How the NHS COVID-19 app will continue to be used

After the NHS COVID-19 app had prevented up to 600,000 cases, according to a study, Med-Tech Innovation News caught up with Wolfgang Emmerich, CEO of Zuhlke UK, which created and operates the app, to discuss what next, and how long the app might be needed for.   

You say the app will be in use for some time – can you put either a timescale on how long that will be, or indeed a scenario when it might no longer be needed?

It will not be needed once COVID-19 has been eradicated. All predictions, however, are that this is quite some way off. While the vaccination programme has really begun very well there are going to be limitations of what and how quickly it can be achieved. Firstly, no vaccine is 100% effective. Even though they might not get very ill there will continue to be people who will get infected and will be able to transmit the virus to others. Secondly, it has also become clear that the uptake of vaccination is not universally high and there will continue to be parts of the population who will need protecting. Finally, it will still take some time until herd immunity is achieved and certainly during that period the app has an important role to fill in order to contain infections.

Approximately 600,000 cases have been prevented by using this app – how did you come to this number?

It was not us who proposed this number. It was found by researchers from Oxford University and the Alan Turing Institute, who investigated the impact that the app has had. The approach is described in detail in the blog post by Mark Briers. They used two different methods. The first one modelled the impact using model parameters informed by data collected via the app. The second approach compared neighbouring postcode districts that have a similar demographic and socio-economic structure but different uptakes in the app and found that those post codes with higher uptakes had significantly lower infection levels. A statistical model was used to arrive at the above figure.

In terms of downloads – what do you think of the uptake with the public? Is 56% of the eligible population a good number?

In terms of uptake of world-wide contact tracing apps 56% is higher than most countries have achieved. This is the result of the app providing features other than pure contact tracing. What matters though is not the download number but the number of daily users, which stands at around 16.5 million and is still very high by international comparison. We aim to further increase the use because every 1% increase in usage reduces infection rates by 2.3%.

In terms of continuously updating it – have there been any challenges during the first few months of use?

The app is ground-breaking because it uses a digital approach to contact tracing that has never been used before the pandemic started. It uses very new technology built into Apple and Google’s smartphone operating systems and the need for continuous updates arrives as a consequence of this. It is not possible for Apple, Google and the NHS COVID-19 app team to get everything right from the start, to predict how the virus will mutate and how public health policy changes. By continuously releasing improvements we have now got the best contact tracing app in the world.

Can there be any further updates to it – e.g. advice and act as proof for people who need to claim allowance for self-isolating?

There will be further updates. We have a long roadmap of work that takes into account the changing nature of the situation. We will, however, not change the underlying principles of the app and privacy-by-design is one of them. As a result, we will not be able to use the app to provide evidence that people are self-isolating as that would require access to location and identity data, which the terms of the Apple and Google API license prevent us from using.

How do you envisage this app will be used as part of the wider strategy including testing for infections, antibody testing and vaccinations?

We very recently released Version 4.4, which supports the input lateral flow test results. Lateral flow tests are part of this wider strategy as they provide almost instant results. However, they are not as accurate as lab-based PCR tests and the app will now suggest booking a lab-based test after certain lateral flow test results have been input. We are also looking at changes to the app in response to the vaccination role out.

In what way is the App significant for the development of medical technology, and regarded in the future as a milestone?

The app is a Class-1 medical device and has received a CE mark following registration by the MHRA. To be able to register the app as a medical device required following a rigorous development process and to provide evidence that it has been tested thoroughly. Having apps as medical devices is a recent trend and the NHS COVID-19 app is probably one of the most widely used medical device apps worldwide.