Contact tracing apps: a brief overview

A recent query forced me to update my understanding of contact tracing apps as used (or not!) during the current pandemic. I found resources such as these from The Register and the BCS helpful in gaining a rapid understanding. More recently, Claudia Pagliari has reviewed the ethics of contract tracing apps. Here's my brief summary:

Different countries have adopted different approaches to contact tracing. In some, GPS location tracking is used to establish when people were collocated. In others, QR code solutions, that record when people check in and out of buildings, can identify who was in the same building at the same time, but not whether they were ever in close physical proximity. Both these approaches may compromise people’s privacy as they depend on centrally storing data that identifies the phone, location, and time. Their technical effectiveness relies on the precision and accuracy of the data and the reliability of the matching algorithm that identifies collocated people.

A third approach, facilitated by Apple and Google, is decentralised. Put simply, this relies on Bluetooth connections between devices: devices exchange IDs (and potentially distance, inferred from signal strength). If the owner of one of the devices subsequently reports a positive test result then notification is sent to all phones for which the IDs have been stored within the past 14 days. This avoids recording location and is better for respecting individuals’ privacy; it also limits the utility of data for other purposes such as public health research.

The practical effectiveness of any solution depends on how many people adopt it (60% of the population is a widely used figure) and on people being collocated with their phones; some countries achieve this through regulatory means (e.g., by controlling people’s right to travel); others rely on “public spiritedness”.

All approaches rely on the accuracy and timeliness of reporting test results, and on the quality of app programming. Another potential limitation of contact tracing apps is that while different regions adopt different solutions, each only applies locally, and may be undermined by international travel.

In summary, there are many obstacles to implementing an effective contact tracing app that respects individual rights as enshrined in the laws of many countries. A well designed and deployed app may reduce infection rates but no app will eliminate Covid-19 without other, complementary, interventions.

Extraordinary experiences (April)

Another month of lockdown, and a few new experiences (see previous posts), of which the most challenging was my mother being hospitalised. Her presenting symptoms were very low blood pressure (postural hypotension) which was resulting in falls, plus fluctuating temperature. Neither paramedics nor her GP thought it was Covid, but when she got to hospital she tested positive, so was transferred to a Covid ward. We had been unable to visit her for several weeks, but had been able to see her over FaceTime, and had created a youtube playlist for her carers to share with her so that she could see our faces and hear our voices at other times too.

Losing even that level of contact with her was hard. What was even harder was the sense that, as her attorneys for health and welfare, we would have to make decisions about what interventions she would receive if her health declined further. We braced ourselves for the worst while hoping for the best (though everything on the news leads one to expect the worst). Being unable to visit, we were entirely reliant on reports from the nurse responsible for her care at any given moment. Fortunately, we didn't have to make any hard decisions because her health gradually improved and she was discharged after 9 days.

Each day, I called at what I thought would be a convenient time for them. Occasionally, the designated nurse was available to talk; more often, I had to try multiple times (6 or 7 on some days) between work meetings to catch them: I don't know how many patients each nurse was responsible for, but obviously they were doing full barrier nursing, with all that means in terms of changing PPE after seeing every patient. After the first 2-3 days I gave up asking for medical details such as temperature or blood pressure or what medications she was on because it took so long for the nurse to access the notes (either paper or on the electronic record) that the costs to them of doing so outweighed the benefits to me of having a full picture of her progress. So I just heard the things that they could easily remember: whether she was up or in bed, how well she was eating, whether she was singing. I think when Mum stops singing, that will really be the time to worry!

I'm very grateful to the different care teams (and support staff) looking after Mum in both hospital and the care home, but the Covid situation brings into sharp relief  how essential those people are to mediate between family and people like Mum, who can't use any technology for communication themselves. That creates a really narrow channel of communication.

In other news: the bluebells have been beautiful this year, and I think we've now explored every possible track within a couple of miles of home. According to my health app, my average step count in April is the highest since recording began - presumably because I'm making a specific effort to get out for my one precious walk a day (and can't do things like climbing which don't contribute to the step count).

I'm learning a lot about the human body through the process of doing two sessions a week on it (remotely) with the grandsons. We're particularly enjoying Operation Ouch and Kahoot! quizzes. I have also learned to be a barber, but won't be taking it up as a profession.

Work continues, and continues to be demanding. Students, research team and colleagues mostly seem to be adapting well to the changed demands and circumstances. The latest non-work activity is making reusable face masks for all the family. The first one was made from scraps of fabric that we had lying around, and looks more like a bikini top made by someone with a poor awareness of the normal female form, but if it helps reduce spread, who cares? I've just made ones featuring Pikachus for the boys and am tempted to make one of those for myself...

