When it launched, COVIDSafe was marketed as Australia’s ticket out of lockdown, so long as everyone downloaded it. “If you want to go outside when the sun is shining, you have got to put sunscreen on. This is the same thing,” Prime Minister Scott Morrison said at the time. Two months on, state and territory health departments are yet to declare the app has identified any people exposed to COVID-19 who weren’t already found by traditional contact tracers.
COVIDSafe was ‘sunscreen’ for coronavirus, until it wasn’t. Have we chosen the right solution to the pandemic?
And as the app’s technical challenges have been revealed, public health experts are questioning whether the app is a distraction from the “real work” of controlling coronavirus.
It’s too early to provide a verdict, but it is common for technologies to be presented as “our knights in shining armour” during a pandemic, according to Julie Leask, a public health and infection disease specialist at Sydney University.
It’s human to see something we can hold, something that’s tangible, as more helpful than “the more invisible human behaviours and public health capacities that are still at the heart of our control of [COVID-19]”, she said.
A Health Department spokesperson said all its communications about COVIDSafe highlight the app as just one important tool in controlling COVID-19.
“Communication clearly places the app alongside the need for physical distancing, good hygiene and the importance of staying at home if unwell (and getting tested),” she said.
The risk of complacency
As the country faces a spike of cases in Victoria, some public health experts are concerned the Government’s comparison of the app to sunscreen could make Australians complacent,.
Often the hardest thing for people to change about their health is their behaviour, according to Adam Dunn, who leads biomedical informatics and digital health at the University of Sydney.
“It’s much easier to prescribe someone medication … then convince them to completely change their lifestyle,” he said.
While a simple technical solution to the coronavirus lockdown is an attractive idea, it’s not so easy.
Holly Seale, a senior lecturer at UNSW’s School of Public Health and Community Medicine, said focusing on the app’s benefits to the individual may have raised expectations beyond what is technologically possible.
Instead, Dr Seale suggested public health campaigns should focus on its collective benefit to the contact tracing process.
“We’re so used to apps being able to tell us what’s happening to us individually. This app isn’t able to do that. But, collectively, this app’s information will be able to help those on the ground,” she said.
Today the “Stay COVID free and do the 3” catchphrase is used in advertisements, a Health Department spokesperson said, to encourage Australians to download the app as well as maintain hygiene and distancing.
And the Government is speaking about it less often. In the two weeks after launch, the Prime Minister Scott Morrison mentioned COVIDSafe in 14 press conferences, interviews and media releases that are transcribed on his website. He’s mentioned it just once in the past two weeks.
A technical solution to the coronavirus lockdown is an attractive narrative — and one both Government and many parts of the media ran with.
But Dr Leask said caution was necessary, especially as the public was presented with little evidence for the app’s effectiveness.
“As the saying goes, with every complex problem there’s a solution that’s simple, clear and usually wrong,” she said.
Modelling released today by the public health think tank the Sax Institute suggests a second wave of COVID-19 infections in Australia is likely if social distancing measures and testing decline.
The research found that in this scenario, the COVIDSafe app could help curb the number of infections.
But this modelling makes some assumptions: that uptake of the app reaches more 60 per cent of the Australian population, and that the app works as it is intended to.
Sax Institute senior simulation modeller Danielle Currie said that while COVIDSafe has not reached these targets yet, the modelling is reason for optimism.
“What our work shows is that using the app and promoting it widely is worthwhile, assuming that there are technological improvements. This should give the government confidence to continue its pushing,” she said.
Dr Currie said that the app could still prove to be helpful in places like Victoria where there are outbreaks.
“If there’s not many cases, the app won’t pick it up. But if we do get a lot — and the model suggests we might — it could be very helpful,” she said.
The other options
So could the time, millions of dollars and effort spent on COVIDSafe have been invested elsewhere instead, to better effect? There’s no one answer.
As a behavioural researcher, Dr Leask would like more funding for public health research — how to provide better messaging for communities where English is not their first language, for example.
And in Dr Dunn’s view, Australia would have benefited from more communication about contact tracers and the work they do, as well as more financial support for such teams overall.
For others, masks are the issue of the day. Epidemiologist Mary-Louise McLaws, who advises the World Health Organisation, hopes Australian authorities implement firm guidelines on face masks, because currently the Government doesn’t recommend them.
The World Health Organisation (WHO) initially said healthy people did not need to wear masks but later revised its advice, recommending their use whenever social distancing was impossible.
“[The Government] should be telling people to wear a mask on public transport in or outside of hotspots. It really stands to reason that they should be enforcing masks in some situations,” Dr McLaws said.
Lidia Morawska, who is an expert in aerosol science at the Queensland University of Technology, is frustrated the potential airborne transmission of COVID-19 has been overlooked by authorities.
She makes the case for concrete guidelines on ventilation of high-traffic venues like restaurants, cafes and churches so people aren’t at risk from potentially infected particles lingering in the air.
If the café you’re sitting in for a few hours doesn’t know much about the science of air movement, which is pretty likely, this could be problematic, Dr Morawska said.
“We need investment in proper guidelines about ventilation to protect people indoors from infection transmission,” she said. “Researchers have been calling for this since SARS-CoV-1.”
There’s still much to learn about aerosol transmission of COVID-19. The WHO has acknowledged its danger in clinical settings, but is waiting for more peer-reviewed research to assess its risk in other environments.
In the end, Dr Leask believes Australia’s best solutions for controlling COVID-19 remain those that have proven their worth time and again.
“Looking back, you can’t beat good old-fashioned public health … when you don’t yet have a vaccine or a treatment that’s established as being really effective,” she said.
“Until we have those things, it is going to be public health capacity, having big contact tracing teams, having really convenient, well promoted testing.”