COVIDSafe was ‘sunscreen’ for coronavirus, until it wasn’t. Have we chosen the right solution to the pandemic?

When it launched, COVIDSafe was marketed as Australia’s ticket out of lockdown, so long as everyone downloaded it.

“If you want to go outside when the sun is shining, you have got to put sunscreen on. This is the same thing,” Prime Minister Scott Morrison said at the time.

Two months on, state and territory health departments are yet to declare the app has identified any people exposed to COVID-19 who weren’t already found by traditional contact tracers.

And as the app’s technical challenges have been revealed, public health experts are questioning whether the app is a distraction from the “real work” of controlling coronavirus.

It’s too early to provide a verdict, but it is common for technologies to be presented as “our knights in shining armour” during a pandemic, according to Julie Leask, a public health and infection disease specialist at Sydney University.

It’s human to see something we can hold, something that’s tangible, as more helpful than “the more invisible human behaviours and public health capacities that are still at the heart of our control of [COVID-19]”, she said.

A Health Department spokesperson said all its communications about COVIDSafe highlight the app as just one important tool in controlling COVID-19.

“Communication clearly places the app alongside the need for physical distancing, good hygiene and the importance of staying at home if unwell (and getting tested),” she said.

The risk of complacency

As the country faces a spike of cases in Victoria, some public health experts are concerned the Government’s comparison of the app to sunscreen could make Australians complacent.

Often the hardest thing for people to change about their health is their behaviour, according to Adam Dunn, who leads biomedical informatics and digital health at the University of Sydney.

“It’s much easier to prescribe someone medication … than convince them to completely change their lifestyle,” he said.

While a simple technical solution to the coronavirus lockdown is an attractive idea, it’s not so easy.

Holly Seale, a senior lecturer at UNSW’s School of Public Health and Community Medicine, said focusing on the app’s benefits to the individual may have raised expectations beyond what is technologically possible.

Instead, Dr Seale suggested public health campaigns should focus on its collective benefit to the contact-tracing process.

Today the “Stay COVID free and do the 3” catchphrase is used in advertisements, a Health Department spokesperson said, to encourage Australians to download the app as well as maintain hygiene and distancing.

And the Government is speaking about it less often. In the two weeks after launch, the Prime Minister Scott Morrison mentioned COVIDSafe in 14 press conferences, interviews and media releases that are transcribed on his website. He’s mentioned it just once in the past two weeks.

A technical quick fix

A technical solution to the coronavirus lockdown is an attractive narrative — and one both the Government and many parts of the media ran with.

But Dr Leask said caution was necessary, especially as the public was presented with little evidence for the app’s effectiveness.

“As the saying goes, with every complex problem there’s a solution that’s simple, clear and usually wrong,” she said.

Modelling released today by the public health think tank the Sax Institute suggests a second wave of COVID-19 infections in Australia is likely if social-distancing measures and testing decline.

The research found that in this scenario, the COVIDSafe app could help curb the number of infections.

But this modelling makes some assumptions: that uptake of the app reaches more than 60 per cent of the Australian population, and that the app works as it is intended to.

Sax Institute senior simulation modeller Danielle Currie said that while COVIDSafe had not reached these targets yet, the modelling was reason for optimism.

“What our work shows is that using the app and promoting it widely is worthwhile, assuming that there are technological improvements. This should give the Government confidence to continue its pushing,” she said.

Dr Currie said the app could still prove to be helpful in places like Victoria where there are outbreaks.

“If there’s not many cases, the app won’t pick it up. But if we do get a lot — and the model suggests we might — it could be very helpful,” she said.

The other options

So, could the time, millions of dollars and effort spent on COVIDSafe have been invested elsewhere instead, to better effect? There’s no single answer.

As a behavioural researcher, Dr Leask would like more funding for public health research — how to provide better messaging for communities where English is not their first language, for example.

And in Dr Dunn’s view, Australia would have benefited from more communication about contact tracers and the work they do, as well as more financial support for such teams overall.

For others, masks are the issue of the day. Epidemiologist Mary-Louise McLaws, who advises the World Health Organization (WHO), hopes Australian authorities implement firm guidelines on face masks, because currently the Government doesn’t recommend them.

The WHO initially said healthy people did not need to wear masks but later revised its advice, recommending their use whenever social distancing was impossible.

“[The Government] should be telling people to wear a mask on public transport in or outside of hotspots. It really stands to reason that they should be enforcing masks in some situations,” Dr McLaws said.

Lidia Morawska, who is an expert in aerosol science at the Queensland University of Technology, is frustrated the potential airborne transmission of COVID-19 has been overlooked by authorities.

