By Bernadette Ballantyne
Wuhan, China – a city of 11 million people and a commercial, manufacturing and transportation hub, sitting at the confluence of two of Asia’s longest rivers, the Yangtze and the Han.
It is winter of 2019, temperatures are dropping and local hospitals record a rise in cases of pneumonia, which itself is not unusual. All over the world, seasonal flu often leads to lung infections. But this is something different…
In the first week of January, China reports 44 of these cases of pneumonia – origin unknown – to the World Health Organisation (WHO). The first thought by many doctors treating patients in Wuhan is that SARS has returned, though just one week into 2020 they identify that SARS is not the cause. Like SARS it is a coronavirus, but it is a new a coronavirus, one that has never been seen before, it is called COVID 19.
By the 12th January, before any cases of the virus have been reported overseas, China publishes the unique genetic viral code that tells the world exactly what the structure of this virus is.
And scientists in South Korea start doing something remarkable.
WHO executive director Dr Michael Ryan: “There is a moment at which you have to step forward and go after the virus. In order to do that – and we’ve seen examples in places like Singapore and Korea where governments haven’t had to shut everything down, they’ve been able to make tactical decisions regarding schools, tactical decisions regarding movements and been able to move forward without some of the draconian measures.”
South Korea’s Plan of Action
South Korea had experience to fall back on. In 2015 it was hit by Middle East Respiratory Syndrome and recorded the largest number of cases outside the Middle East. With 186 people contracting the virus and 36 deaths, the government was determined to learn lessons from this.
Five years on and with a new threat emerging South Korea acted fast, symptom screening at airports for anyone travelling from Wuhan in China. At this point COVID 19 hadn’t even been identified but the high number of pneumonia patients reported to the WHO caused South Korea to take immediate action and it began checking incoming travellers for symptoms such as high temperatures.
At the same time South Korea was developing diagnostic testing kits before there was even a single suspected case of COVID 19 reported in the country.
Eventually the event that South Korea had been carefully planning for occurred – on January 20th, the virus arrived in South Korea. A woman in her 30s arrived at Incheon International Airport from Wuhan in China with a high temperature, which turned out to be a symptom of COVID 19.
This passenger was immediately quarantined in a designated isolation hospital. For the next 14 days, 44 individuals that she had come into contact with were monitored, and the local health services were ready to test them for COVID 19 should any symptoms appear.
Virus Surges and Apps Emerge
It was only a day later that the second case arrived, also from Wuhan, this time it was detected at Gimpo Airport via thermal scanners. Again, for the next 14 days individuals that had come into contact with the passenger were monitored. Anyone testing positive would immediately be quarantined and their contacts traced.
As the number of cases grew so did the data on who was affected, where they had been, and where they were quarantined. The government pledged to be transparent and immediately began posting data on the number of people affected, where they were located and their travel history including sending text messages to people in areas of high risk.
The Ministry of Interior and Safety then developed the “self-quarantine safety protection app” which enabled people in quarantine to be in contact with their caseworkers as well as tracking their location with GPS to make sure that they were remaining in isolation. This empowered the people of South Korea to take evasive action in the form of new contact tracing apps, which became a reality by mid February. Corona 100m alerted anyone who came within 100 metres of an infected person and it was downloaded one million times in the first ten days of its launch on 11th February. Corona Map and Coronaita shortly followed with user friendly interfaces giving yet more ways for people to avoid contagion.
The combination of a stringent response to both detection and tracking was in full motion by the end of February. At this point in time 85,693 people throughout South Korea had been tested via the network of local hospitals and clinics. However, despite these measures, the numbers of cases continued to increase.
South Korea Reaches its Peak
Though fatality rates remained low, on the 29th of February 909 people tested positive for COVID 19 which was the most in a single day. This brought cases to 2,931. The measures that South Korea introduced helped to reduce the spread of the virus, but it by no means stopped it. And as many other countries were about to discover, it was going to get a lot worse.
But for South Korea the 29th February became a turning point and by the end of March this peak of 909 new infections had fallen to around 100 new cases per day. By the end of March over 410,000 people had been tested in South Korea and just under 9,800 were positive. 162 people had died – a fatality rate of 1.7%.
