Published on the 11/09/2020 | Written by Heather Wright

After months of searing criticism, the tent has opened (slightly)…

After copping screeds of criticism for keeping its work inside the Covid-19 response tent, the Ministry of Health has opened up on future plans for CovidTracer development, including the addition of bluetooth abilities – and the difficulties it has faced along with way – but is remaining coy about the CovidCard trials and the card’s potential benefits.

Shayne Hunter, deputy director general data and digital for the Ministry of Health, after acknowledging many lessons learned on the communications front, says bluetooth trials have been underway since August and will continue through to October, with the findings to be released publicly thereafter.

He confirmed that the Ministry, along with app development partner Rush Digital, has been exploring Bluetooth ‘right from the get-go’ with regular contact with Singapore, Australia, Ireland and the UK.

“One of the things we need to avoid is overwhelming our contact tracing people.”

But Hunter also admits there’s a been a reluctance ‘to just leap in’, expressing concerns about whether the technology would overwhelm contact tracing teams.

“We were trying to understand whether the technology was suitably robust, but also what we’ve been trying to understand is to what extent does it aid, or potentially hinder, the contact tracing process,” he says.

“One of the things we need to avoid is overwhelming our contact tracing people with essentially a lot of people they need to contact who may not in fact be close contacts.”

“Bluetooth doesn’t tell you about location, it just tells you about proximity and so we are looking to understand whether the Apple/Google event [sic] notification framework and the work they have been fine tuning for three months now, and that is now implemented in the Irish app, is something we are now comfortable to push out.”

If the ENF (Exposure Notification Framework) trial is successful, it’s slated for a November release into the app.

That focus on not overwhelming contact tracing teams extends to the alerts which can be sent via the CovidTracer app to anyone who has been in ‘a location of interest’. While the feature was added to the app back in August, only a single use of it has been made public.

Hunter, speaking at a Health Informatics (HiNZ) webinar this week, gave some clues as to the reason why, noting that the development team has programmed into the releases the ability to customise notifications to be more specific around what the alert recommends users do.

“We have a level of sophistication in the app now that means we are less likely to overwhelm our contact tracing people if we hit go on sending out an alert.”

Hunter’s concerns seem contrary to official advice to users of the app: “You are not required to start self-isolating after you receive a contact alert. However, if you feel unwell or start to develop COVID-19 symptoms, you should immediately contact Healthline on 0800 358 5453. Contact tracers will get in touch with you directly if you are identified through the contact tracing process as having a higher risk of exposure to COVID-19, for example if you were seated in close proximity to the confirmed case.”

Risk-based contact alerts are scheduled for release in October, along with gamification to drive ongoing usage – though the Ministry admits it has no idea yet what form that gamification will take. Multi-language support may follow in November, but that’s still to be confirmed.

CovidCard
Meanwhile, Hunter says trials for the CovidCard will get underway this month and ‘probably’ run into October.

The Ministry has been coy on where planning for the trials, announced in early August and slated to be held in Rotorua, is at. MBIE too, is giving little away on a separate trial in Managed Isolation and Quarantine facilities. Minister Megan Woods indicated nearly two weeks ago that the trials would kick off in around two to three weeks.

Hunter did confirm that the trials are largely around the human behaviour elements of the technology – such as people’s willingness to wear a lanyard, rather than the technology itself. However, Hunter says the trial will also look at how and when data will be brought into the manual contact tracing process and how it is used within contact tracing to inform decisions – whether for close contacts or ‘recursive contact tracing’.

They come despite Sam Morgan announcing earlier this month that his team were no longer working with the Ministry on the project, frustrated at the ongoing delays and inaction.

A report will be produced after the trials and will be made public, Hunter says.

Running on adrenaline
It was a project fraught with privacy challenges along with dealing with multiple agencies, Ministers, a fragmented health system with differing levels of technology adoption, collaborating across the fragmented health system and searing analysis from both media and public.

Michael Dreyer, Ministry of Health general manager of national digital services, says the team ran on ‘adrenaline and good will’, ultimately resorting to ‘cutting stuff out so we can give people a break’.

Hunter notes that when it came to the QR codes, which he admits were initially too complex for businesses to create, the privacy aspect added additional complexity.

“The quickest and simplest thing we could have done was have a URL off the back of a QR code and capture some details that way. But we got a pretty strong steer early on that we were going to have to manage the privacy side of this really quickly, even though we had really good social license to get on and provide a solution, we knew at the end of the day that the privacy card was always going to be one that was going to be played.”

Hunter also alluded to one other factor which no doubt has had a strong hand in development: “We have left ourselves in a good space in terms of any scrutiny that we will undoubtedly get when there is an enquiry or review or whatever it may be.

“Generally speaking we produced high quality, bug free products, so we proved we can not only do it but do it under pressure.”

The contact tracing system itself leveraged the new national screening solution, which the Ministry had been investing in over the prior year.

“It had a couple of key components – the Amazon public cloud layer and on top of that a Salesforce layer with case management and CRM,” says Dreyer.

Repurposing, and the building of ‘some new bits’ saw a minimum viable product for a new national contact tracing system stood up in eight days.

It wasn’t an initial winner, however.

“We were told it wasn’t so usable,” Dreyer notes.

The team spent the next month working with public health units to drive iterative improvements and these have since been expanded to include processing of new arrivals through the testing regime in MIQ facilities.

Hunter also mentioned the 15 minute processing time for individuals to register their contact details to be tracked through Covid testing facilities. “It’s too slow. We can definitely look at digital for that.”

Test results too could potentially be delivered back to the CovidTracer – or Covid Pro – app. “There are a number of logical extensions that we are actively working through at the moment.”

Work is also beginning on building a new framework to manage Covid vaccinations, should a vaccine come available. The initial release is expected to be in place for February 2021.