Nearly 40% of Icelanders are using a Covid app, but it hasn’t helped much
technologyreview.com
technologyreview.com
Where contact tracing apps help is for contact events where people are in relative proximity for sustained periods of time. It seems that prolonged contact is a major factor in spreading the virus. If you're on a train with someone for half an hour, you'd not be able to identify them through regular contact tracing, and they wouldn't be able to be altered. On an aircraft this can usually be done as the airline cooperates with public health authorities to identify those sitting near a given individual on the plane etc.
The impersonal but sustained contact situations are the ones apps can really help with, by raising the number of people able to be alerted to their risk of exposure. Traditional tracing handles people you know. App-based tracing, if it gets adopted, can help with the people you don't know but are sitting near, or otherwise around for a prolonged period.
Also most chess GMs per capita, 2nd most cars per capita, it goes on..
If you were to split a large country such as the USA or China into parts with a third of a million people, chances are that, for any of these, there would be a parts that beats Iceland.
There may be exceptions such as the highest usage of hydro-power usage, as they have a rather unique geology. Vatican City won’t be beat on popes per km², either (it has just over two)
Just over 4 actually. There are 2 popes in 0.49 km^2 so 4.1.
[1] https://www.reddit.com/r/dataisbeautiful/comments/g77wwj/oc_...
The Most Dangerous Equation
Ignorance of how sample size affects statistical variation has created havoc for nearly a millennium
https://pdfs.semanticscholar.org/91c1/f00095ca156ea39fe0f225...
This means that the scalability advantages of tech don't synergize well with the uses of contact tracing. If you don't have very many cases to worry about, a dedicated team of humans will do just as well. And not have nearly the same long-term privacy issues.
That seems unlikely to me given that no jurisdiction has unlimited resources, not everything is captured on camera, patient's memories aren't perfect, and there may be incentives to lie or otherwise under-report certain contacts when things aren't completely anonymous. (For example, in many countries patients are likely to avoid revealing contact with a drug dealer.)
In comparison, DP-3T (and also the joint Apple-Google framework based on an earlier revision of it) will capture any significant contact provided that both parties are carrying appropriate devices. It also maintains anonymity, so it removes nearly all incentives to mis- or under- report. It's not a replacement for teams of people, but it should provide significant improvements in areas where the majority of people are carrying such devices.
> And not have nearly the same long-term privacy issues.
Neither DP-3T, the Apple-Google framework, or the TCN protocol have any significant privacy implications (beyond whatever is already associated with carrying the physical device doing the tracing, and to the best of my knowledge of course).
As to Iceland's 40% uptake, their app isn't anonymous - in the event you test positive you share your full location data with the people doing the contact tracing. It's also not built into the operating system so there's more friction for user uptake.
At very low case rates, the overhead and required adoption rates for an app-based tracing system are major disadvantages against human contact tracers. As case rates go up, that overhead starts to pay off and apps make sense. But as case rates continue to go up further, you get less and less information from contact tracing. At some point, when case rates are high enough, it basically becomes a single bit of information: did you go out? Yes? Then you were probably exposed. At that point, the app isn't adding much value!
I believe that in many places around the world dealing with COVID-19, we are closer to the latter scenario than a lot of people think. No, we're not literally in the scenario above (it was an exemplar), but the general point that case rates may be too high for contact tracing to "save us" is still worth making.
One thing the app might be used for is to allow visitors in without quarantine. Prove you have tested negative recently and use the app so if you do get sick we at least have a vague idea of where you were.
If the place you went to doesn't have the sanitiser part then they're probably breaching their public health obligations. You can ask them to put out sanitiser or report a breach.
https://forms.police.govt.nz/forms/covid-19-breach
As an aside, I'm impressed in NZ that there's a central place to report issues but then issues are dispatched to the right agency to follow up. That makes it super easy to report issues.
[0] https://www.stuff.co.nz/national/300016238/nz-covid-tracer-w...
If we're ever going to get our lives back, and not be on indefinite timeline of "maybe there will be a highly effective vaccine" we actually need the virus to circulate among people who can safely get it, get over it, make antibodies which historically - before the advent of highly effective vaccines - is how pandemics ended.
