The NHS Test and Trace app has two flaws: QR codes and people

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England and Wales’ contact tracing app is finally set to launch nationally tomorrow, and that has Michelle worried. She lives in Newham, one of two testing grounds for the second iteration of the controversial app, and visitors aren’t using the NHS Test and Trace app when they check-in to visit a charity where she volunteers.
“Our visitors are not representative of the locality,” she explains. “They tend to be more middle class… [and] pretty tech savvy.” And even then, only one in five use the QR code at the gate to sign in, leaving the community garden to also manage its own contact-tracing list for everyone else without the app.

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Conflicting QR codes are one of several problems raised by the contact tracing app, alongside residents having phones too old to use the app, language challenges in this diverse area, and distrust of the government. Such problems can be addressed, but there isn’t much time: the app is set to launch on September 24, even though the survey for the trial ends on 27 September, giving no time to consider the results.
“My fear is that this is going to be just another waste of a vast amount of public money which could have been avoided by getting the pilot results in first, tweaking the app if possible or abandoning it if it looks likely to have minimal take up,” Michelle says. “Let’s hope not.”
After all, that’s what happened to the UK’s first contact tracing app, a bespoke, centralised design that was abandoned in favour of a decentralised model using a system from Apple and Google. This second version has been trialled in the Isle of Wight as well as Newham.
Running the trial in Newham was a good choice. It’s one of the most diverse areas of the country, and has been hard hit by Covid, at one point recording the most deaths per capita in the country. “Because of long-standing features of health inequality, deprivation, and poverty, we were particularly exposed and vulnerable,” says Rokhsana Fiaz, the mayor of Newham. And that’s why she was keen to trial the app locally. “If it can work in a community with this profile, it can work anywhere.”

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The app uses Bluetooth to track who a user crosses paths with when out and about, sending a notification if someone they’ve been in close proximity to finds they’re infected with the coronavirus that causes Covid-19. Early reviews of the app suggest that’s working as well as Bluetooth can: the signal may be distorted by thick walls or suggest people in two different flats spent an evening together even though there was a wall between them. There are no stats currently available for how many alerts the contact tracing app has sent.
The concerns raised by Newham early adopters aren’t focused on the technology itself. Instead, it’s a people problem: some people can’t or won’t download and install the app, while others have been confused by the QR code system.
Alongside the Bluetooth contact tracing feature, the app has a QR code scanner for registering at venues such as pubs, restaurants and bars. However, plenty of businesses in the test areas haven’t registered with Test and Trace or printed the code specific to them. That means some Newham residents have been unable to find a QR code to test the app with, or end up scanning QR codes for unrelated contact-tracing efforts, such as those run by a pub chain or retailer. Wetherspoons, for example, didn’t take part in the trial by posting NHS Test & Trace QR codes in its Newham pubs, though it does have QR codes up for its company-wide version.
Newham residents told WIRED that they’ve barely seen any of the official NHS QR codes in shops or restaurants. Others say they’re confused as to whether a QR code on the door is the right one to scan or not, as existing contact-tracing systems also use the codes – just wait until these codes are ubiquitous and scammers start putting up false ones. And some residents reported that the QR code throws up an error message in the app or simply takes too long to scan, causing queues to enter a shop — hardly ideal in these times of social distancing. “Although the app looks good, if I can’t use the QR scanner, it defeats the object of the app’s purpose,” wrote one app reviewer on Google Play.

