‘We urgently need an app to fight coronavirus’: Oxford scientists say phone bluetooth can be used to trace infections from a patient and that ‘it would massively reduce transmission’

  • Oxford researchers say a contact tracing app should be launched very quickly
  • The sooner it’s released the sooner it can help to get people out of lockdown 
  • It comes as the NHS is rumoured to be working on its own COVID-19 tracing app 
  • Coronavirus symptoms: what are they and should you see a doctor?

A mobile coronavirus tracing app could help to significantly slow the rate of virus transmission if it is built and released quickly, scientists claim.

Researchers from Oxford University have been studying how COVID-19 is transmitted and whether mobile apps could help slow the spread.

In a report for NHSX and the Norwegian Institute of Public Health, the Oxford bioethicists say a rapidly built app could bring countries out of lockdown safely.

The UK government is working on a mobile app that is expected to use bluetooth to identify who coronavirus patients have been in contact with to then trace them. 

Oxford researchers haven’t built an app but say if they were to build one it would use the bluetooth technology being proposed by the NHS. 

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A number of coronavirus apps are already available for iPhone and Android including one produced with support from the NHS to track symptoms – not just for coronavirus but generally

Researchers say time is of the essence when it comes to getting the most out of a virus tracing app and it should be launched quickly. 

A bluetooth based app would be enough to meet the requirements of slowing the spread and it wouldn’t need to store or track specific locations. 

This technology is already being used by the Singapore government for their app.

The NHS app would require at least 50 per cent of the population to install it for it to work effectively as it relies on remembering who they have been in contact with.

The app would detect other phones in close vicinity using bluetooth signals then store a record of those contacts on the device.

If someone tests positive for COVID-19 they could share those contacts with the NHS and people could then be alerted to isolate. 

This approach is backed by the Oxford research team, who say their mathematical models support using low power wireless signals.   

The team focused on working out the way the virus spreads and used that to determine the best possible technology approach to slow the spread. 

‘It uses a low-energy version of Bluetooth to log a memory of all the app users with whom you have come into close proximity over the last few days,’ said co-author David Bonsall, speaking about the ideal tool for use in tracing the virus.

‘If you then become infected, these people are alerted instantly and anonymously, and advised to go home and self-isolate. 

‘If app users decide to share additional data, they could support health services to identify trends and target interventions to reach those most in need.’

There are some risks with a bluetooth app though, especially around the reliability of the short-range and low-power wireless technology.

Nicky Whiting, Head of Compliance at Bulletproof, said bluetooth is known to have vulnerabilities and this could be worse if it is launched quickly. 

‘There are concerns that developing an app like this quickly can result in poorly executed code that could potentially contain security vulnerabilities,’ he said.


The Ministry of Health in Singapore uses bluetooth data to monitor users’ location and see how far they are away from other people (left) and the NHS offers a symptom checker (right)

‘It’s been seen many times in the past when apps and software are rushed out that they are found to contain significant weaknesses.’ 

HOW WOULD THE APP WORK? 

The Oxford team have proposed a mobile app that would make use of a phones bluetooth signal.

It requires at least half the population to install the app and could help get people out of lockdown faster.

It keeps a note of other devices running the app that you’ve come into close contact with.

If you are diagnosed with the virus then everybody you’ve been near will be messaged advising them to isolate. 

Dr Bonsall, who is a researcher at Oxford’s Nuffield Department of Medicine and clinician at Oxford’s John Radcliffe Hospital, said the bluetooth technology would require considerable buy-in from the population.

‘Our findings confirm that not everybody has to use the mobile app for it to work,’ he said.

‘If with the help of the app the majority of individuals self-isolate on showing symptoms, and the majority of their contacts can be traced, we stand a chance of stopping the epidemic.’

Professor Christophe Fraser from Oxford University’s Big Data Institute said we need a mobile tracing app urgently and everyone has to use the official version.

‘Our analysis suggests that about half of transmissions occur in the early phase of the infection, before you show any symptoms of infection. 

‘Our mathematical models also highlight that traditional public health contact tracing approaches provide incomplete data and cannot keep up with the pace of this pandemic.’ 

Authors argue a mobile app can reduce transmission at any stage of the epidemic by giving more accurate data on who users have come into contact with.

They say it applies in countries or regions where the epidemic is just emerging, at the peak of the epidemic, or to support a safe transition out of lockdown.  

 This could help to alleviate some privacy concerns expressed by tech industry experts, who warn that data could easily be stolen or hacked.

It raises ‘a key conflict between the need for mass surveillance on the spread of the virus and the issue privacy’, says Mark Skilton from Warwick Business School.

