In the latest edition of the COVID-19 wrap, public health researcher Alison Barrett reports on some timely new research and analysis of digital contact tracing, and also addresses a critical determinant of health.
Quantifying SARS-CoV-2 transmission suggests epidemic control with digital contact tracing
Ferretti, L et al., Science, 31 Mar 2020
Without a vaccine, the best ways to manage the spread of COVID-19 are through hygiene, physical distancing, testing, quarantine and contact tracing, a process where attempts are made to find all contacts of a confirmed case of COVID-19 and notify them of the exposure.
The authors of this study estimated that between a third and a half of COVID-19 infections occurred before there was an onset of symptoms in the source, and that the rate of infections from pre-symptomatic individuals was at a rate almost high “enough to sustain an epidemic on its own” (R0=0.9 (0.2-1.1); see Figure below).
The authors advise that SARS, in comparison, had a rate of infection from pre-symptomatic individuals that was almost zero.
Image sourced: Science Mag, under the terms of the Creative Commons Attribution license
What this suggests is that the COVID-19 epidemic is not likely to be controlled by isolating only symptomatic individuals and that pre-symptomatic people need to be isolated also.
To do this effectively, rapid contract tracing is required.
The researchers then found from mathematical modelling, that due to the rapid spread of COVID-19, traditional manual contact tracing may be too slow for SARS-CoV-2 and they recommend the use of smartphone apps as an additional tool to help expedite the contact tracing process.
A limitation of the study should be noted: as the researchers used the growth rate of the epidemic from its early stages in China, the intervention methods (case isolation and contact tracing) applied in the modelling will be more applicable to earlier stages in an outbreak.
Authors of a piece in the Harvard Business Review suggest that East Asian countries (China, South Korea, Taiwan and Singapore in particular) that have been successful in flattening the curve have done so by being collectivist cultures, and by actively utilising various methods of technology (such as smartphone appsmobile phone alerts, use of location tracking to collect data and trace contacts. It should be noted that the authors haven’t cited any studies confirming a link between the use of technology and flattening the curve in these countries.
While Ferretti and colleagues recommend the use of smartphone apps to help the contact tracing process, they acknowledge some ethical concerns, largely to do with use of the data gathered and that public trust and confidence in this technology is vital to their success.
Many countries across the globe are utilising, or in the process of implementing, smartphone and other technology to help in their management of COVID-19; however, concerns have been raised.
An editorial published in Nature on 29 April, discussed some concerns about use of smartphone apps to manage the pandemic, including:
- Concerns over accuracy (if the app is linked to self-diagnosed test results instead of official test results, this could cause undue alarm to contacts)
- Lack of public consultation in development
- Storage of data (it is best for data to be stored in many different places rather than in one central storage location)
- Use of Bluetooth as the main communication technology between phones, a technology known to have been used in security breaches
- Lack of published evidence of the efficacy of the apps in doing what they are intended to do.
These issues and others are reiterated in a paper, yet to be formally published in the scientific literature, by Faculty of Law members at University of New South Wales.
The authors analysed the steps taken by the Australian Government in releasing the COVIDSafe app, finding that there has been a lack of transparency surrounding the app. They provide some recommendations for the Government to justify public trust in the app.
The full report can be found here but some of the recommendations for the Australian Government include:
- Correcting misinformation about how the app works
- Announce details of planned studies to evaluate the effectiveness of COVIDSafe in tracing contacts
- Making the full source code available to the public
- Parliamentary legislation to strengthen safety against misuse of the app
- Ensure that the app collects only data it needs.
While these concerns have been raised, the UNSW authors of this paper and the authors of this Nature editorial also acknowledge the time pressures surrounding COVID-19 and the need to implement necessary measures to manage the pandemic.
The UNSW authors conclude:
Decisions are always made in a context, and Australia is dealing with a pandemic that has already taken nearly 100 lives in this country.
Decisions about whether to install and run this app remain individual decisions, but are best made after obtaining as much information as can reasonably be obtained and put in the balance.”
Rough sleeping responses to COVID-19 Forum
Australian Alliance to End Homelessness (AAEH), 30 April 2020
Following their forum on 7 April, the AAEH hosted another opportunity on 30 April for leaders in the sector to provide an update on activities over the past month and a discussion about the best course of action as we approach the recovery phase of the COVID-19 pandemic.
Professor Paul Flatau from the Centre for Social Impact advised that an estimated 3,000 individuals experiencing homelessness across Australia have been provided temporary accommodation in the past month; at least half of these were rough sleepers.
The response to COVID-19 from the sector has been swift and strong; a great amount of work has been done in a bid to provide temporary accommodation and support to some of those most vulnerable to infectious diseases.
While the numbers are not known, the members of the panel also advised that people experiencing homelessness in some regional and rural locations have been rehoused in the last month.
Now that many rough sleepers are in temporary accommodation, it becomes imperative to find ways to provide support for them in the coming months and beyond COVID-19, to ensure that as few as possible return to rough or overcrowded sleeping.
Members of the panel believe the pandemic has enabled a great opportunity to find more permanent solutions to end rough sleeping.
Nicole Bartholomeusz, from CoHealth in Victoria, said there is a real risk of a second wave of infections as restrictions are lifted; she would like to see more investment in community health for vulnerable populations, including those experiencing homelessness.
Associate Professor Cameron Parsell from The University of Queensland highlighted that the health emergency has pushed governments to respond. He said this response should continue, with state funders and service providers collaborating.
AAEH are hosting a third forum on Tuesday 12 May (11:30am-1:00pm AEST) to hear perspectives from the Commonwealth and local Governments. You can register here.
Watch the forum discussion
Other COVID-19 resources
- Evidence from Campbell systematic reviews on the economic response to COVID-19
- Richard Lehman’s COVID-19 reviews – In this weekly round-up, Richard Lehman looks at a personal selection of articles of relevance to clinicians dealing with covid-19
- Association of Australian Medical Research Institutes: A list of COVID-19 research taking place in Australia
- Resources to help support wellbeing of health workers.
Alison Barrett is a Masters by Research candidate and research assistant at University of South Australia, with interests in public health, rural health and health inequities. Follow on Twitter: @AlisonSBarrett. Croakey thanks her for providing this column as a probono service to our readers.
See previous editions
- Deaths, tweets, vaccines, Africa, children, strategy, communication and behaviour change
- Mental health impacts, public health interventions and global policy
- Sleep, wastewater, drugs and tests
- Providing shelter, understanding transmission, messaging matters, learning from China, and a show not to miss
- Smoking, kids, communities and cruise ships
- Ranking global health, impact of quarantine, rural and remote health concerns, outbreak investigations, and reasons for humility