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The other challenge is downloading the app. Residents were sent out a detailed, four-page letter with instructions on how to install the app and use one-time codes to activate it for the trial, which residents said was off-putting – especially so for those who don’t speak English as a first language. The council has pushed for the app and online advice for it to be available in several languages, including Polish, Gujarati, Urdu and more, but as Fiaz notes, Newham has more than 100 languages and dialects spoken locally.
The residents who did head to the App Store or Google Play to download the app faced another hurdle: it only works on recent smartphones, running Android 6.0 or iOS 13.5 later; that’s iPhone 6S and newer. However, that risks leaving out people with older phones, in particular those without the money to buy a newer one. A story in the Newham Recorder quotes an 82-year-old resident of Manor Park as saying he couldn’t download the app because his smartphone was too old, with Age UK warning this could leave those most at risk of Covid being treated as “second-class citizens.”
That applies to younger residents too. The app was originally limited to those over the age of 18, which Jason Strelitz, head of public health at Newham, notes leaves out young people when there’s a lot of concern about how they can spread the virus. The Newham team pushed the developers to lower the minimum age from 18 to 16 with the aim of not only getting more younger people considering the risks of Covid but also letting them help their older family members with the app. “There’s a multi-generational component that young people could be engaging with their parents or their grandparents to use the technology if they were empowered to be part of that solution,” he says.
People power could be what helps make the contact tracing app work, across languages, economics, age and other challenges. When the trial started, Newham deployed a network of community helpers. “What really helped locally was we put quite a lot of time into mobilising a series of conversations with our community networks, faith leaders and local businesses to give them a demo,” Fiaz says. However, those are the ones that have chosen to work with the council. Matthew Porter of Christian church network Transform Newham, says he asks faith leaders if they’ve been using the app. “Inevitably, some are and some aren’t yet,” he said, adding they were “spread across a spectrum of enthusiasm.”
Tahir Talati of Muslim Engagement and Development (MEND) Newham says the mosques he works with all have the code put up at the door, but “rying to get worshippers to use it is a different problem.” The majority of attendees are over 60, he says, and convincing them to download an app and register for it is “not something they’d be used to,” he says, though they’re willing to sign up to contact tracing via a pen and paper. “That works better.” His own local mosque has been visited by the council for support spreading the word about the app and has volunteers at the door to explain the process, but prayer times tend to be hectic with many people arriving at once making it difficult to help more than one or two people each time.
There’s another challenge facing the app: trust in the government. Among people who can download and use the app, there’s a subset who won’t because of privacy concerns, partially sparked by debate around the first version’s centralised design, as well as wider government distrust. “There’s specific trust issues that are a hangover from the public discourse from the [first] Isle of Wight pilot, and that dovetails with generalised trust issues around the government’s response to Covid,” Strelitz says. “That creates a challenging environment for mass uptake.”
That’s not helped by the lack of transparency around this app. The Newham team still don’t know how many downloads the app has seen and haven’t seen any figures pertaining to its success. Despite complaining in the media weeks ago, neither has the mayor of London, Sadiq Khan. “From the early stages of the outbreak the Mayor has made clear that an effective test, trace and isolate system is vital to stopping the spread of Covid-19 and preventing a disastrous second lockdown,” a spokesperson for the Mayor of London said. “Unfortunately, despite repeated requests, the Government is still refusing to share data on the trial of its Test and Trace app in Newham.” The Department for Health and Social Care didn’t respond to requests for further information, so we simply don’t know how successful the pilot has been.
Even without such key data, Fiaz and Strelitz are positive about the trial, saying they welcomed the chance to add another tool to their arsenal in the fight against Covid, in particular in a borough so hard-hit by the disease. But they were adamant it’s just one tool; testing delays must be fixed, local in-person contact tracing efforts are still required, and the health impacts of deprivation acknowledged and addressed. “The app is not a silver bullet,” Fiaz says.
Fiaz adds that the development team took on feedback, such as the age and language concerns, and she has confidence they’ll continue to make positive changes after it’s rolled out nationally this week. But there’s plenty of useful information that the three-week pilot hasn’t yet supplied, which will come via the research survey that’s still ongoing.
Notably, that survey will look at why some people haven’t downloaded the app – information you’d think the government would want before it tries to get an entire country to install it. “My main concern… was the unbelievable timetable of launching the app nationally before the results of the pilot were returned,” adds Michelle. “I would have thought analysis of the responses was crucial before a national launch.”
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