Adopting this approach occasionally may lead us to think that we all need to re-evaluate what lessons we think we have learnt, as what may seem like success in the short-term may not seem quite as successful in the longer-term as the pandemic goes through a series of waves.
So, what have we really learnt about the virus and how it is transmitted and behaves?
- Who transmits the virus? In the early months of 2020, we did not appreciate the extent to which this virus has the potential to be transmitted asymptomatically. The fact that asymptomatic transmission is a significant factor changes the whole way we need to think of this virus, as well as manage it. As the head of one of the national systems told me in frustration in March of this year: “Ebola was easy – you knew who was sick and who was not – and you knew that there were not going to be significant numbers of people around who were totally asymptomatic. The implication of this is that we do not know how best to deploy what resources we have.” Personally, I was shocked to hear this. Ebola was the condition we all fear more than any other and to describe it as “easy” to manage is an understatement of course, but the point made is relevant.
- How does this virus get transmitted? We know it's a respiratory virus, and so we also know that we need to manage transmission using hygiene like washing hands and wearing masks in enclosed places – but what are the viruses it behaves like? How does it appear to operate? Initial approaches in early 2020 were based on our response to the flu virus, including atypical flu viruses like H1N1. What is becoming clearer is that it is becoming more likely that this virus spreads most efficiently in a different way. Thus, the most “efficient” spread is not necessarily the more predictable linear spread of flu viruses, but a more random spread. One which is more dependent on the environment – and where certain factors like crowded places, close contact and closed places can give rise to “superspreading” events. We have certainly seen this happen in churches, markets and other places.
The implications around our better understanding of the virus are significant when it comes to how best to manage a test and trace system, as well as messaging. In this context, Japan has been a place where all of this has come together. The public messaging around the “three Cs” – avoiding crowded places, close contact and closed places, and the use of artificial intelligence and data to perform 'retrograde contact tracing' which identifies common places and people within them that seem to be present in high numbers of infected people. This approach then leads to meticulous and exhaustive approaches to manage to identify anyone who was in these places, thus potentially extinguishing transmission emanating from the superspreading events or places.
This is a wonderful real example of how best to use the data we have and how best to manage to reduce transmission by concentrating your resources to get the best potential gain.
We must still learn how to use data more effectively
We now know this disease and its manifestations better, and our knowledge around treatment has also improved. Furthermore, we can also better predict who, out of the people infected, is more likely to require ventilation, which has been demonstrated by countries like Israel who have used existing and historic EMR data and techniques, like the deployment of artificial intelligence to identify insights in this area.
The real lesson, however, is around the use of data and the trust we still need to engender amongst our populations to allow technology to play its part in assisting us in mitigating the worst of this pandemic. The potential of using mobile phone technology or the use of tokens amongst populations to assist in the management of test and trace is starting to be better understood, as are the technological limitations which still exist, although the likelihood is that these will be overcome.
What is more problematic is the fact that this pandemic has highlighted that we have not done enough to assist our populations to understand the benefit of technology and the fact that the use of data to personalise their health and care is in their interest. The conversations about privacy, secondary use of data, and the potential to overlay data which will allow us to deliver a far more personalised and appropriate offering to people have not been well articulated. The potential adverse effects associated with the inappropriate use of data predominate when one looks to the column inches in newspapers or in the media.
'Trust takes years to build, seconds to break and forever to repair'
We need to continue to have these conversations where they have started and start to have these conversations where they have not. If there is something which history teaches us, it is that in places which have had an open vigorous and prolonged debate around the most appropriate secondary use of data, the chances of a successful conclusion increase. By success, I refer to a place where the balance between the rights of the citizen to privacy is given the weight it deserves, and this is balanced by the potential advantages of an individual allowing their data to be used in a predetermined and mutually agreed manner.
These discussions are not likely to be simple, as the journey to get to a situation of trust never is. As we know, trust takes years to build, seconds to break and forever to repair.