The take-up of the government’s COVIDSafe app has been truly remarkable, with over two million downloads in the first two days of release. The Federal Government has an objective of 40 per cent of the Australian population becoming registered users.
Possible privacy and security concerns have been raised by others and I do not propose to deal with these. However, it seems many people are happy to bypass those issues and accept the government messages that “we’re all in this together” and “to do the right thing”. Fair enough, Australians are generally well–motivated. Or perhaps some are also motivated by the promise that COVIDSafe will facilitate a restoration of personal freedoms so missed during the lockdown.
But there has been little discussion on the actual effectiveness of the app in combatting the spread of Covid-19. Its main purpose is to trace and identify any persons with whom you have had close contact and who have tested positive to coronavirus. This holds true even if the exposure is during a period of incubation, as the data is stored for 21 days. You can be notified if an individual you met who was not Covid-19 positive at the time, subsequently becomes ill and tests positive a week later. You can then be tested to determine if the exposure resulted in transmission of the virus.
This, of course, is an important and worthwhile objective. But while it may well be a useful tool it is being grossly oversold. The model has some serious flaws, which if not clearly understood, will not only mislead the average Aussie but may cause defective containment strategies.
To understand the flaws, we need to be cognisant of the behaviour of this virus. Despite the World Health Organisation (WHO) infamously parroting assurances from the Chinese Communist Party in January that there was no evidence of human-human transmission, we know that the Wuhan coronavirus is highly contagious. Events where one infected person attends a dinner party with a dozen guests and, by the conclusion of the function, nearly all are infected have been recorded. The virus is readily transmitted in the atmosphere via microdroplets and from surfaces where it can survive from a few hours to several days depending on conditions. Surfaces to consider include door handles, shopping trolleys, handrails, elevator buttons, shop counters, and indeed anything which may be handled in the public domain.
It is because of such ease of transmission that strict social distancing of being at least 1.5m from other persons, hygiene by hand washing, use of sanitisers on hands and surfaces touched by others and possible use of medical facemasks and gloves are recommended.
It is precisely because Covid-19 is so contagious that the COVIDSafe app has major serious deficiencies.
The first serious flaw lies in how a close contact for reporting purposes is defined. The app on your phone will connect to another COVIDSafe user via Bluetooth. The definition of a close contact for notification purposes to state and territory health authorities is those “who have been within approximately 1.5 metres of the infected user for 15 minutes or more” as measured by the phone to phone connection via the app.
This means that potential contacts with an infected person for a period from one second to 14 minutes 59 seconds are outside the notification definition. This is a massive hole in the proverbial bucket through which many transmissions of the virus could flow.
The entire social distancing protocol is built around minimising viral transmission opportunities, even for brief periods.
So you could come into contact with an infected person briefly for a few minutes whilst shopping and this contact is not within the definition. Or you might sit next to an infected person on a bus for 10 minutes and this would also be outside the parameters of the app. Indeed, the vast majority of our encounters with others in public would fall outside the COVIDSafe definition. The COVIDSafe definition of close contact creates a much lower standard because of its arbitrary 15-minute time threshold.
The Government has provided no explanation as to why at-risk contacts under 15 minutes are excluded. Currently, Australia has been phenomenally successful in reducing the rate of new cases so the numbers involved should be manageable.
If your exposure to coronavirus is not from personal contact but arises from a contaminated surface, then the Covid-19 app offers nothing in terms of contact tracing. We do not have robust data on what percentage of cases is acquired via contaminated surfaces. Obviously, hygiene is critical but in terms of utility to identify and trace sources, this entire cohort, whatever its proportion, is unrecogined by COVIDSafe.
It is well known that the elderly are particularly vulnerable to the effects of coronavirus. According to the Federal Department of Health, the median age of those who have succumbed in Australia to the disease is 79.5 years. While there are some exceptions, generally this is also the demographic which struggles most with technologies. So, while it is early days it is reasonable to speculate that it is precisely the most vulnerable who might be the least likely to access and use COVIDSafe.
What does this all mean in practical terms? There seems little doubt that the Government has significantly oversold the effectiveness of the COVIDSafe app. Perhaps it has indulged in some deliberate hyperbole in order to push the take up. While it might be a useful adjunct tool, the serious deficiencies, particularly involving contacts of a shorter time than 15 minutes, must be reviewed.
The public should not be lulled into a false sense of security. You cannot rely on this app as an assurance that you have not been exposed to coronavirus in a form which causes transmission. If this were to occur, the name COVIDSafe would be an oxymoron with consequent harm.
Use COVIDSafe if you wish but be aware that in addition to the privacy security issues, it has major limitations from a health perspective too. It is certainly no panacea and no magic wand. This app should not be the principal driver of the strategy to relax lockdown restrictions.
Dr David Adler is a former Deputy Medical Secretary of the Australian Medical Association.
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