Total isolation policies prevent broad population immunity. We know from decades of medical science that the population develops immunity while acquiring antibodies.
But yes, caution is necessary. We don't have enough evidence to push forward a national strategy that's based on people developing immunity without a vaccine.
Here's WHO's statement on this matter:
https://www.who.int/news-room/commentaries/detail/immunity-p...
"Herd immunity" without a vaccine, as a strategy, is equivalent with doing nothing and let the virus wreak havoc on the population.
Can vaccines even be developed if there's no natural immunity?
Being exposed to the same antigen while you have an immunity should reactivate this immunity, that's a reason why a "herd immunity" tactic could work, at least for a time
However if the natural immunity w/o reactivation only last a year or less, you will end up with a new outbreak at the end of the period. And if the immunity period is shorter than the recuperation one, you will have a virus that will be a lot more lethal.
The possible scenarios for this I can come up with are:
1. No immunity after initial infection
2. Bad test methodology (contamination etc)
3. Bad tests. The article doesn't mention the test type, so perhaps they were initially misdiagnosed (false positive), then infected upon return to the ship. The implication from this would be that the virus is still prevalent in the crew on board the Roosevelt...
Here is a recent article with some useful links discussing immunity: https://www.sltrib.com/news/2020/05/13/coronavirus-immunity/
Look at the bigger picture. In today's immensely innovative world there will almost certainly be a vaccine or anti-viral or some effective treatment within a year or two.
The goal for those of us who are lucky enough (in normal times it can be a curse) to live on an island is not to hide out forever - it's to hide out until that treatment is available.
Please don't spread misinformation.
We most certainly do not (https://blogs.sciencemag.org/pipeline/archives/2020/05/04/hy...). No effective treatments are currently known. There's hope that monoclonal antibodies will work, but they come with their own list of caveats (https://blogs.sciencemag.org/pipeline/archives/2020/05/14/mo...).
Again, please don't make things up. Stop spreading misinformation! It's already incredibly difficult for laypeople to make sense of the chaotic, frequently changing, and often conflicting reports at this point.
https://www.ncbi.nlm.nih.gov/pubmed/32205204
My intention wasn't to demean but rather to provide a clear and understandable message for other readers who might lack the scientific background to critically evaluate your claims. I was also hoping that you'd take the hint that perhaps you lack the requisite background knowledge to commentate usefully on the topic.
The first two links are the ones with unexplainable results (to put it charitably) by the now infamous Dr. Raoult. The third one is a review which identifies previous successes in vitro and argues for further clinical trials to take place. In vitro studies are useful for identifying drug candidates to test but say absolutely nothing about whether something will work in practice.
Meanwhile, the link I provided in my previous comment neatly summarizes the current clinical data on the topic. In a nutshell, hydroxychloroquine does not appear to be particularly useful for treating hospitalized patients. It might or might not have some mild beneficial effects and it definitely has serious safety concerns; the arrival of additional clinical trial data in the near future should hopefully give us a more complete picture.
I stress again that there are currently no known effective treatments.
The early reports suggested it was only useful in combination with zinc supplements, which seems to have been largely forgotten or ignored, from what I've picked up on in comments and links across multiple sites over the past month or two.
There are groups where symptomatic incidence is lower. Sure. But JFC some of those symptomatic cases are awful, with lifelong impact.
Someone used the Russian Roulette metaphor early on and it continues to resonate with me. We see over and over again surprising case histories all across the demographic, age, and health history map. Too many that are completely unexpected and for which there are presently no predictive metrics.
We are slowly learning more about what this virus can do, and we have a sense of what it will do when presented with a known vulnerable population. It is remorseless.
But even for "low risk" populations it is exactly like Russian Roulette. You and 9 others might be at the peak of known clinical health measurements and it may leave those others unscathed- that we know of- while it will destroy your lungs or your liver or cause you to have a stroke.
With all respect to the goal of broad population immunity, for my family- we stay carefully isolated and adopt all defensive protocols, we wait for a vaccine, and we advocate for govt entities to provide the liquidity to keep safely running the various life sustaining machines that our interdependent world depends on.
