Apps for the next pandemic

It may be too late for this pandemic, but some of the apps under development could be useful in the early stages of the next large outbreak. There should be no rush to launch any new ‘shiny thing’ that undermines or conflicts with HM Government’s current advice to the public on their behaviour.

Currently proposed apps tend to fall into one of three overlapping categories, plus egregious random ridiculousness:

  1. Open Standards and survey apps
  2. Contact tracing
  3. “Immunity certificates” and testing apps

Plus what happens afterwards…

1) Palantir, Open Standards, and survey apps

The Palantir dashboards could be entirely public. For the same reasons that NHS England hasn’t said the Palantir dashboards will be public, not everything about real-time health should flow without friction.

Open Standards in healthcare are a good thing; Open Standards in public health in the time of a pandemic rely on every actor moving with understanding, responsibility, and the gravitas appropriate to the situation. Then someone invites Facebook…

If asking people to fill in a daily COVID-19 survey is good, for example, and more people filling in interoperable surveys is good, then surely Facebook promoting a survey daily to everyone on their homepage is even better? Especially when Facebook can see exactly who clicks what, and people can be tracked all across the web (fbclid)… or maybe Facebook could just do this all itself (and be trusted not to use it for its advertising algorithms)?

Just as Huawei are politically toxic in the UK right now – but are keeping the mobile networks working anyway – and Palantir are completely aware that they’re creepy by design – their logistics platform is world class, though it’s more often used to move people closer to death than further away – so Facebook have the same naive arrogance in 2020 that they had in 2015, without any appreciation of what happened in the interim.

All standards get abused.

In a public health context, it isn’t enough to merely claim that you won’t shit in the water supply; you must have everyone else believe that you don’t – in addition to not actually doing it. Your track record matters.

Newbie missteps in implementing an Open Standard for flu tracking will undermine the good work of all of those entities which have been doing this for some time.

2) Contact Tracing – good apps or bad apps?

A contact tracing app can be encouraged for social care and NHS staff to use to help them protect themselves, their clients/patients and families – and there is no way such an app can be launched and not be usable by everyone else, since people will install it anyway – so it has to work. That does not mean it is necessarily a good idea.

While the Government’s communications strategy has improved in the last week or so, its ability to launch an app that doesn’t undermine the ‘stay at home’ narrative is, in practice, likely to be low – even if well intentioned. And this DHSC has an unfortunately poor record of promoting digital mediocrity and clinical irrelevances. Even in the current crisis, Matt Hancock shows little sign of changing his spots or improving his discretion

At best, a rewrite of the Singapore app so that it instead stores a list of random Bluetooth LE beacons on-device would be a beginning, then allowing the sharing of beacons ‘seen’ in a particular time frame after the user presses an “I have symptoms” button. While it looks like the Government has gone with Oxford, we don’t yet know who actually wrote the NHS tracing app, how badly they’ve screwed up the inevitable Facebook / Grindr / TikTok integration, or whether they’ve taken shortcuts in their implementation at the expense of the people they want to use it.

Any contact tracing app will only be installed and working on the devices of those who choose to use it. (In the same way that Boris Johnson said he’d still shake hands…) People may have learned a great deal in the past few weeks, but those who choose to use the app will likely already be following the rules, and those who don’t, well, don’t…

And, in the bigger picture, we must ask: would we do this for HIV? For whatever we do for COVID will be copied by others – first for COVID, and then by others for other conditions.

Given the volumes of users and devices required for contact tracing to be even minimally effective, there is non-trivial scope for ‘tourists’ to stand outside Number 10’s gates near the journalists for a few hours, and then press the “I’m Infected” button for giggles and chaos.

3) “Immunity certificates” and testing apps

The tests will come. They are coming. And there will be a time when such tests are necessary to affect what a citizen should do next; that time is not now, but it is approaching.

  • Antibody tests can show that you have had the virus, and are effectively immune (for now).
  • Antigen tests can tell you that you’re not currently infected with the virus.
  • In terms of results, what you want is a negative antigen test, and/or a positive antibody test – a distinction that scientific illiterates who’ve repeatedly been told to disregard experts may find difficult to make.

There will be some who (lawfully or otherwise) choose to limit access to those with the ‘right’ form of either test. Whether by employer, or social groups, or at the border. Do we want to become one of those countries that takes blood samples as people try to pass through customs? China may choose to do so, but who do we want to be?

While minimal central infrastructure is required for a contact tracing app that one hopes is used by a high enough percentage of the population for it to be meaningful, testing apps have very different requirements.  

When there are perverse economic incentives around testing, one person with known immunity might take the test in place of others – and others may feel compelled to expose themselves for the chance to feed their kids, or return to a ‘normal life’. Any mass testing infrastructure will rely not only upon the accuracy of the test itself, but upon there not being harm(s) for one type of outcome compared with another. 

And any centralised list of confirmed test results will, by definition, be a list of the entire population and their digital devices. A National Identity Register in all but name. The choices and actions of the unreformed ‘institutionally ignorant’ Home Office with regard to such datasets in the past now creates harm for everyone, should this be attempted.

Incentivising people to lie about their status will cause harm. And forcing people to disclose they have had (or not had) any temporarily notifiable disease has ugly precedent, with practices steeped in prejudice and racism. 

The costs of ongoing institutional intransigence, blind spots, and/or delivery failure are all coming due in a period where agility is most needed and where the results are most visible. This is clearest in the NHS supply chain, but it applies to institutions (of all types) which, when they are most needed to deliver something new, end up just doing the same thing they did before.

People will follow Government’s lead. A million people in a week responded to Treasury’s announcements by first understanding their circumstances, and deciding they needed UC.  GDS and NHS digital teams have deployed hundreds of structural changes to their services, in addition to thousands of content changes, but others – most notably DWP – seem to have done little more than shuffle people around. 

When the vaccine comes, we want people to have survived, and our society to have survived too – not be degraded into the sort of fear and bigotry that embody Marsham Street’s default perspective. 

After ‘stay home’, five strains of flu are normal

Last year, there were four strains of flu; now there are five. In a perspective of years, that difference is minimal.

The country will go back to (a new) normal. Do we really want abusive employers or others to be checking antigen and antibody status for employment in Wetherspoons, or at an Amazon warehouse – or so you can pick your own kids up from the school gate? 

If not that, then how do we treat someone who gets off a plane from anywhere – whether they came from China (with their choices), Trumpistan (with their inaction), NYC (with their resources), or Africa (with their resources)? What is the goal of “immunity certificates”? And how will that work at Heathrow?

The Home Office will, of course, default to racism and prejudice; fingerprinting arrivals because its Ministers and officials have long wanted to (it went badly). Actions and cultures predicated on secrecy rarely prove effective.

For any category of app to be effective, you need enough users using it for users to be able to expect others to have it. Announcing an app at the PM’s daily press conference might (hopefully) achieve that. And the app might even do what it’s supposed to. But making that announcement in a way which doesn’t undermine even more vital public health messaging would need a degree of demonstrated competence that NHS England / NHSX have thus far failed to deliver at any point since their inception.

Substantive details on particular points:

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