‘Using devices on our mobile phone to monitor certain data and send messages to change people’s behaviour may sound Orwellian, but with this pandemic turning into a long game, we may need to use all the digital tools at our disposal.’

The Oxford team say done properly an app could also reduce the serious, psychological and economic impacts caused by widespread lockdowns. 

Critically, the researchers suggest a mobile app can help slow the spread of infection until vaccines and antiviral treatments become widely available.

HOW APPS ARE HELPING THE FIGHT AGAINST COVID-19 

Different countries are taking a range of approaches to using mobile data, location data and software to track or monitor COVID-19 cases.

Singapore has launched an app called TraceTogether than uses bluetooth to determine if the user has come into contact with someone infected by COVID-19. 

It works by exchanging short-distance signals between phones to detect others with the app. 

Then if you get the virus medical officers can check the app records to see everyone you’ve come into contact with and trace the spread.

Italy, China, Taiwan and Israel have introduced their own government-sanctioned tracking technologies to monitor possible lockdown breaches.

Some of these new measures link movement data directly to a smartphone user’s identity, while others seek to collect a anonymised set of data to observe general movement trends.

Taiwan is rolling out a mobile phone-based ‘electronic fence’ program that uses location-tracking to ensure people who are quarantined stay in their homes.

Taiwanese police will be alerted within 15 minutes if someone is caught outside quarantine, who can be fined up to T$1 million (£28,218).

Meanwhile, in China, a ‘Health Code’, obtained through popular online payment platform Alipay indicates whether they’re allowed to enter public spaces – and reportedly feeds data back to police, the New York Times reports. 

The Australian Government has launched an app to provide up-to-date information about the coronavirus pandemic.

The app, which launched on Sunday, has a symptom checker, advice on hygiene and social distancing. It also allows Australians to see exactly how many confirmed cases there are in each state.

‘A contact tracing app can foster good citizenship by alerting people at risk, it can also help ease us out of confinement If we know we’ve not been in contact with anyone infected we can leave home safely, whilst still protecting our loved ones and avoiding a broader resurgence of coronavirus in our community,’ said Fraser.

Given the level of infection across much of Europe, the team believe ongoing development of a mobile app partnership across the union would massively reduce transmission and avoid a resurgence in the number of cases.

They say it would provide an opportunity for all citizens using mobile contact tracing apps to contribute towards ending the epidemic. 

An app strategy could also be used by low- and middle-income countries, earlier in the epidemic, to rapidly control transmission and get ahead of the epidemic now.

The Oxford team highlight that the mobile contact tracing app should still be combined with isolation of cases, tracing and quarantine of contacts, physical distancing, scaled-up diagnostic testing, decontamination and hygiene measures.

‘If the mobile app is widely adopted in any country, and combined with other critical interventions such as physical distancing and widespread testing, our models suggest the epidemic could be brought under control,’ said Bonsall.

‘This app is a tool for each and every person affected to contribute towards protecting their health services, supporting vulnerable people and simultaneously gradually releasing communities out of extended quarantine.’

The team say it is vital that rigorous ethical standards underpin the development of any mobile app dealing with the coronavirus pandemic.

They say a number of ethical requirements need to be considered to enable public trust and confidence, including the security of their data.

Professor Michael Parker, Director of the Wellcome Centre for Ethics & Humanities, said it is possible to save lives and protect civil liberties with an app.

‘The app should be opt-in, provide secure data storage and privacy protection, and be informed by public and user engagement at every stage of implementation. 

‘With these guarantees and, if widely installed by users across a country or regional bloc, a mobile app could even help to end the epidemic.’

Countries around the world are planning or have already launched mobile apps designed to track, slow down or inform people about the epidemic.

Singapore has launched an app called TraceTogether than uses bluetooth to determine if the user has come into contact with someone infected by COVID-19.

Australia, Singapore and others have information apps available already and a group of volunteers are developing an open source app for the World Health Organisation

The WHO app will be a simple information tool at first but could also include tracking and tracing information that will be available to national governments in a future release

It works by exchanging short-distance signals between phones to detect others with the app.

Then if you get the virus medical officers can check the app records to see everyone you’ve come into contact with and trace the spread.

This is similar to the app being proposed by the Oxford team and to the software the NHS is rumoured to be developing. 

As mobile apps launch over the coming weeks and months, the Oxford research team urges people to support official apps, developed by trusted institutions, and their partners, such as the mobile contact tracing apps under advanced assessment in several European countries. 

Professor Fraser concludes, ‘Our hope is to support communities with life-saving information as the pandemic worsens and help to release countries from large-scale isolation. 

