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Overly critical remarks about the upcoming NHSX Covid-19 contact tracing app, could cost lives, warns expert

Jagvinder Singh Kang, a top specialist technology and data protection lawyer, plus the International Head of IT Law at pre-eminent law firm, Mills & Reeve, warns what he deems to be "unhelpful criticism of the upcoming NHSX Contact Tracing App by privacy advocates," could cost lives and plunge the UK into continuous lockdown.

With under a week to go until the Government’s launch of its contact tracing operation with over 25,000 contact tracers, Kang believes such manual contact tracing alone is unlikely to be sufficient to curb the virus. He strongly believes an automated solution is what is needed, hence the requirement for the NHSX app.

Kang provides a simple example to illustrate the deficiencies of a purely manual process. He draws on the scenario of trying to determine who may be infected by a carrier of the virus, who is travelling in a carriage on the London Tube. Not only is that carrier putting others at risk, but so is everyone that has been in close proximity to that carrier, including those who have entered and left the same carriage at various stops during the journey.

Furthermore, all of those individuals, will no doubt come into contact with, and potentially infect, others during that day, the coming days and weeks, until they self-quarantine, either following testing or the appearance of symptoms.

Kang remarks: “Once someone is that they are a carrier of the virus, think about how difficult and time consuming it would be, for that person to then work out: where they had been over the past week or so (when they were contagious); with whom they had had contact during that time (including strangers); and how long the contact has been (to seek to determine exposure risk), such as passing someone whilst exiting the Tube station, versus being seated close by to someone on the London tube."

Kang states: "In such circumstances, it's apparent there will be delays in identifying those who are infected. Such delays will risk the R-Number exceeding one, as infected individuals continue to unknowingly infect others. This in turn, is likely to trigger another potential exponential wave of the coronavirus, thus triggering another lockdown." The widespread resurgence of the virus following relaxing of social distancing in South Korea earlier this month, is a startling reminder of this prospect.

Kang stresses the situation is made more complex, as certain individuals may not be aware at the time that they are coming into contact with others, that they are carriers of the virus, either due to the symptoms not being fully evident, or because the individuals are asymptomatic. In either case, such individuals will still be contagious.

Now consider the above scenario, where all contact with known and unknown individuals, timings of occurrence and exposure periods, are automatically processed, and infection risk warnings issued, without individuals even having to think about it. Those are the benefits which the NHSX app provides.

The Government has already announced that the NHSX app is not going to be launched at the same time as the contact tracing operations next week. This is in part due to further work being required on the NHSX app, and in part to address public confidence in the upcoming NHSX app.

Kang urges the need for public recognition of the tremendous effort which the NHSX development team is undertaking in difficult circumstances. This includes extreme time constraints, the pressure of coming up with a life-saving solution, whilst all the time facing a barrage of negative public commentary. Kang reminds us: “One must not lose sight of the fact, that the development team consists of individuals who are not isolated from the personal effects that the virus is having on them and their loved ones." Furthermore, he highlights: “Overly critical or alarmist remarks about the NHSX app, are therefore, not constructive in helping the NHSX development team, who are spending their time on working to save the UK population and remove them from the restrictions of lockdown.” Consequently, he suggests that privacy advocates and the media should be more mindful of this.

Kang acknowledges that the NHSX app needs further work, including from a data protection alignment perspective. However, as Kang has already noted in his published paper, 'NHSX Covid-19 Tracing App-Nothing to Fear But Fear itself!’ (published on 22 May 2020 by the Society for Computers and Law), it is not the case that the NHSX app is being proposed to be launched where it is devoid of privacy, security and utility considerations. Kang is concerned that privacy advocates and the media seem to be overlooking this, which seems to be fuelling negativity in respect of the NHSX app.

Herein lies the problem according to Kang. He cautions against unnecessarily undermining the UK public's confidence in the NHSX app. Otherwise, this will lead to a low uptake of the NHSX app, which will not deliver the required efficacy for curbing the virus, thus costing further lives. This follows from reports which have suggested that an NHSX app uptake of at least 56% of the UK public is required, to help curb the virus (which translates into 80% of the UK public who have a smartphone).