She makes the case for concrete guidelines on ventilation of high-traffic venues like restaurants, cafes and churches so people aren’t at risk from potentially infected particles lingering in the air.

If the cafe you’re sitting in for a few hours doesn’t know much about the science of air movement, which is pretty likely, this could be problematic, Dr Morawska said.

“We need investment in proper guidelines about ventilation to protect people indoors from infection transmission,” she said. “Researchers have been calling for this since SARS-CoV-1.”

There’s still much to learn about aerosol transmission of COVID-19. The WHO has acknowledged its danger in clinical settings, but is waiting for more peer-reviewed research to assess its risk in other environments.

In the end, Dr Leask believes Australia’s best solutions for controlling COVID-19 remain those that have proven their worth time and again.

“Looking back, you can’t beat good old-fashioned public health … when you don’t yet have a vaccine or a treatment that’s established as being really effective,” she said.

Article Courtesy: www.abc.net.au/

Why COVIDSafe hasn’t helped, yet.

COVIDSafe was sold by the Government as essential to lifting coronavirus lockdown restrictions, but the app is yet to provide much assistance to local health authorities.

Since its launch on April 26, more than 6.2 million people have downloaded the app. But so far, no local health authorities have announced that COVIDSafe identified any otherwise unidentified contacts.

Authorities say that is because case numbers in Australia are so low.

“Australia is in a fortunate position with so few cases across the country, including returning travellers who would not have the app,” a Department of Health spokesperson said.

Data from the app has been accessed in around 30 coronavirus cases nationwide, during a period when around 565 new cases were diagnosed in Australia, including infections acquired overseas.

Nevertheless, health authorities continue to urge Australians to download it.

On the weekend, deputy chief medical officer Paul Kelly said COVIDSafe could prove useful for contact tracing if there was a spike in infections from recent Black Lives Matter protests, but only if people had the app on their smartphones.

One person who attended the protest in Melbourne on Saturday is among Victoria’s eight new coronavirus cases, however it’s not yet known if that person had the app.

“The COVIDSafe app would be absolutely critical and crucial in this type of setting. It’s exactly what it is designed to do, is to pick up cases when you don’t know the people around you,” Dr Kelly said.

“We’ve had a very good uptake of the COVIDSafe app, but the majority of people that have mobile phones have not downloaded the app so far.”

Contacts identified via manual contact tracing

In Victoria, the contact tracing app is yet to identify any close contacts of people diagnosed with COVID-19 that were not also identified via the traditional and painstaking manual contact tracing process.

That’s despite the state finding 21 coronavirus cases that had the app and allowed health authorities to access COVIDSafe data.

In May, Victoria announced that one potential exposure had been picked up by the app that manual contact tracers did not locate, but further investigation later found the interaction did not meet the close contact criteria.

“With only a small number of cases being reported each day in Victoria, there have been few opportunities to use the app so far — and we hope this continues,” a spokesperson for the Victorian Department of Health and Human Services said.

In New South Wales, low levels of community transmission have also provided few opportunities to use COVIDSafe.

A spokesperson for NSW Health said the state’s new cases over the past 15 days were predominantly people in hotel quarantine.

So far, data from COVIDSafe has been accessed fewer than 10 times in the state. It’s unclear whether close contacts were identified in those instances.

In Queensland, there have been no COVID-19 positive individuals identified as COVIDSafe users.

And in Tasmania, the Northern Territory, the ACT, Western Australia and South Australia, where there are few or no new coronavirus cases, local health departments told the ABC they have had no opportunity to use the app.

Data from COVIDSafe, which uses Bluetooth to transmit and record IDs from smartphones with the app that are within range, is uploaded with consent to a central database when someone is diagnosed with COVID-19.

It is then analysed to identify close contacts — considered to be those within approximately 1.5 metres, for a period of 15 minutes or more.

Measuring the success of COVIDSafe

It’s premature to judge the success of a public health intervention like COVIDSafe, according to Seth Lazar, who leads the Humanising Machine Intelligence project at the Australian National University.

“There’s just not enough cases and not enough time,” he said.

“For any measure you want to look at, you want to have enough cases and enough data.”

But it’s unclear how the contribution of COVIDSafe to Australia’s contact tracing regime will ultimately be measured, and there are few public benchmarks.

While more than 6 million Australians have downloaded it, this is still short of the 40 per cent of the population target first discussed as part of the Government’s plans to ease lockdown restrictions.

That goal has since fallen by the wayside. Acting Secretary for Health Caroline Edwards told a Senate committee investigating the COVID-19 pandemic response in May that there was no download target at all.

And while Australia’s low rate of community transmission provides few opportunities for use, the technical reliability of the app to transmit and collect data is still hotly debated.

