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

June 17, 2020 | by

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.

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

May 5, 2020 | by

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.