

Updated 29 April. Adrian was also kind enough to forward additional information to Readers on Alcuris MemoHub (left) as a finalist in the remote care category. Partners in the test are Clackmannanshire and Stirling Health and Social Care Partnership (HSCP), East Lothian HSCP, South Tyneside Council, and Stockton on Tees Borough Council and last for about two to three weeks. Release

COVID-19 contact tracing

NHSX announced the release, in coming weeks, of a contact tracing app to track your movements around people and if you become positive for coronavirus, “you can choose to allow the app to inform the NHS which, subject to sophisticated risk analysis, will trigger an anonymous alert to those other app users with whom you came into significant contact over the previous few days.” The app is being tested in ‘early alpha’ at RAF Leeming (Computer Weekly). The app will tell users that they are OK or if they need to self-isolate. Far more controversial, if one cares about privacy, despite all the caveats. Based on the articles, NHSX is targeting a release of the app by mid-May according to the BBC, which also broke the RAF test. It will presumably acquire a snappy name before then. ComputerWeekly 24 April (may require free business registration), Matt Hancock Commons statement 22 April