A recent report by NHS England has pointed out that 16.2% of the population who tested positive for coronavirus, when they died were from BAME communities. The statistics came last week after a review was announced to examine the disproportionate number of BAME people being affected by Covid-19.
According to the 2011 census, the BAME community constitute about 10.8% of the UK population, which means a greater proportion of deaths are coming from the BAME groups. Out of 16.2%, 3% is of Indian heritage, 2% is of Pakistani and 0.6% is of Bangladeshi origin.
The UK is therefore racing against time to design and implement a contact tracing app in a desperate attempt to curb the spread of coronavirus before a “predicted” second-wave dismantles the NHS. Caught in the crosshairs of easing lockdown restrictions and executing an app with data protection concerns, the British government has a host of other challenges cut out for itself. But beyond everything can technology challenge community transmission and triumph medicine?
“A contact tracing app will help curb the second wave of coronavirus pandemic if there were to be one as predicted.
“But tracing will have to be further assisted by rampant testing- which is not happening at the moment- besides other protective measures already in place,” said Dr. Rajay Narain, consultant cardiologist at St. George’s University Hospital, London in a statement to Asian Voice.
However, Dr Parijat Bhattacharjee, a consultant across North West London hospitals including Northwick Park, Central Middlesex and Ealing said, “Tests and more tests are definitely the answer. But with the Asian community, whether they are elderly or youngsters, language and cultural barriers are major problems. And with that, contact tracing through apps may not be the single best solution for all. They may not even understand what is being told or misunderstand the message.
“We need community help for contact tracing, for example- the government could take the help of newspapers and other media sources that cater to that particular community to spread awareness or collect and transmit informations. Others like community organisations and places of worship could also help.”
Emulating South Korea and Singapore’s success
Through this app, the British government hopes to emulate the success of countries such as South Korea and Singapore where the pandemic has accosted in a cumulative 300 deaths (South Korea- 240 deaths and Singapore-12 deaths) approximately as of Tuesday 28th April. This has bolstered the health secretary Matt Hancock to believe that weeks of self-isolation will result in a significant decline in the infection rates. The government believes that the app will, therefore, assist health authorities in monitoring and tracking new emerging cases, as the UK prepares to gradually ease the lockdown. But, medical experts warn the government of realistic results to its optimistic policy.
“The model has been successful in South Korea and Singapore. But bear in mind these countries had relatively lower population densities as opposed to the UK. More fundamentally, they had imposed all protective measures- social distancing, contact tracing, rampant testing-much before the scale of the spread of the virus had overwhelmed the government. This was successful because they had very few Covid-19 positive cases when they implemented this system.
“Now, the UK has already registered over 140,000 positive Covid-19 cases. For weeks the health secretary has been aspiring to achieve the ambitious target of testing 100,000 people daily and failed to meet them. You need to test more people for the app to work. The government website, which was inducted for key workers to be screened, has been crashing on and off. Under such circumstances the government has to design a multi-factorial approach in handling coronavirus,” continued Dr Narain.
Problem with the Asian community
Public Health England had stopped the traditional contact-tracing approach of interviewing and testing asymptomatic Covid-19 patients on March 12 after it reported the government about community transmission. The government and the NHS, therefore, turned to technology where they piloted a contact tracing operation at an RAF base camp in North Yorkshire last week.
The app works by relying on Bluetooth signals to log when smartphone owners are close to each other - so if someone develops Covid-19 symptoms, an alert is sent to other users they may have infected. This involves technical complexities.
Person ‘x’, provided he has installed this app, is required to keep his Bluetooth on. Similarly, when person ‘x’ meets other people, even they are required to keep their Bluetooth on for the app to successfully identify the contagions. Now, a recent poll suggested that 80% of smartphone users in the UK will be required to download any such app for contact tracing to provide basic information for it to be scientifically useful. Under the current GDPR rights, people are advised to keep their Bluetooth off for the fear of fraudsters who are accessing personal data and information registered on their phones.
Contact tracing within the Asian community, that has been hit the highest among the BAME, is a difficult job. Many elderly people, who are most vulnerable, do not use smartphones to its full capacity. Even if they do, persuading them to use it is a challenge in itself. The most vulnerable ones will switch off mobile data and bluetooth to save battery and cost of using mobiles. So how do you trace them?