‘The maths is clear: the more people that use a contract tracing app the better chance we have of getting ahead of this epidemic and eventually stopping it in its tracks. 

‘If a country reduces the epidemic growth rate to below zero, the epidemic will rapidly decline and eventually stop. Together we can make this possible.’

Bonsall says to work, this approach needs to be integrated into a national programme, not taken on by independent app developers. 

‘If we can securely deploy this technology, the more people that opt-in, the faster the epidemic will stop, and the more lives can be saved,’ he said.

The findings have been published in the journal Science.

WHAT DO WE KNOW ABOUT THE CORONAVIRUS?

What is the coronavirus? 

A coronavirus is a type of virus which can cause illness in animals and people. Viruses break into cells inside their host and use them to reproduce itself and disrupt the body’s normal functions. Coronaviruses are named after the Latin word ‘corona’, which means crown, because they are encased by a spiked shell which resembles a royal crown.

The coronavirus from Wuhan is one which has never been seen before this outbreak. It has been named SARS-CoV-2 by the International Committee on Taxonomy of Viruses. The name stands for Severe Acute Respiratory Syndrome coronavirus 2.

Experts say the bug, which has killed around one in 50 patients since the outbreak began in December, is a ‘sister’ of the SARS illness which hit China in 2002, so has been named after it.

The disease that the virus causes has been named COVID-19, which stands for coronavirus disease 2019.

Dr Helena Maier, from the Pirbright Institute, said: ‘Coronaviruses are a family of viruses that infect a wide range of different species including humans, cattle, pigs, chickens, dogs, cats and wild animals. 

‘Until this new coronavirus was identified, there were only six different coronaviruses known to infect humans. Four of these cause a mild common cold-type illness, but since 2002 there has been the emergence of two new coronaviruses that can infect humans and result in more severe disease (Severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) coronaviruses). 

‘Coronaviruses are known to be able to occasionally jump from one species to another and that is what happened in the case of SARS, MERS and the new coronavirus. The animal origin of the new coronavirus is not yet known.’ 

The first human cases were publicly reported from the Chinese city of Wuhan, where approximately 11million people live, after medics first started publicly reporting infections on December 31.

By January 8, 59 suspected cases had been reported and seven people were in critical condition. Tests were developed for the new virus and recorded cases started to surge.

The first person died that week and, by January 16, two were dead and 41 cases were confirmed. The next day, scientists predicted that 1,700 people had become infected, possibly up to 7,000. 

Where does the virus come from?

According to scientists, the virus almost certainly came from bats. Coronaviruses in general tend to originate in animals – the similar SARS and MERS viruses are believed to have originated in civet cats and camels, respectively.

The first cases of COVID-19 came from people visiting or working in a live animal market in Wuhan, which has since been closed down for investigation.

Although the market is officially a seafood market, other dead and living animals were being sold there, including wolf cubs, salamanders, snakes, peacocks, porcupines and camel meat. 

A study by the Wuhan Institute of Virology, published in February 2020 in the scientific journal Nature, found that the genetic make-up virus samples found in patients in China is 96 per cent identical to a coronavirus they found in bats.

However, there were not many bats at the market so scientists say it was likely there was an animal which acted as a middle-man, contracting it from a bat before then transmitting it to a human. It has not yet been confirmed what type of animal this was.

Dr Michael Skinner, a virologist at Imperial College London, was not involved with the research but said: ‘The discovery definitely places the origin of nCoV in bats in China.

‘We still do not know whether another species served as an intermediate host to amplify the virus, and possibly even to bring it to the market, nor what species that host might have been.’  

So far the fatalities are quite low. Why are health experts so worried about it? 

Experts say the international community is concerned about the virus because so little is known about it and it appears to be spreading quickly.

It is similar to SARS, which infected 8,000 people and killed nearly 800 in an outbreak in Asia in 2003, in that it is a type of coronavirus which infects humans’ lungs. It is less deadly than SARS, however, which killed around one in 10 people, compared to approximately one in 50 for COVID-19.

Another reason for concern is that nobody has any immunity to the virus because they’ve never encountered it before. This means it may be able to cause more damage than viruses we come across often, like the flu or common cold.

Speaking at a briefing in January, Oxford University professor, Dr Peter Horby, said: ‘Novel viruses can spread much faster through the population than viruses which circulate all the time because we have no immunity to them.

‘Most seasonal flu viruses have a case fatality rate of less than one in 1,000 people. Here we’re talking about a virus where we don’t understand fully the severity spectrum but it’s possible the case fatality rate could be as high as two per cent.’