Dr Lazar said contact tracing apps like COVIDSafe may provide the most benefit during a second wave of coronavirus infection, and that mass gatherings like the recent protests might provide a test for the app’s efficacy.

“It’s a scenario where you’re going to get anonymous close contacts, but it’s also a scenario where you may want a more privacy preserving approach,” he said.

The Digital Transformation Agency, which developed COVIDSafe, has released a number of updates to the app, including most recently the ability to download the app from non-Australian app stores — an important step, given the restriction risked preventing travellers, migrant workers and others from accessing the technology.

“The Australian community can have confidence the app is working securely and effectively, despite the lack of community transmission of COVID-19,” a DTA spokesperson said.

Article courtesy: www.abc.net.au

COVIDSafe privacy protections now locked in law

The privacy protections behind Australia’s COVIDSafe contact tracing app are now enshrined in law after the underpinning legislation passed through parliament with minor improvements.

The Privacy Amendment (Public Health Contact Information) Bill cleared the senate without amendments on Thursday morning, two days after it was introduced by the government.

The legislation seeks to allay privacy concerns within the community, replacing an interim determination issued under the Biosecurity Act when COVIDSafe was launched last month.

It introduces strict penalties of up to five years jail for those that collect, use, disclose (include outside of Australia) or decrypt COVIDSafe data for any purpose other than contact tracing.

The legislation also makes it illegal to force someone to use COVIDSafe and outlines the data handling requirements expected of the health department and Digital Transformation Agency.

Since the draft legislation was released last week, Labor has secured several amendments to improve the laws after constructive engagement with attorney-general Christian Porter.

“This is now a stronger and better piece of legislation as a result of constructive engagement between Labor and the government,” shadow attorney-general Mark Dreyfus said on Tuesday.

Improvements include “greater clarity about what data is protected”, restrictions on law enforcement becoming the COVIDSafe data store administrator and six-monthly public reporting requirements about COVIDSafe’s operation.

The bill also gives the Office of the Australian Information Commissioner “greater oversight” of the app and the data it collects, and ensures the office can investigate privacy breaches even when they overlap with an law enforcement investigation.

“To be clear: this bill will introduce the strongest privacy safeguards that have ever been put in place by any Australian parliament,” Dreyfus told the house of representatives on Tuesday.

“That is despite the fact that the COVIDSafe app is voluntary and the data that it collects is, compared to other personal information that’s routinely collected by governments and corporations, relatively innocuous. This bill takes privacy seriously.”

But serious questions over the app’s effectiveness remain, which Labor, the Australian Greens and Centre Alliance have argued cannot be addressed by legislation alone.

These include technical issues with COVIDSafe’s Bluetooth performance on iOS, which the DTA has admitted could limit the app’s effectiveness capturing ‘digital handshakes’ with other devices.

The DTA’s decision to hand Amazon Web Services the contract for the COVIDSafe app and national data store using a limited tender process has also been questioned.

Labor has insisted that Australian-owned providers offering protected-level cloud services like Sliced Tech, Macquarie Telecom and Vault should have been given the opportunity to bid for the contract.

DTA CEO Randall Brugeud last week gave some reasoning for the selection, with the contract covering hosting, development and operational of the COVIDSafe app and national data store.

This line was reiterated by foreign affairs minister Marise Payne on Wednesday, who said “the contract with AWS is a combination of hosting, development and operational services, which is more extensive than services provided by pure hosting providers”.

“While there are several Australian cloud providers that could have provided elements of the service that AWS has provided, AWS’s ability to scale very quickly in this pandemic context and to provide a broader range of services is beneficial for the purposes to which the COVIDSafe app is to be put.

“In relation to the CLOUD Act, any transfer of data to any country outside Australia will constitute a criminal offence under the provisions of the bill and attract a penalty of five years imprisonment.”

After a short debate on Thursday morning, the bill was passed after Labor opposed any further amendments to the legislation, including the introduction of a strict sunset clause.

“Labor believes that there is a strong public interest in putting these privacy protections in place as soon as possible, and so Labor will not be supporting any amendments that delay the passage of this bill,” Labor senator Murray Watt said.

More than 5.6 million Australians have now downloaded and registered for COVIDSafe since it was released two-and-a-half weeks ago.

Deputy chief medical officer Paul Kelly on Wednesday said that the portal allowing state and territory health officials to access data collected by the app was now up and running.

He said all agreements with states and territories had now been signed and that health professionals involved in the contract tracing process trained to use the portal.

The DTA released the source code for COVIDSafe app late last week, but will not be releasing the code that relates to the national data store.

Article courtesy:  www.itnews.com.au