What’s really happening with the NHS Covid-19 app trial

The UK started piloting its contact-tracing app on the Isle of Wight on May 5. More than a month later, the app has all but disappeared from the public conversation about the government’s strategy to fight the coronavirus pandemic. And, as the wider contact tracing system whirrs into action, we still have no idea what happened in the pilot – and how it was supposed to shape the UK’s contact-tracing plan.
Health secretary Matt Hancock’s initial announcement that the app would be rolled out nationally on the first of June eventually did not materialise. On May 28, England inaugurated its contact-tracing system, powered by 25,000 call centre workers phoning and emailing the contacts of people who tested positive for Covid-19; the app was not part of the system. Asked when the app will be released, Hancock told The Daily Telegraph, “we’ll launch it when the time is right”. September seems now a realistic launch date.


The slump in emphasis on the app is conspicuous. Up until the Isle of Wight debut, the app, developed by the NHS’s innovation branch NHSx, had been lionised as a key tool to keep the virus at bay after the lockdown. The launch itself was also widely touted by the government, which announced that 60,000 people – out of a total population of 140,000 – had downloaded the app on the Isle of Wight. (In fact, that figure might have included people who had downloaded the app more than once, or those who managed to download it even if they were not on the island.) Those users would be able to report through the app whether they had developed symptoms, which would at once allow them to get tested for Covid-19, and automatically notify all the people they had crossed paths with for more than 15 minutes in the previous two weeks. If the test returned a positive result, human contact-tracers would follow up with each of the patient’s contacts on the phone.
Questions started emerging shortly after the launch, the most pressing of them being: was the app working? An analysis by The Times has extrapolated from the difference between the rise of cases on the Isle of Wight and those on the mainland that the app has managed to first detect and then squash the contagion – but there are too many variables involved to accept that case as convincing. The government itself hasn’t published any figure regarding the number of tests or people who have started to self-isolate thanks to the app. Simon Bryant, the director of Public Health for Hampshire and the Isle of Wight says he does not have specific data regarding tests made as a result of users reporting symptoms on the app.
Local news website On the Wight has been posing exactly those questions, which taken together amount to a wider question: what exactly is being tested on the Isle of Wight? The question was asked and somehow answered, in the House of Lords, on May 19. Jane Jones, a life peer for the Green Party, asked junior health minister James Bethell what “the aims and objectives of the trial” were. Local Green representative Vix Lowthian, Jones said, had flagged up that the population of the Isle of Wight was confused.
Bethell’s answer was light on detail: the point of the pilot was learning from it. But one of the things learnt, he said, was that “it is probably a mistake to launch an app before you have got the public used to the idea of tracing”. But such comments have done little to clear up what the trial trial is trying to achieve.


“When it comes to launching the test and tracing programme, we will begin with the tracing, not with the app”, which the government would do some weeks later, Bethell added. Bethell did not respond to multiple requests for comment. A spokesperson for NHSX said that the organisation was “hoping to publish an evaluation shortly with findings”.
The general sense is that the pilot’s purpose was mostly about gauging the app’s acceptance among the public, rather than its effectiveness at containing the virus. “We’ve never had an app like this before. [You want to understand:] how does this work in reality? Do people accept it, which phones could or could not download it?,” Bryant says. “How would you use something like this, If you don’t carry your phone around all the time?”
Even if initial reports positing that contact-tracing apps would only be effective at an adoption rate of 60 per cent have since been rectified, you still want more people rather than fewer to download the app. Short of making its download compulsory, that means people have to be willing to download it. “For the app to work, people are going to have to trust it,” says Martin McKee, professor of European public health at the London school of hygiene and tropical medicine, and a member of the Independent Sage, a group of scientists publishing advice about the coronavirus crisis.
If trust – quantified in downloads – is what has been measured in the Isle of Wight pilot, that would explain the absence of any release of figures from the government except for, indeed, the number of downloads. It would also explain the choice of a sparsely populated isle as the testing ground for an app whose usefulness would mostly shine through in the hustle-and-bustle of a metropolis.


“For me, the Isle of Wight was an odd selection, especially during lockdown because it’s a relatively closed community with lots of physical distancing between strangers,” says David Mccoy, professor of global public health at Queen Mary University. “The mobile app is useful for identifying contacts who are not known. Its value will be most useful for situations where a Covid case has been in close and prolonged contact with lots of strangers, such as in public transport.”
Why has the app’s wider launch been repeatedly postponed, though? The discovery of technical limitations has likely something to do with it. Even as the app tested on the Isle of Wight is about to undergo its first update, reports have emerged revealing worries within NHSX about Bluetooth’s ability to accurately calculate the distance between two users. The same report says the unit is considering backtracking on its decision to rely on a centralised approach that gives the NHS access to app data, over the decentralised system of alerts developed by smartphone makers Apple and Google, which underpins contact-tracing apps in countries including Italy, Switzerland, Latvia and Poland.
Even in other countries, contact-tracing apps have faced difficulties. The government of Iceland, where about 40 per cent of the population has downloaded the official contact-tracing app, has underlined that the app was far from a “game-changer”; in Singapore, concerns about data privacy and general distrust of the government led to a relatively low adoption rate: only about 25 per cent of the population. In Italy – which launched its contact-tracing app last week in four regions ahead of a national-rollout on June 15 – the app has swiftly been seized as a political football, with rightwing leader Matteo Salvini pledging never to download it.
Britain’s delay would be less significant had the government – and especially Hancock, who launched his own Matt Hancock app in 2018 – not touted the app so loudly, before letting it languish in development limbo. Apps were never going to be anything more than a component of the wider contact-tracing effort. “It’s just another tool in our armoury,” Bryant, the public health director, says.
England’s contact-tracing system itself has been repeatedly criticised from the get-go, when contact-tracers working for call-centre companies complained of non-existent training and lack of guidance. On the Isle of Wight – where the contact-tracing service was launched simultaneously with the app – local reporters and politicians, including the Green Party’s Lowthian, have expressed confusion about the fact that contact-tracers are based on the mainland and have no familiarity with the island’s topography.
The Independent Sage also advocates for a more localised approach – on the Isle of Wight and in the whole of the UK. “This should never have been done through call centres. It never made any sense to do it like that,” McKee says. “Testing and tracing needs to be rooted very much in the local setting, there should be local ownership over it.”
“Ultimately, it’s going to be done best if it’s done by people who know the local area and the population. And that’s not happening.”
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