England has finally rolled out its Test and Trace app, which we are all being exhorted to load on our smartphones. It’s good to see that the new app takes privacy seriously, using Google and Apple’s framework. But nobody seems to have worked through the implications of what the Test and Trace app can lead to, which is Lockdown by stealth.
We regularly read about fraud in sport, whether that’s cricket, football or horse racing, where a player accepts money to affect the result. There are arrests, trials and the culprits either banned or sent to jail. But what happens when a Government Minister takes a bet on a Government policy and then manipulates the data to win it?
It may sound bizarre, but that’s what has happened here in the UK, with Matt Hancock, our Secretary of State for Health. In an interview on LBC with Nick Ferrari, he was asked if he would take a £100 bet on reaching his target of accomplishing 100,000 coronavirus test each day by the end of April. Anyone with a scrap of morality would have answered “I don’t gamble on people’s health”, but not young Matty. Although not an ex-Etonian, like many of this cabinet colleagues, Matty always looks as if he wants to be seen as one of the posh boys who likes a flutter. After a brief hesitation, he accepted the bet on behalf of NHS charities. I’m sure that Nick Ferrari thought he was betting on a certainty, unaware that the result was about to get fixed.
As the UK moves towards a more major lockdown, it’s becoming apparent that this will not be a short-term disruption. Imperial College have published their modelling plans, on which the UK strategy has been based and it’s clear there is no quick fix. The Coronacrisis looks set to be with us for the next twelve to eighteen months.
It’s a hundred years since the Spanish flu pandemic, for which society had no medical solution. The result was that millions died around the world, as the best that medical science could do was to alleviate the symptoms of the dying. Since then, medical science has progressed to the point that people expect it to save them this time around. The unfortunate truth is that we have no drugs or vaccine available and it will probably be eighteen months before we do. Until then, all we can do to limit the spread is suppression, i.e. keeping people apart to reduce the number of infections.
Where we have made advances is in the technology to treat those who progress to secondary infections which are resulting in the death toll. Again, we have no pharmaceutical cure, but we can use ventilators on Intensive Care Units which can save many patients. Not all, as anyone with underlying health issues is likely to succumb. The following chart, based on US stats from Statista shows the percentage of patients who need intensive care after hospital admission, broken down for different age ranges. It also shows the mortality rate. If you are young or healthy, ventilators have a big effect on survival rate.
Last year, the Wellcome Foundation inaugurated a programme at the Edinburgh Festival called The Sick of the Fringe (#TSOTF16) to explore some of the boundaries and synergies between the worlds of medicine and the arts. Healthcare is a major issue in Scotland; barely a day goes by without an article in the national press about the impending obesity, stroke or heart attack crisis and the effect it will have on healthcare provision. In the second year of TSOTF it was interesting to see whether it had started to have an effect. There certainly seemed to be some progress in the way new writing tackled healthcare issues.
It’s over forty years since the first personal wireless telecare products came to market. Over the years, along with many others, I’ve been writing about their potential and the opportunity they present to save healthcare costs and by extension, our healthcare systems. Five years ago, many of us got excited when the Tricorder Prize was announced, with the promise of a Star Trek-like device that would diagnose multiple conditions being demonstrated by 2015. That deadline has now slipped to 2017, but it’s not stopped a plethora of new healthcare devices being announced in the meantime, helped along by the twin vogues of crowdfunding and lifestyle.
So where are all of these digital health devices? If you visit a hospital or GP, they’re mostly noticeable by their absence. Startups are coming and going with ever greater rapidity, whilst healthcare costs grow relentlessly. What is stopping digital health devices fulfilling their potential? At the recent Future of Wireless International conference, I chaired a session with speakers from within the medical device community and working at the sharp end of healthcare, who shared their views about the challenges. It was one of the most brutally honest and candid discussions I’ve come across, which deserves to be heard by anyone entering this market. So here is a precis of their essential advice for any digital health startup.
There’s a lot of hype around the first Google Glass operation, performed last week at the Clinica Cemtro in Madrid. Although Glass was used in this instance for training purposes, it doesn’t take much imagination to see its potential for guiding a surgeon. That’s a step which fulfils much of the original promise of remote robot surgery, which we now see in a somewhat emasculated form in the Da Vinci robots, which are arguably adding more glamour than technology to routine procedures.
If we take that mental step towards guiding and assisting surgeons through Google Glass, it leads us to ask the more important question of how we select and train surgeons, and what patients should expect of them. If we want the best manual technicians we may not want to retrain our current surgeons, but look for a new breed. That resonates with George Brandt’s play Grounded, which won awards at Edinburgh this year. It looks at the issues in reassigning fighter pilots to operate drones. It has a magnificent performance from Lucy Ellison and has relevance to many other areas, particularly the brave new world that Clinica Cemtro are letting us glimpse. If you’re in London before 3rd Oct, go and see it at the Gate Theatre.
Let’s look at how those three things come together.