If we drive the economy into another Great Depression that will kill many people as well. Federal government liquidity injections are not a solution. At some point if people aren't out working to create value then society will disintegrate.
Yes, this is the point I am trying to make. But most of the demographic here (who already work from home or easily transitioned to doing so) likely don't find it difficult and are mostly unaffected.
There is essential work, those jobs are wartime/highly hazardous jobs, and deserve all of the support and gear that actual war fighters get. That isn't happening.
Finally, Fed liquidity is a tool with far greater power than we are utilizing. To not exercise that power, and to not equip hazard roles- is simply barbaric.
Good luck and good health to you.
We don't have a model for how to understand exposure and immunity dynamics for this population. My personal sense/estimate is that between 10% and 20% of the child population has been sufficiently "exposed" to now be considered "safe" but I would not bet my children's lives on that measure. I am eagerly awaiting the day I can get my kids tested for antibodies, but even if they test positive I can't consider them or us to be "safe" until we know a whole lot more.
At any rate, given just the reported numbers, a conservative back of the envelope risk-of-significant-impact from "exposure" in the teen/pre-teen set is somewhere between 1 in 1,000 and 1 in 10,000.
Which says there been three coronavirus related teen+preteen deaths with no underlying conditions (all of which were teens IIRC) in NYC and another 6 with underlying conditions.
Do you have a more reliable source?
Also, 1 in 1000 is close to the estimated infection fatality rate for the general population (estimated between 0.1% and 0.5% normally) and kids are supposed to be a couple of orders of magnitude less at risk than the population average. So your numbers all seem utter nonesense to me.
I've never even heard of a preteen death of covid.
There is a very real risk that won't work. If it worked, why would we only do it in emergencies? Government may as well provide funding for essential services all the time.
The government would simply be handing out money to the people working in essential services who are doing real (and quite risky, apparently) work while. You would be receiving the benefits without doing anything. That is almost the 'paid in exposure' meme that artists have to put up with.
The economic system is crafty, it will figure out that there is dead weight somewhere and start to optimise around it. This might be unprecedented so the failure modes are beyond me - but it won't be pretty if it goes on like that. Gluts would probably not be the end of the world but severe shortages are possible.
In Australia we had an official government inquiry into why the price of milk was so persistently low. No other problems. Just low milk prices. That is what happens when a free markets run the food delivery system. That won't happen if the government steps in and starts making decisions about what is fair and who needs which items.
If you're ignoring the rates then you might as well say that driving to work is like Russian roulette.
Do you have any figures (graphs ideal) for the lung damage (or other long term health effects) distributions?
There's a lot we don't know and some worrying signs that it might not just be an brief, acute, occasionally severe, illness.
If you have it then it is in your lungs (it's a respiratory disease)
You really should go to a doctor for the skin condition at least.
> Plague has at least 2 forms: one if its in your lung and another in the skin. I'm wonder if this might not be similar.
There's no evidence of that. There are some very occasional skin conditions associated with COVID but they don't don't sound much like this.
General pontifications aside, I’m sorry that you’re sick, and hope that you recover quickly and cleanly.
Well, sure. That is what has been happening anyway. But it's hard to keep the low risk people away from the high risk people all of the time. Or are you really not going to ever visit grandma again, potentially for years?
So, even if you're low risk, it helps to know if you've been exposed so you can isolate yourself and protect the high risk people.
Nice idea on theory but in practice it's shown to be very difficult to do.
In Australia we tried to keep aged care homes isolated, and it was catastrophic - something like 25% of deaths were from a couple of cases that were undetected and made it into aged care homes.
In Sweden this was explicitly their plan and here's what happened:
“It’s very difficult to keep the disease away from there,” he said. “Even if we are doing our best, it’s obviously not enough.”
But he said: “We are not putting anybody’s lives above everybody else’s lives – that’s not the way we’re working.”
Tegnell said in late April that at least half of the country’s deaths had been in nursing homes.
“We really thought our elderly homes would be much better at keeping this disease outside of them then they have actually been,” he told Noah
https://www.businessinsider.com.au/coronavirus-sweden-lockdo...