Extraordinary times (week 3)

I suspect that this might be my last blog post on the lockdown, unless (or until) something catastrophic happens to family, friends or myself. Things feel as if they are settling into a new routine. [Postscript: a post about April mostly features my Mum being in hospital.]

We are keeping in touch with family and friends a little-and-often: quantity compensating to some extent for lower quality (I really, really miss hugs). I particularly miss outings with my mum (who has dementia): it's hard to keep an online conversation going for long with someone who has little memory and is persistently singing "Yankee Doodle" or "London Bridge" at the other end, whereas it was relatively easy to chatter about things in the environment on an outing.

As I noted last week, online Pilates works pretty well. Zumba is more challenging, but also more fun: who says you can't dance badly in your own living room? I haven't found an adequate online or home-based substitute for climbing. We're lucky that there are lots of footpaths and lanes near our home; we're exploring places we've never discovered before within a mile of home. The spring flowers are looking lovely, and bluebells will be out soon.

With no more university teaching for a while, it's been more meetings than classes. An online PhD viva worked surprisingly well, though I think it was more stressful for everyone than a normal face-to-face one (and that's stressful enough!). I'm learning to schedule gaps between meetings, and also a lunch-break, because these now have to be scheduled. Face-to-face, comfort breaks can be negotiated informally in-the-moment, but that's much harder to do online. Basically, working from home is more intense, particularly when it's back-to-back meetings. And particularly when those meetings involve rethinking all the plans we had for the next several months (no face-to-face interviews, no observational research...).

It still seems very surreal, knowing that the current situation is really challenging and distressing for many while it's actually just a bit weird for us. But it seems like a "new normal", at least for a while.

Extraordinary times (week 2)

I already noted key experiences from the first week of enforced working from home. At that time, we could still go out. This week, it has been lockdown, with just one walk a day and essential trips (mostly food shopping). The weather has been bright (if a little chilly) all week so it has felt surreal: everything feels fine, almost like a staycation, and yet things are so much more difficult for many other people:

• the healthcare professionals (including paramedics, porters, cleaning staff, teachers of key workers' children...) who are keeping the healthcare system functioning and putting themselves at risk for all of us.
• the people delivering essential services (including food, refuse collection, internet and more) so that it can feel like a working staycation for those of us working from home.
• people who find themselves in isolation or separated from loved ones or stuck in the wrong country as borders closed.
• people whose income has dried up, whose businesses are threatened, who aren't sure how they will pay the bills.
• parents now managing home schooling on top of everything else, and/or people supporting eldery relatives who are living independently.
• and of course people who are having to deal with the worst of Covid-19, experiencing the loss of family or friends or feeling like they have been "hit by a train" (can't remember who described it like that) themselves.

So it seems like the best way to apply my skills is to maintain "business as usual" for the students and colleagues I work with. And to stay at home to do that. In many ways it has been a mundane week.

Monday's teaching was challenging. The topic was "global healthcare" – I could not have anticipated quite how we would be viewing this topic when I planned it six months ago. I could record the lecture ahead of time, but I really wanted the students, particularly those who had experience of other healthcare systems, to share their insights. But with over 30 students joining remotely, some with very dodgy internet connections, it was impossible to involve them all, even though I'd included a "google slides" document for people to contribute key points. It all got particularly stressful when my own connection got flaky and kept dropping the audio channel. About three weeks ago, I lost my voice (laryngitis) in class, and now my internet connection was delivering virtual laryngitis. And I still haven't worked out how to make group discussions work well with 30+ participants spread around the world.

We did our first sessions of remote yoga and Pilates at home.  All furniture pushed to one side.It worked amazingly well, probably helped by the fact that we knew the teachers and most of the moves pretty well already.

On Tuesday, I had my first remote teaching session with the grandsons. The older one was keen to learn; the younger was just tired. Kahoot! quizzes were great, though I've found that creating ones tailored to the children are better than using other people's quizzes. When I invited them to do and show me a drawing it was challenging to see it, particularly since they weren't sure where the camera was at their end. But we can learn and get better. This week, the themes will be rainbows, light and eyes.

On Wednesday, I chatted with my mum over facetime. She was out in the garden, enjoying the sunshine, and seemed happy. But the sun shining on the screen meant that she couldn't really see me, so it was more like a phone call than video. I remain relieved that she is in good hands.

