Last Week on My Mac: Whatever happened to Exposure Notifications?

With many of us looking back over the last year since the official start of this pandemic, I’m not surprised at the silence over one of our most spectacular failures: apps to support test and trace programmes, specifically Exposure Notifications.

It must have been close to a year ago that Apple and Google were busy collaborating on what was originally termed ‘contact tracing’ on the billions of smartphones they effectively control. Their proposals were revealed on 10 April 2020, and released (in iOS 13.5 at least) on 20 May. Look in Wikipedia’s entry on the subject, and you’ll see that a total of 28 nations and 22 US states now have official apps which support Exposure Notifications. Glance down through that list, though, and you’ll see those who, over the past winter, also suffered the worst in the second wave of Covid infections.

That there was a second wave at all is damning evidence of the failure of policies which relied on the success of national test and trace programmes. A second wave had been forecast and modelled by many experts over the summer of last year. Governments had ample time to prepare measures to minimise the impact of any second wave, if not mitigate it away completely. For the UK and others, this meant a complete overhaul of the way in which testing was undertaken, and a new fully-functional contact tracing system, including a smartphone app.

Early trials of the contact tracing app were undertaken in April, at the same time that Apple and Google announced Exposure Notifications. I was one of more than 50,000 who took part in the next trial in May. But that first app had chosen to go it alone, and under mounting pressure the English (rather than British) government scrapped that, and paid for the development of a second app which is based on the Apple and Google frameworks, which I also trialled from mid August.

By that time, the incidence of fresh cases of Covid-19 had plummeted to a low, and were rising steadily when the first release of the app was ready on 24 September, just as it was becoming needed. An update was released at the end of October, as the rise in infections was rapidly becoming untenable.

For an app on which the health of the country depended, and must already have cost upwards of £12 million, there’s a remarkable lack of statistics on its use or effectiveness. The best figure that anyone appears to have come up with is that the app had been downloaded 19 million times by the end of October. That has since grown slightly to 21 million downloads, with about 16.5 million who still appear to be using it. Feasibility modelling used to decide whether to proceed to develop the app in the first place had been based on the assumption that about 60% of the population would use it; in reality that percentage hasn’t even reached half that (28%). Detailed analysis has also revealed that app uptake has been lowest in areas with densest population, such as London, where cases have also been most frequent during the second wave.

Research on the effectiveness of that and other Exposure Notification apps has been scant and of shockingly poor quality. A recent brief review has clutched at the straws offered in just six studies, most of which have had to rely on modelling to predict what might be expected, rather than measuring what has been achieved. To realise any significant public health benefits from smartphone apps, they desperately need many more users, and deeper links to healthcare and sensitive personal information. The Apple-Google dream of Exposure Notification in a privacy vacuum simply doesn’t do enough to have an impact on the pandemic.

The main reason for poor uptake of these privacy-protecting apps has been a lack of public confidence in governments, such that people won’t give the state any opportunity to harvest their personal data. Neither has there been any incentive for the public to use an app. Indeed at one stage in England, those who were notified by the app to go into quarantine forfeited a one-off support payment of £500. That bug wasn’t addressed for more than two months, during the height of the second wave late last year.

Sadly, none of this has anything to do with Apple or Google, although I can’t help wondering whether anyone involved with Exposure Notifications would willingly do the same again. With the wisdom of hindsight, maybe we should all have guessed that what seemed such a good idea at the time would end up a can of festering worms.

It’s not that we haven’t made good use of modern technology to help us cope better with the pandemic. So many have been able to remain in the safety of their home thanks to online shopping, and the ability to work from home has ensured many have avoided risk by travelling to and being at their normal workplace. Children and other students have continued with their studies, and we’ve all been able to keep in touch with those we can no longer meet. Technology has enabled a great deal, but when it comes to public health it has cost a fortune and achieved precious little, despite a great deal of will and wishful thinking.

Afterword: Where next?

The second wave happened across the world, sparing few countries, even those whose populations were enjoying summer because they’re in the southern hemisphere, and many which had been held up as examples of what we should all have done in the first wave. One unavoidable reason for the second wave is because that’s how pandemics behave, it’s part of their dynamics.

The avoidable reasons all go back to the fact that, as infection rates rose during the late summer and early autumn, governments pressed ahead with plans to return schoolchildren, university students and employed populations back to ‘normal’ life regardless. When they did respond to rising infection rates, what was done was too little and much too late, despite open criticism from their expert advisors.

Currently, there are two tried and proven approaches to controlling Covid-19:

  • Strict restrictions on movement, enforced quarantine, and invasive loss of privacy – used with success in China, South Korea, and New Zealand, although none of those has yet been able to completely eliminate cases.
  • High vaccination coverage, which has been well proven in the past.

Sadly, we delude ourselves if we think that we can get away with ‘normal’ life without most of us being vaccinated. Trying that simply leads to further waves, mounting death tolls, then viral mutation and the start of a new cycle.

As far as I am aware, humans have not been able to vaccinate themselves out of any previous pandemic. This is because the higher the rate of infection, the higher the proportion of the population needs to be immune (not just vaccinated) in order to bring the infection rate under control. Vaccination is known to be most effective, and efficient, when the population has a low infection rate which is at least static if not falling. While vaccines remain in short supply, it’s therefore better to concentrate campaigns on populations with lower and falling rates of infection achieved by effective measures against spread within the population. It’s also vital that vaccines are delivered into arms and not put into stockpiles, where they do nothing to protect people’s lives and health.