I’m old enough to remember being sent to play with other children who had measles and chickenpox. That was before we had vaccines for either. We’d have a happy time picking off each other’s chickenpox scabs, leaving our generation marginally scarred for life. It was an understandable practice – neither disease had a high child mortality rate – it was far more dangerous in adults, so keeping up herd immunity this way had pretty good odds.
We’re about to come out of lockdown and enter the “New Normal”, whatever that may be. It means that as far as Covid-19 is concerned, we’re back in the pre-vaccination world. Throwing technology at the problem appears to be the first choice of most Governments, but we should think about whether there are some pre-vaccination strategies which are worth revisiting.
In the previous article I looked at the tools the UK Government has available to deal with the coronavirus pandemic. Essentially, they have two. The first is to increase the number of ventilators and ICU beds, which gives more people with severe respiratory infections a chance to recover. That means that doctors and politicians can avoid the unpleasant choice of deciding who gets treated and who does not, but only if the number of infections are curtailed in the first place, so that we don’t run out of ventilators.
The second is the lockdown tool. It is currently a crude On/Off switch, which limits infections by keeping everyone at home. At the moment, it’s not flexible – you’re either locked down, or you’re not, unless you’re a key worker or in an essential industry. The hope is that few key workers will be infected, either because they have sufficient Personal Protection Equipment, or they’re able to social distance whilst doing their jobs. Everyone else has to stay at home. A lucky few can continue to work, but most are either furloughed or become unemployed, putting the economy in stasis.
The Government, quite rightly, is desperate to find ways to ease the lockdown. The question is how to do that without immediately seeing infection rates rise?
The flavour of the day is to roll out smartphone apps which can trace whether you have come into contact with someone else who is infected. The theory goes that if you do, you can be alerted and stay at home until you’re tested. If you have coronavirus, you self-isolate. If you don’t, you’re free to go back to work. Like many proposals for phone apps, it sounds simple, which is why it’s so appealing. Particularly to people like Matt Hancock, who has always had a bit of a penchant for phone apps, which he believes will save the NHS. What nobody is mentioning, is that for contact-tracing to work, we will need the ability to provide at least half a million additional tests that can be administered at home every day.
In the UK we’re about to enter a further three weeks of lockdown. There’s growing pressure from Keir Starmer, the Labour Party’s new leader, for the Government to explain how we exit that lockdown. A lot of people are looking to technology to answer that, largely in the form of tracking applications. This article was going to be about how well that approach might work, until I remembered that it’s a good idea to understand the problem before trying to solve it. I’ll go into the details of contact tracking and tracing in my next article, but first we need to look at some history to see why we need it.
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.