On Thursday, I was teaching a smaller group who all seemed to have reasonable internet connections. We shared photos and sketches of multimodal interactions in our homes, from ovens and toasters to toothpaste tubes (since we couldn't access a surgical simulator, which was the original plan), and it worked really well. I'm still not sure what the surgical equivalent of toothpaste is, but I'm sure there must be one.

That evening was the first online Zumba class. This didn't work as well as the Pilates because the Zumba experience depends more on the sense of other people around one, and also requires more space, but it was still lovely to dance like no-one's watching. Which they weren't (since I had to turn the video off to maintain the internet connection).

So it seems that people who are afflicted by Covid19 are reliant on the health service while those of us who are fortunately well so far are reliant on our internet service providers. Plus food and loo rolls. Thank you to all!

There's a short update about week 3. Things are becoming normalised until there's a major change...

Extraordinary times

Two weeks ago (Monday 9th March), I stood at the front of a class and said "In the unlikely event that UCL closes before the end of term..." and within a week all face-to-face teaching had been cancelled. Such is the experience of exponential change. I know I'm not alone in realising that views I held a matter of days ago were untenable. I am guessing that this process of revising beliefs and attitudes isn't over yet.

The last day I was in the office was just two days after that wildly incorrect assessment. I'd planned to work at home the end of that week anyway. Since I work at home quite often I was already set up for most things, but there were a few items I hadn't brought home. The most critical turned out to be my interoperable collection of "so 1990s" Filofaxes. I ordered one. I've lost continuity in my note taking, but by asking all my team to remind me what we'd agreed in our previous meetings I'm catching up quickly. Home delivery worked brilliantly too.

Improvised desks are sprouting up in our house, such as a standing desk made up of an old bookshelf with a small "laptop desk" which is located right next to the wifi router for use during the more critical online meetings.

I had to do a rapid rethink on all my teaching: lectures got recorded ahead of time so that I wasn't totally reliant on our home broadband at the critical time (that worked easily once I'd mastered the uploading software for the virtual learning environment). Class quizzes worked well remotely. Class discussion with over 30 students was challenging. When I had a smaller class a few days later, I mercilessly brought each student into the discussion, keeping a list of who had contributed and who hadn't yet. Not as good as face-to-face, but not bad either.

This coming week, I'd have liked to do a discussion exercise with digital postits in class. I considered several alternative tools for this; some required too much set-up for a single session; some work better asynchronously than in real time; I've ended up just sharing an online document that all students can contribute to, and we'll see whether we can build a discussion around that. It's all a bit of an adventure.

Many of our MSc students are having to rethink their projects for this summer because we have to assume they won't be able to travel or to do any collocated data collection. That's yet another challenge. But at least we can all access library resources from our homes because of all the work that has been done to make them remotely accessible.

I seem to be spending most working hours in online meetings. Many of these work as well as traditional meetings. More importantly, we're using the same videoconferencing technologies for social events: for sitting around in the evenings with friends and family – not just one-to-one like phone calls, but collecting in groups, socially close while physically distant.

None of this would have been possible, even a few years ago. Even if the foundations of the Internet were established in the 1960s and the early World Wide Web around 1990, the tools that we're now using on top of these structures have all been developed within the past few years. And they are getting easier to use and to fit into our lives very rapidly.

If SARS-COV2 had emerged three years ago, I don't know how we would have dealt with ageing parents who believed that they could live independently but actually needed a lot of support (to which they were unrelentingly hostile). Since then, my father has died and my mother is now in a care home, living with advanced dementia. I wouldn't want to visit (even if permitted) for fear of passing on COVID-19 to the wonderful residents or staff. So last week we tried using FaceTime to chat (with support from Jo the manager). I wasn't hopeful that Mum would engage at all, but she seemed to recognise me (at least as a close female relative, if not necessarily as her daughter). We had a good few minutes' surreal chat interspersed with Mum singing then, as I made to say goodbye, she leant forward and kissed the phone. It was strange, and yet poignantly lovely to have this kind of connection when we can't be together. Even if both the phone and Mum's lips then needed a clean!

On Friday, we had a take-away. It seems important to support our local restaurants as they are forced to close and take-aways are the only option. I wonder whether it will continue to be a safe option at all in the coming weeks.

Schools closed on Friday (20th March), which is going to add to the stresses of our children continuing to work while also home schooling. Family have been recruited as remote teachers. Granny will be doing reading and writing; Grandad is starting with some "horrible history"; Auntie will be teaching French; and I'm concocting some science lessons. If we thought remote teaching of students was challenging, remote teaching of small boys ia likely to be substantially more so, but at least it will mean regular contact, and we'll all learn something new in the process.