However, the UK which is smaller than both, lost that advantage only because of their botched response to the Covid-19 pandemic.
Regardless of how badly we're handling it, our risk was vastly different to the others.
Its a very different comparison. NZ and AUS are very similar to GB culturally and politically.
Its very notable that most countries that experienced SARS and MERS (burning it into their cultural and political will) are dealing with COVID very well.
Maybe a century ago.
Governments of neither country ever entertained the idea of herd-immunity. Elimination was always the goal.
Both were early to restrict international arrivals. The UK lagged behind.
Both countries were leading the world in per capita testing March through April — i.e. when it mattered. Again, the UK lagged behind.
Both Australia and NZ are almost back to BAU, again, the UK will lag behind.
No Australian government has made any kind of indication that elimination is a goal, and nor was herd immunity a goal. The goal was time to prepare the country, and to minimise the death toll.
As it happens, it has been functionally eliminated in SA/NT/WA with no new cases in May and zero active cases. But the expectation is that new cases will arise as travel restrictions ease but contact tracing will be sufficient to control them.
This was a big factor. When Australia started closing its borders (on Feb 2), it was being condemned by the WHO and China for doing so [1]:
"WHO director-general Tedros Adhanom Ghebreyesus said in Geneva that despite the emergency declaration, there is "no reason for measures that unnecessarily interfere with international travel and trade"."
I was tracking conferences in the UK at the time (I run a website with conference listings), and one of the UK conferences kept quoting that WHO statement as a reason to insist their conference was still happening and people should fly to the UK for it... for another six weeks, right up until the UK lockdown. Meanwhile conferences in the rest of the world were cancelling themselves "out of an abundance of caution". The UK was one of the countries that took the longest for their conferences to cancel (Germany was the other).
[1] https://www.abc.net.au/news/2020-02-02/coronavirus-china-sla...
I know we'd restricted direct flights from China or the Wuhan area earlier, but citizens and permanent residents (and their families) could still arrive. We were still allowing international visitors in mid March - they only cancelled the F1 GP in March 12th, the day it was supposed to star, when all the international drivers/teams/fans/media-circus were already in Melbourne.
https://www.theguardian.com/sport/2020/mar/13/formula-one-au...
I'm still trying to find when the UK implemented the same restrictions on China that Australia did. Apologies for a Daily Mail link, but it suggests that a week later the UK was still struggling to implement restrictions on travel from China due to EU rules [1] (but then, the Daily Mail would say that). Deutsche Welle suggests that a Europe-wide ban didn't happen until 17th March, and even then the Schengen still remained open [2].
As for the F1 GP, I'll just paraphrase our WA Premier: "They do things differently on the east coast" ;)
[1] https://www.dailymail.co.uk/health/article-7968785/UK-ban-fl... [2] https://www.dw.com/en/coronavirus-germany-implements-non-eu-...
We are quite a way from being "almost back to BAU". This weekend we allowed cafes, restaurants, and food serving areas of bars to reopen, but only to 10 people at a time (so many have not reopened, since only 10 customers is completely unviable financially for many places). Bars (for drinking) and entertainment venues are still closed. The cafe nearest me is playing with fire right now - they have 8 outdoor tables, all more than 2m apart, but had al of them filled with 2, 3, or 4 people around each - easily 20-25 people seated while I was there. And there were still people crowding around the door clearly not "social distancing" waiting for a table to open up, and ignoring the cafe owner's request to spread themselves out to comply with the health advice...
The plan is to get back to "everything open as normal" by the end of July, but it'll only take a serious "second wave" for that plan to be found unworkabe, I suspect...
Not even slightly. We (Australia) only just (this week) had some states start to loosen up the initial list of restrictions, so some businesses and social activities can restart in limited fashion. But we're still on "stage 3" restrictions - with stage 4 being the most restricted.
In my own state (Victoria), we're going slower as we've recently had some new infection clusters show up, which we don't want to get out of hand.
For example, the greater Sydney area has 400 people/km^2 while the UK is 259/km^2.
60% of Australians live in 1M+ cities, while only 27% of Brits do. That's 15M dwelling in big Australians cities. Only 17.65M in the UK.