If the death rate is truly two per cent, that means two out of every 100 patients who get it will die. 

‘My feeling is it’s lower,’ Dr Horby added. ‘We’re probably missing this iceberg of milder cases. But that’s the current circumstance we’re in.

‘Two per cent case fatality rate is comparable to the Spanish Flu pandemic in 1918 so it is a significant concern globally.’

How does the virus spread?

The illness can spread between people just through coughs and sneezes, making it an extremely contagious infection. And it may also spread even before someone has symptoms.

It is believed to travel in the saliva and even through water in the eyes, therefore close contact, kissing, and sharing cutlery or utensils are all risky. It can also live on surfaces, such as plastic and steel, for up to 72 hours, meaning people can catch it by touching contaminated surfaces.

Originally, people were thought to be catching it from a live animal market in Wuhan city. But cases soon began to emerge in people who had never been there, which forced medics to realise it was spreading from person to person. 

What does the virus do to you? What are the symptoms?

Once someone has caught the COVID-19 virus it may take between two and 14 days, or even longer, for them to show any symptoms – but they may still be contagious during this time.

If and when they do become ill, typical signs include a runny nose, a cough, sore throat and a fever (high temperature). The vast majority of patients will recover from these without any issues, and many will need no medical help at all.

In a small group of patients, who seem mainly to be the elderly or those with long-term illnesses, it can lead to pneumonia. Pneumonia is an infection in which the insides of the lungs swell up and fill with fluid. It makes it increasingly difficult to breathe and, if left untreated, can be fatal and suffocate people.

Figures are showing that young children do not seem to be particularly badly affected by the virus, which they say is peculiar considering their susceptibility to flu, but it is not clear why. 

What have genetic tests revealed about the virus? 

Scientists in China have recorded the genetic sequences of around 19 strains of the virus and released them to experts working around the world. 

This allows others to study them, develop tests and potentially look into treating the illness they cause.   

Examinations have revealed the coronavirus did not change much – changing is known as mutating – much during the early stages of its spread.

However, the director-general of China’s Center for Disease Control and Prevention, Gao Fu, said the virus was mutating and adapting as it spread through people.

This means efforts to study the virus and to potentially control it may be made extra difficult because the virus might look different every time scientists analyse it.   

More study may be able to reveal whether the virus first infected a small number of people then change and spread from them, or whether there were various versions of the virus coming from animals which have developed separately.

How dangerous is the virus?  

The virus has a death rate of around two per cent. This is a similar death rate to the Spanish Flu outbreak which, in 1918, went on to kill around 50million people.

Experts have been conflicted since the beginning of the outbreak about whether the true number of people who are infected is significantly higher than the official numbers of recorded cases. Some people are expected to have such mild symptoms that they never even realise they are ill unless they’re tested, so only the more serious cases get discovered, making the death toll seem higher than it really is.

However, an investigation into government surveillance in China said it had found no reason to believe this was true.

Dr Bruce Aylward, a World Health Organization official who went on a mission to China, said there was no evidence that figures were only showing the tip of the iceberg, and said recording appeared to be accurate, Stat News reported.

Can the virus be cured? 

The COVID-19 virus cannot be cured and it is proving difficult to contain.

Antibiotics do not work against viruses, so they are out of the question. Antiviral drugs can work, but the process of understanding a virus then developing and producing drugs to treat it would take years and huge amounts of money.

No vaccine exists for the coronavirus yet and it’s not likely one will be developed in time to be of any use in this outbreak, for similar reasons to the above.

The National Institutes of Health in the US, and Baylor University in Waco, Texas, say they are working on a vaccine based on what they know about coronaviruses in general, using information from the SARS outbreak. But this may take a year or more to develop, according to Pharmaceutical Technology.

Currently, governments and health authorities are working to contain the virus and to care for patients who are sick and stop them infecting other people.

People who catch the illness are being quarantined in hospitals, where their symptoms can be treated and they will be away from the uninfected public.

And airports around the world are putting in place screening measures such as having doctors on-site, taking people’s temperatures to check for fevers and using thermal screening to spot those who might be ill (infection causes a raised temperature).

However, it can take weeks for symptoms to appear, so there is only a small likelihood that patients will be spotted up in an airport.

Is this outbreak an epidemic or a pandemic?   

The outbreak was declared a pandemic on March 11. A pandemic is defined by the World Health Organization as the ‘worldwide spread of a new disease’. 

Previously, the UN agency said most cases outside of Hubei had been ‘spillover’ from the epicentre, so the disease wasn’t actually spreading actively around the world.

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