Kang highlights: "Without a contact tracing app, contact tracing is resource and time intensive. This is already apparent from the need to have 25,000 contact tracers available next week. Such contract tracers will initially, use interviews to seek to determine who someone has been in contact with.”

Kang continues: “As is apparent from the example above, this gives rise to difficulties when people are no longer in lockdown, and individuals are in proximity with strangers, or moving around so that their timing exposure around other individuals is not easy to recall or verify.”

Kang reminds us, that if contact tracing purely through interviews could be effective in curbing the virus, one has to question why other countries have had to supplement their contact tracing operations with additional information, such as mobile location data and credit card transaction information. Of course, the NHSX app does not use any such privacy intrusive information. Kang notes: "The irony is that privacy advocates who are so against the NHSX app, are failing to realise that the potential risks of privacy intrusion are significantly greater through non-app contact tracing compared to app contact tracing.”

Kang concludes by highlighting that certain popular commercial apps, which for example, help someone find out where they left or lost their house keys, collect much more information than the NHSX app, including location data in some cases. Yet, millions of users are using them without giving such data use a second thought. Kang comments: “We as a nation, have to recognise that the NHSX app can be a ‘game changer’ for: mitigating against repeated lockdowns; curbing the spread of the virus; saving lives; as well as safeguarding our NHS Heroes.” He continues: “However, its efficacy is dependent upon a high uptake of the app. Consequently, it is important for the UK public to be aware that the NHSX, ICO and Government are collectively working together (with security, privacy and health objectives in mind), to help ensure that the NHSX app saves lives.”

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76% of Brits have altered their behaviour in light of the coronavirus outbreak.

Behavioural findings from Walnut Unlimited:-

• Nearly half (48%) have changed their personal hygiene habits and just under half (46%) have stopped shaking hands with people. Naturally people are more likely to have done the easy things though – compare these numbers to 17% who have stopped using transport and 14% who have worked from home more often.

• (Claimed) stockpiling is apparently lower than you might expect – 18% say they’ve stockpiled food and 16% say they’ve stockpiled toiletries, toilet roll or medicines.

• Over a third (39%) have avoided being in crowded places.

More general demographic findings:

• Younger people, especially 18-24 year olds, are more likely to say that they feel overwhelmed, significantly more so than all other age groups (34%)

• At the time of surveying, people are predominately worried about the potential impact which coronavirus might have on their physical health (31%), as opposed to other impacts such as household financial situation (26%) or work prospects (20%)

• As you might expect, younger people are more likely to be worried about the impact on their financial situation – 1 in 10 (11%) of 18-34 year olds are ‘extremely worried’ (vs. just 1% of 65+)

• Those who are working are significantly more likely to be worried about the impact on their financial situation than those who are retired (26% vs. 16%).

• Apart from those on ‘Up to 14k a year’ who are the most worried about the impact on their finances (37%), there’s not actually that much difference in how worried people are on other income levels.

• That said, a pretty hefty 75% of those who said that they currently feel negative about their household finances are worried about the impact that CV is going to have – 38% are extremely worried.

• Renters are significantly more worried than homeowners (36% of renters worried vs 20% who own their house outright, or 25% who own their house with a mortgage)

• The level of worry around the impact on current physical health really does not differ much by age group. 18-34: 31% worried, 18-44: 29% worried, 45-64: 33% worried, 65%+: 34% worried

• Concerns about coronavirus and the impact it will have on people’s mental health is more of an issue with younger age groups. A third of 18-24s and 25-34s (31% and 34% respectively) are worried about this, with 1 in 10 extremely worried. For older age groups its about 20% worried, e.g. 22% of 45-54s, 22% of 55-64s and just 9% of 65+

*Walnut Unlimited interviewed a nationally representative sample of 2011 GB adults aged 18+. Fieldwork was conducted between 13th -15th March 2020.

They work across retail and customer experience, technology, financial, FMCG, brand and communications. Information about Walnut Unlimited can be found here: www.walnutunlimited.com

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Type 2 Diabetics miss out on annual kidney test which can signal irreversible damage, survey reveals

The urine test, which identifies early markers of kidney damage, isn't routinely undertaken by GPs and nurses in annual reviews, sometimes because many patients are reluctant to provide a urine sample.