Our biggest cattle station (think "cow farm" for non-Aussies) is almost 10% of the land area of the UK. We have ~20 cattle stations larger than 10,000 square kilometers. You'd only need to aggregate the top 15-17 biggest farms to get the same amount of land area as the entire United Kingdom. (Admittedly, far far less productive land, most of which probably qualifies as desert, but still...)
https://en.wikipedia.org/wiki/List_of_the_largest_stations_i...
The point here is the opposite: that the east coast is reasonably dense and useful for comparison purposes.
Central Australia has pretty much the density of the North Atlantic...
The map here strongly proves your point: https://worldpopulationreview.com/countries/australia-popula...
And mine too - look how much of the country is devoid of towns with at least 10,000 people in them... I just slurped that table into a spreadsheet, there are 24,860,107 people represented in a coloured dots in that map. From that site's total population of 25,463,119, that leave 603,012 people spread across that vast unmarked unmarked grey interior...
Perth of course is the most isolated major city (1M+) on earth - over 2600km from the next 1M+ cities (Adelaide and Bali).
It's very true that London is more dense but Sydney is a reasonable city to compare to dense urban areas anywhere in the world.
If you’re saying that the British attitude of “use common sense” is what made it more susceptible, then I agree.
The disparity in population distribution is no where the near the massive disparity seen in COVID 19 outcomes.
Australia has a population of 25 million which makes in more than one third the size of the UK with its population of 66 million.
Also 10 million of that 25 million live in just the two major cities of Sydney and Melbourne which I'm sure are just as densely populated as cities like London, Liverpool etc.
To date UK COVID deaths total 34466 or 508 deaths per million.
By comparison Australia has 98 or 4 deaths per million.
There is more than population distribution at play here.
Vietnam is a notable one.
Germany which is doing much better has land borders with 9 (?) different countries, of which most are still open for commercial traffic.
Can you clarify what you mean by this?
Iceland is whatever you call the opposite of that. Grandma very rarely lives with her family, she lives by herself -- hopefully with her partner -- until she is unable to and then moves into a system that ranges from living-alone-with-help to typical old folks homes, and will gradually move towards more care as her health allows.
So that's wrong in the original comment, but the rest seemed pretty spot on to me, and doesn't change the argument much I think.
They already did the very first traditional contact tracing, worldwide. We know a lot from this data. And they also did tracing via the mutating generations. Full scale.
At 38% penetration only about 15% of contacts with a carrier will be warned. That is indeed not going to do much.
Furthermore, the user has to actually report their infection, which probably not everyone is going to do.
If we multiply all of those terms, the end result will be much lower than 15% even in this scenario. The tracing apps seem more like wishful thinking than something that is going to provide sufficiently broad and reliable coverage to have anything more than a marginal impact.
This is supposed to be a "technology review". Did the writer bother to ask "WHY NOT"?
PS: Happy to stand corrected if someone else was able to read between the lines and find some reasons.
At the moment we're going several days at a time with zero new cases.
It makes it a more difficult sell to the general public, when the overall feeling is that we've 'beaten' this.
I get the feeling most of the general public aren't preparing for future outbreaks because, like most places, I think everyone wants to rely on the hope that the worst is over.
e: Why am I getting downvoted? Just conditioned on | getting infected by covid, means more likely to have had more contacts.
Without also being able to know the location of people without a positive diagnosis, the app probably doesn't help that much.
But I don't think this necessarily applies to apps being developed for other countries where Bluetooth is being used to measure person to person contact directly.
This article lacks any real insight into what isn't working or why.
the app is open source of people are interested; https://github.com/aranja/rakning-c19-app
Even if the identifiers were encrypted with a public key that only the tracer service had the private key to, couldn't a bad actor register as a bunch of actual people and then have them show as coming in contact with infected people?
Beacons, identifiers, constitutions, and public keys don’t come into it.
https://www.axios.com/axios-ipsos-coronavirus-week-9-contact...
(...if I even used a smartphone)
Obviously everyone has their own set of value judgments, so I can't say such people are wrong.