Like China, South Korea was now past the worst of the virus. Sadly this was not yet true for the rest of the world where the number of cases of COVID 19 began to explode. The WHO’s instructions were simple: test, test, test. Some, like Germany, did immediately. Others did not.
The UK was slow to start testing, In March 2020, only people with symptoms that were severe enough to be hospitalised were tested for COVID 19, thus resulting in fatality rates being increasingly higher than countries like Germany who made testing an immediate priority.
At the end of March 2020 in the UK, 25,150 people had tested positive for COVID 19 and 1789 had died – a fatality rate of over 7 percent. As the virus continued to spread undetected and models predicted that the NHS would be totally overwhelmed, the government issued a total lockdown for the UK. Still testing was limited.
Two months later, the UK was finally able to test anyone with symptoms and there were different methods introduced for being tested for the virus. These included drive-through regional testing sites and the issuing of home testing kits.
Still the death toll rose. As of 27th May, the number of deaths increased rapidly to 37,460 – giving it the 2nd highest death toll in the world behind the US.
The Data Dilemma
Without adequate testing the UK couldn’t provide developers with data to create apps similar to Corona 100m, Corona Map and Coronaita, but would these have helped during the early stages of the viral spread? Infectious disease specialists and bioethics experts at Oxford University say that it would have.
Research from Oxford University found that a mobile app for instant contact tracing could dramatically lower onward transmission. Using a simple algorithm and geolocation data from the phone, to automatically alert people that had been in contact with someone who tested positive, could enable people to take evasive action and stop the spread.
For the UK, there were two main barriers to launching a track and trace app. First, we would have had to have tested people much earlier and more extensively, but secondly there was an issue that is extremely complex and convoluted – data protection.
According to Ben Travers, head of intellectual property and IT at Stephens Scown, to produce an app of this nature, the developer of the app would have to pinpoint a valid reason under Article 9 of the GDPR to process the data.
Ben says that apps similar to the ones used in South Korea being introduced here “could require a more advanced consent mechanism than you might traditionally see. A tricky part of all of this will be understanding the data flows behind the app, including any third parties who will provide infrastructure and have access to data. Understanding these data flows and communicating to the end user may not be easy.”
The COVID Symptom Tracker App
Yet some developers did start working on mobile apps. The COVID Symptom Tracker app, developed by a team from Kings College London and developer Zoe was the first opt in health monitoring app in the UK to be launched to track COVID 19. The team shared it on 24th of March and 1.8 million people reported their symptoms in the 7 days that followed.
In the space of 36 hours, a hackathon ensued. Julien hastily pulled together anyone within Zoe with any kind of technically related expertise that could help. After forming a team, they worked on coding, hosting and talking to medical experts at King’s College. It was intense, and it was an experience that left them starved of rest, but by Friday 20th March at approximately midnight they had cracked it. A version of the app was then submitted to both the Google Play Store and the Apple Store, which was then accepted on the following Monday (23rd March).
“I had literally no idea what was happening in the world!” says Julien. “I didn’t watch any news…nothing. All of us were working 18 hours a day on various improvements, it’s really, really unique in many ways to go from an idea on Thursday, to Wednesday next week, you’ve got more than 1 million people using a piece of software.”
Just a few days after its launch 1 million people had voluntarily reported their symptoms. It was becoming increasingly clear that tracking symptoms of COVID 19 could generate useful data, especially as by this point the UK was still only testing people with symptoms severe enough to be admitted into hospital.
Data Is Vital
Zoe, uses a cloud-based system, which Julien says is essential from a storage and security perspective.“You delegate that to a company, such as Google or Amazon who are very, very good at managing your servers and keeping them up to date and making sure there’s not a big security hole” he says. “Whereas if you had your own servers, suddenly you would be responsible for all of that and that’s make it a lot harder…”
Julien also emphasises that the app is giving data that can offer up new correlations of the virus that the scientists could research and that it is this that makes it really useful.
“What matters is, does the researcher have useful data and can make interesting discoveries? So they have not published a lot yet. But I understand that there is actually a lot going on and a lot that is being discovered. So I’m really, really looking forward to what they do…’
Five months on from the first case of COVID 19 being reported in the UK and nearly 40,000 deaths later, there is sadly still a long way to go until this pandemic passes. However, experiences from all over the world are showing that from biomedical engineering to mobile apps, technology can play a vital role in helping us better manage this type of crisis in the future.