A new UK-wide survey, conducted by Napp Pharmaceuticals, suggests 54% of GPs and nurses who treat patients with type 2 diabetes don't perform a vital routine test annually, which is used to identify early markers of kidney damage.

The Urine Albumin-to-Creatinine Ratio (UACR) test is used to detect protein in the urine, signalling kidney damage which can lead to fatal complications.

According to survey respondents, the UACR test, recommended by UK guidelines for diabetes management isn't administered annually to all patients as it should be because many patients are unwilling to provide a urine sample (38%, most frequent reason given by healthcare professionals.

Chronic kidney disease, the progressive, irreversible destruction of the kidneys, has far reaching effects on the body, especially the heart.

Kidney function naturally declines with age, but this decline is accelerated in 1.9 million patients who also live with Type 2 Diabetes in the UK.

In these patients, any kidney damage results in a 23% increased likelihood of death over 10 years, compared to only 12% for Type 2 Diabetes  alone.

Early identification of kidney damage, as identified through theUACR test, can help provide a ‘window of opportunity’, where rate of damage can be slowed or halted with correct treatment and lifestyle changes.

Diagnosis, prevention and slowing the rate of decline in kidney disease is critical to the successful management of the known co-morbidities in Type 2 Diabetes.

It's also a vital factor in reducing the strain on services used to manage Type 2 Diabetes. Diabetes is estimated to cost the NHS £14 billion per year. Over 80% of those costs are the result of managing complications of the disease, including those associated with the kidney and the heart.

Routine kidney function testing is an important way of identifying those people who are at risk of disease progression.

Dr Kevin Fernando, GP with Specialist Interests in Diabetes & Medical Education, North Berwick Health Centre said: “The kidneys are often overlooked in favour of the heart in the treatment of Type 2 Diabetes.

"But if you protect the kidneys, you can help protect the heart. Any sign of accelerated kidney damage, no matter how early, multiplies the risk of death. By making a small change to clinical practice to routinely measure kidney function and motivate patients to provide samples, doctors and nurses have an opportunity to spot damage early and positively intervene in those patients who are identified as being at risk.”

According to the HCPs surveyed, the most frequent reason given for not conducting the UACR test is that patients are unwilling to provide a urine sample.

This may be because patients are unaware of the impact of kidney damage on their health, as the vast majority of patients do not ask about it in their annual diabetes review.

Awareness and action on kidney damage are a partnership between the healthcare professional and patients. Despite 79% of HCPs surveyed admitting that they knew the UACR test should be used as best practice, 75% underestimated the impact of kidney disease on cardiovascular mortality.

Once they were told of the level of risk, 85% responded that their colleagues would be more likely to conduct kidney function testing if they were aware of the true increase in risk of death.

A spokesperson from the National Kidney Federation said: “Effective diabetes management means more than just blood sugar control. So many patients and doctors are unaware that kidney damage is occurring and just how serious it can be for someone with diabetes.

"If patients knew the true impact of kidney disease, they may be more willing to provide a urine sample to help prevent further decline. We call on patients to learn about their health and for doctors and nurses to take the time to explain that by giving a urine sample we can identify any kidney disease, to monitor its progression and predict future health.”

Dr Aisling McMahon, Executive Director for Research, Innovation & Policy at Kidney Research UK said: “These survey results are sadly unsurprising, indeed they bear out findings from our own research among people with diabetes. Large numbers of people within this patient group are unaware they are at increased risk of developing kidney problems, and how life-limiting those kidney problems can become. Having a simple urine test can help diagnose kidney problems early, and treatment and adjustments to lifestyle can make an enormous difference.”

The survey, commissioned by Napp Pharmaceuticals, was conducted online via the physician network, SERMO during October and November 2019. Only UK Practice nurses and GPs who confirmed they were actively involved in the management of patients with T2D were able to participate.

Anyone who wants to know if they are likely to be at risk of developing kidney problems can take Kidney Research UK’s quick online health check: https://kidneyresearchuk.org/kidneyhealthcheck/

Image with permission from www.pixabay.com

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