Amid strategic meltdown over PPE and testing, the UK government has made steady progress on at least one prong of its Covid-19 approach: the NHSX contact tracing app. The BBC reported today that the app is being tested out at an RAF base in North Yorkshire and is billed for release in mid-May – potentially around the time that lockdown restrictions start to be eased.
The UK government has confirmed few technological details about the app, except that it will be based on Bluetooth Low Energy, a feature that is included as standard on all of today’s smartphones. However, an app-based approach towards contact tracing risks excluding older demographics, who are least likely to use smartphones, but are most at risk of dying from the virus.
Data from Ofcom indicates that while 80 per cent of all adults owned a smartphone in 2018, only 47 per cent of 65-74 year olds, and 26 per cent of over 75s did. This is supported by data published by Statista, which indicates that only 40 per cent of over 65s used a mobile phone to connect to the internet in 2019. In addition, older people may be more likely to use older smartphones that don’t come equipped with the Bluetooth Low Energy feature. These types of handsets are estimated to make up between 9-12 per cent of the smartphones currently in use in the UK.
While it’s hard to say whether the app will require a continuous internet connection to run, it’s almost certain it will require at least intermittent internet connection, as well as an internet connection to download the app in the first place. For the 60 per cent of over 65s who don’t use the internet, this creates a, potentially insurmountable, roadblock to adoption.
Caroline Abrahams, Charity Director at Age UK, said: “While we welcome any new technology that may help tackle the outbreak, we must ensure that no one is disadvantaged or locked out of services simply because they don’t have a smartphone. A substantial group – including the majority of those aged 75 and over – are not online and most of them never will be. Lack of knowledge, concerns about security, and the cost are some of the reasons why older people do not use the internet.”
This is a more pressing issue given that it’s this demographic which is most vulnerable to the virus. Globally, the death rate for Covid-19 is 15 per cent among over 80s, compared to less than 0.5 per cent in those under the age of 50. Data indicates that although a higher-than-expected proportion of younger people have been admitted to critical care in the UK, over 65s account for close to 90 per cent of all Covid-19 deaths.
A group of epidemiologists and ethicists at Oxford University that are advising NHSX on its app modelled a city of one million people to simulate the software’s impact. The group decided to exclude over 70s from the model, on the assumption that this age group would be self-isolating indefinitely. However, a spokesperson for the NHS clarified that this wasn’t the assumption ingrained in the NHSX app itself. The BBC reported that the government is thinking about giving low-cost wearable devices to those who do not have compatible smartphone handsets.
Low income groups are also less likely to be able to download the NHSX app. Ofcom data shows that although 93 per cent of low income households said they access to a mobile phone, only 67 per cent used a smartphone, compared to 86 per cent of the highest income group. This is more concerning given that there’s some evidence that the effects of Covid-19 are exacerbated by low socioeconomic status.
A Guardian analysis found that of 12,593 patients who died in hospital up to 19 April, 19 per cent were Black, Asian and minority ethnic (BAME), despite these groups only comprising 15 per cent of the general population in England. This effect has been attributed to the increased social deprivation experienced by these groups that raises the likelihood for underlying diseases, compounded by the greater likelihood of being employed in insecure and low-paid labour, and living in overcrowded housing.
“The groups that are most vulnerable to Covid-19 are also the hardest to reach,” says Allyson Pollock, director of the Newcastle University Centre for Excellence in Regulatory Science. “That means that a sophisticated app is not going to reach very poor households and also older people who are the target group.
“What you need are volunteers, contact-tracing and need to rebuild capacity for local data, and people on the ground. Apps are simply a support at best, but they’re not a replacement or a substitute.”
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There’s a raft of arguments why an app might not be the most effective intervention for any of the population, regardless of age. This is also the conclusion the director of Singapore’s TraceTogether app (which inspired the NHSX app) came to, conceding that at present, no technological intervention is capable of replacing the success of manual contact tracing.
This seems to be something that the UK government is waking up to as well. On Thursday, The Times reported that although the government abandoned mass contact tracing a month ago due to lack of testing capacity, it plans to draft thousands of employees including council staff and civil servants to carry out a programme of manual tracing in combination with the app, that Public Health England hopes will be up and running within three weeks.