There are also lots of online classes sprouting up: I'm looking forward to yoga and zumba this week even if they will require us to reorganise furniture even more (in addition to the improvised desks) to make space to move.

We know we are really lucky: we can work fairly effectively from home and we have a garden for fresh air. Mum is safe and well looked after; the rest of the family are all well so far, even if the youngsters are restless. We are aware that many other people have much greater challenges and stresses and grief to deal with. I am truly grateful to all key workers: in healthcare and in keeping essential services (including food, medication and internet provision!) available.

Footnote: Week 2 was still a period of adjustment...

"When I get older..."

The topic of "healthy ageing" is seen a very important. For example, in the UK, there is a challenge of "5 extra healthy years by 2035". It's not clear how that will be measured, or indeed whether it means 5 extra years of life (that will be healthy ones) or targeting improved health within the current lifespan.

At UCL, we had a panel discussion on this theme at the 2019 annual symposium, and the House of Lords Science & Technology Committee is currently conducting an Inquiry into Ageing: Science, Technology and Healthy Living. I had the interesting experience of appearing before this committee last week. The discussion was wide-ranging, but inevitably didn't cover all the themes that are important: it's a huge topic!

Here are a few themes we didn't talk about that I think are important in this discourse:

• Expectations of ageing. There isn't a single experience of ageing. Yes, there can be challenges, such as cognitive impairments (e.g., dementia) and managing multiple morbidities, but this isn't a universal experience. For example, Angela Soper and Ivor McCourt are both climbing at a high standard in their 70s, and many people have great fun as they age, whether it involves demanding physical activity or not.
• Wisdom has a value that complements the qualities of younger generations, and most people have valuable things to contribute to society, provided that structures are in place to empower people to contribute in whatever ways they can.
• There isn't a single date on which we become "old", and good design should be accessible to most people regardless of their age. Indeed, people are likely to find a technology useful in older age if (a) it doesn't carry a stigmatising label of being "for older people", and (b) it is something that they have found useful for some time (and are familiar with).
• Theories such as Self Determination Theory highlight the importance of experiences such as autonomy, competence and relatedness in contributing to quality of life. Autonomy and competence can be promoted or diminished through technology design and the infrastructure that surrounds it. For example, local government services that can only be accessed digitally without providing support for people with limited digital skills are disempowering. Conversely, technology that is easy to use and that gives people access to services they might not be able to access otherwise is empowering.
• Loneliness is one of the most important factors in poor quality of life and cognitive decline in older age. This is predicted to be a growing problem in the UK, and loneliness is associated with mild cognitive impairment (MCI) and dementia. Poorly designed technology and infrastructure contribute to loneliness, but there are some great opportunities to design technologies that bring people together and increase people's sense of connectedness.

Designing for people of all generations is just that: designing for people, recognising that everyone has their abilities and their needs. There's a quotation that goes something like: "Growing old isn’t so bad when you consider the alternative." For some people (e.g., in pain or managing dementia), this might not be true, but hopefully appropriate technologies can help to make later stages of life a positive experience for many people. So can cliffs and swings and other "low tech" stuff!

Image by Claudia Peters from Pixabay

Schrodinger's striking academic

Once again, academics find ourselves in dispute with our employers. And yet again, many of us feel very conflicted about this. I am currently making sense of the alternative "possible worlds" in which I live by thinking of myself as Schrodinger's striking academic.

As long as no-one looks too closely, I am striking and not-striking simultaneously.

It depends on when you look as to whether I am striking or not striking.

Unlike the cat, the transition can go both ways.

I am striking because universities need to manage workloads, promote equality, minimise precarity. We are not cogs in a machine to be worked ever harder: we’re at breaking point.

I am not striking because students aren’t items on a production line. I care about their progress.

I am striking because pay and pensions need to keep up to attract the next generation into a demanding career.

I am not striking because my day-to-day work is not visible to my managers. This may be “industrial action”, but academic inputs and outputs are not tightly coupled.

I am striking because it seems that this is the only way to encourage management to listen.

I am not striking because, based on my employer’s standard working week, I had worked my hours for 2019 by 5^th September. I’m not sure what it means for my employer to withhold pay when I’m working for free anyway.

I am striking because I am standing on picket lines, not crossing picket lines… even if I am then doing a full day’s work from a location off campus.

I am not striking because I have deadlines and there isn’t the slack in the system to catch up later. See note on workloads. No-one else will look after my mental health, so it’s up to me.

I know I am not alone, but that doesn't make the ambiguity any easier. Here's hoping for progress soon...

Image by Gerd Altmann from Pixabay