But my view is that an enforced lockdown wreaks far greater damage to society than the potential privacy implications from a tracking app. If it's an either-or choice, I'm choosing a tracking app over lockdown every single time. It's a no-brainer, and I consider myself a reasonably privacy-conscious individual.
It's important to keep in mind that not all surveillance technologies and methodologies are created equal. The reason that the Apple/Google contact tracing technology has received so much praise is because it's more or less decentralized and all of the data is cryptographically anonymized. Any data that could be associated an individual changes periodically, so it's borderline impossible to track someone with it. There is no central database aside from the list of ID's that are marked sick. There is no location data associated either. In fact, it's blocked by the OS.
I think I'm just going to stop paying to own one... All I really need is a laptop.
I got slammed on here for even raising the question.
The silencing, call out culture in this industry sickens me more than anything about this particular instance of it.
My review of the paper is that their assumptions are overly optimistic and that contact tracing will be largely ineffective even at universal adoption.
* https://science.sciencemag.org/content/368/6491/eabb6936/tab...
https://twitter.com/adamvsteele/status/1259661260406349824?s...
There's a chance that a chance encounter would result in an infection. But then how many data points of low probability events are useful?
However digital contact tracing has a fatal flaw: Bluetooth cannot be used to reliably estimate proximity in dynamic, real-world scenarios as objects (especially human bodies) absorb huge amounts of the signal.
In many scenarios this can make two people sitting next to each other look like they're 10-20 metres away compared to line-of-sight equivalents (just by having a phone in a pocket, handbag, or even next to a head taking a call). You can easily see this using, for instance, Apple's Bluetooth Explorer tool as part of Xcode developer tools [1] (or any of the bluetooth signal strength tools in the Play / App Stores).
You don't have to rely on DIY tests from the internet though. While they're extremely static tests, the Singapore TraceTogether team did some field studies highlighting the significant variability across hardware [2]. Their tests ended in a plea for factory calibration data from hardware manufacturers.
The Singapore team has talked about false positives in depth as a major issue (one was someone in a different apartment, because bluetooth goes through walls), which is why they set a hard, low RSSI value to reduce false positives - this means a lot of true positives will be missed too.
The key Australian dev revealing significant issues in Australia's COVIDSafe app also acknowledged the major limitations of BLE. [3]
The problem of course is you have a situation where you cannot determine if a contact is epidemiologically interesting, because accuracy in real-world situations is really down to the 20-30 metres of Bluetooth range, even over longer time-frames.
This means you either have a huge caseload for human tracers to sort the signal from the noise (and this relies on the memory of all participants) or you have some kind of automated system (such as amber alerts that the NHS talks about) and the challenge there is that no-one knows if they're really interesting epidemiologically, as no-one can tell where each party was in the context.
A recent series of talks by bluetooth experts is extremely informative.
In one, an expert discusses all the significant sources of error which creates the huge variability you can see in DIY tests at home. [4]
There are other great talks in that video, but Jen Watson - who leads a team at MIT engaged in advanced signal processing - delivers a good brief talk of the issues, hoping to use statistical analysis - using detection theory of fluctuating signals to estimate interesting contacts. [5]
The takeaway from all this though is that it's a hard problem, and in Watson's talk she quickly moves on to thinking about additional future capabilities (such as features in upcoming Bluetooth standards) that might help improve the resolution.
This does leave us with a large current problem though. Tracking apps have been thoroughly oversold with little evidence of usefulness, and in the case of the UK and Australia government authorities have refused to publish the algorithms they are using to determine proximity from an RSSI value and a phone model.
There is nothing sensitive about this apart from the fact it may reveal the system is not useful for the stated purposes.
[1] https://twitter.com/crushthecurve_/status/125911361479693926...
[2] https://github.com/opentrace-community/opentrace-calibration...
[3] https://twitter.com/jim_mussared/status/1255498092239036417
Infections happen within families, and spread from one family to another by friends/coworkers. The infected people should be easily able to list all exposed out by name.
An exception is of course mass indoors public events that are forbidden now. This is where a contact tracing app would probably prove to be the most useful.
https://www.nytimes.com/2020/04/20/health/airflow-coronaviru...