Then there is a valid fear of racial profiling and increasing prejudices. As the Tony Blair Institute for Global Change has pointed out that “policymakers must adopt privacy-focused options when all other things are equal, and recommend open and transparent.”
Financial Times has added that manual work is key to trace new infections. It said, “Governments will need to hire huge teams to do the detective work of compiling the contacts of new patients, using follow-up interviews to check for symptoms of the virus and potentially getting in touch with their contacts as well.” This includes equal representation from people from different communities, to address sensitive and culturally important information.
Dr Bhattacharjee added, “Asians are culturally different. We can’t self-isolate exactly how non-Asians would do. We live with extended families. Our elderly are dependent on us – more than others. Explaining contact tracing to such a vulnerable community is hard. Moreover, there is a language barrier and a problem with taking instructions seriously. GP surgeries could send letters to explain things better. But the most important is to explain how contact-tracing and tests work – culturally sensitively and in one’s own language through mediums like ethnic media, places of worship and community organisations.”
Undocumented migrants and data protection
An Ipsos Mori polling commissioned by the Financial Times indicated that at least two-thirds of Britons were prepared to let the government rollout with this model. However, the same poll does not indicate the status of illegal immigrants, and those who are in transit with the Home Office in securing their right to remain in the UK. This includes a significant population of individuals from the Black, Asian and Minority Ethnic (BAME) community living in densely populated cities of Birmingham and Manchester besides other boroughs of Brent, Tower Hamlets and Harrow in London. Getting these individuals to download an app and share their personal information will be a herculean challenge for the Home Office. Nazek Ramadan is the Director of Migrant Voice. Speaking to Asian Voice she said,
“Many migrants, especially those without documents, will be reluctant to use any such app. They are fearful of sharing any information about themselves with any Government department or public institution, scared that this data could be passed on and used to detain or deport them.
“Decades of hostile immigration policies – many of which are enabled by the very act of data-sharing, between landlords and the Government, the police and the Home Office – have left trust at a very low level. Even if security and anonymity could be 100% guaranteed and data-sharing 100% ruled out, many undocumented migrants would still not use this app.
“And this isn’t based on pure speculation. The UK Government had announced treatment for Covid-19 to be free of charge for everyone, regardless of their status. Reports also surfaced that data-sharing between the NHS and Home Office has supposedly largely stopped. But many undocumented migrants are still too scared to access treatment and come forward in admitting they are asymptomatic of Covid-19. A Filipino migrant known as Elvis was one of those – he died from Covid-19 in his home earlier this month because he was afraid he would be charged for his treatment and reported to the authorities.”
Recently, Germany became the first European country to retract its decision around a centralised contact tracing app for curbing coronavirus. Today, as Asian Voice went to print, reports emerged that the UK's coronavirus contact-tracing app is set to use a different model to the one proposed by Apple and Google, despite concerns raised about privacy and performance. NHSX, the digital arm of the NHS has opted for a "centralised model" - meaning that the matching process, where the matching process will happen through computer servers as opposed to the phones to send alerts. As a result, hundreds of the country's cryptography and computer security experts have signed an open letter calling for the government to reconsider the model.
Regardless of the model used, health authorities await definitive evidence to support the narrative that contact tracing apps help in curbing coronavirus.
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KEY POINTS TO REMEMBER
* A recent poll suggested that around 80% of smartphone users in the UK will be required to download apps for contact tracing to provide basic information for it to be scientifically useful.
* Policy makers must adopt privacy-focused options ensuring everything is equal, open and transparent.
* Government needs to recruit huge teams who are culturally aware and sensitive, to do the detective work of compiling the contacts of new patients, using follow-up interviews to check for symptoms of the virus and potentially getting in touch with their contacts as well.
* Government needs to ensure there is no racial profiling and increasing prejudices because of contact tracing among certain BAME communities.
* Apps based gathering and transmitting information may not be adequate in Asian communities. A need for larger and wider campaigns through advertisements in ethnic newspapers, word of mouth, community organisations and places of worship are key to absolute success.
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