Coronavirus - the science: The merits of app trackers and face masks

Edition 4: Countries wrestling with mask policy but there are slivers of good news

This is a series of regular updates from Irish Times Environment & Science Editor Kevin O'Sullivan on scientific initiatives and developments on coronavirus. Previous editions can be found here.

App effectiveness

The HSE is set to roll out the use of a smartphone app to facilitate contact tracing in Ireland. When the owner of a device with this app installed tests positive for Covid-19, data may enable tracing to take place more efficiently and more quickly.

Apps, which allow people to move around after lockdown, have become an integral part of Chinese authorities’ management of citizens. They give users colour-coded designations based on their health status and travel history, and a QR code that can be scanned by authorities.

The apps are specific to each city or province. People given a green code are allowed to travel relatively freely. A yellow code indicates the holder should be in home isolation, and a red code says the user is a confirmed Covid-19 patient and should be in quarantine.

Privacy issues aside, apps initially provide indication of infection within communities. Once a peak is negotiated, they can provide key data while rowing back on lock-in measures.

An Oxford University study published in Science underlines the merits of an app using bluetooth to keep a log of all other app users a person has been in close proximity with over a few days.

Epidemiologist Prof Keith Neal of the University of Nottingham says it does not provide any direct evidence apps control epidemics without the need for quarantine. "They are probably contributing to management of the epidemic," he concedes.

“One concern is that geotracking is a key part in the methodology. If too few people sign up it can only have minimal benefit. Uptake would need to be high and too many people may complain about the big brother aspect of the methods and opt out.”

If used, it could always be deleted afterwards from the phone when the epidemic is over, he notes. All told, “It is well worth trying.”

Contrasting views on merits of wearing face masks

Austria has made wearing face masks outside the home compulsory. Now other EU countries are considering changing their position. France initially advised its citizens not to wear masks, then said they should if they were infected or working in care or retail. Resolving differing messages may be at hand.

The US Centers for Disease Control and Prevention (CDC) is having second thoughts on its advice that people did not need to wear them unless they were sick and coughing, or were caring for someone who was. Cases doubling every two to three days in the country is prompting re-evaluation.

CDC data show high rates of transmission by people who are infected but don’t know it yet. An infected person can be contagious for 48 hours before developing symptoms, if they get them at all. Wearing a mask could cut down on the number of transmissions from asymptomatic people.

It is now considering whether to recommend everybody wear one when out in public but not a high-grade “N95” medical mask. Those are scarce as evidenced by huge shortages on healthcare frontlines.

Ordinary surgical masks and even homemade masks will do in helping to slow transmission in the community, though they don’t ensure complete protection for wearers, it says. while wearing any kind of mask, even a bandanna, will make you less likely to touch your face – an important route for infection.

The WHO, however, has been recommending people not wear a face mask unless they are sick with Covid-19 or caring for someone who is sick on the basis that there was no specific evidence to suggest wearing of masks by mass populations has any potential benefit.

"In fact, there's some evidence to suggest the opposite, in the misuse of wearing a mask properly or fitting it properly," insisted its health emergencies director Dr Mike Ryan.

“Right now the people most at risk from this virus are frontline health workers who are exposed to the virus every second of every day. The thought of them not having masks is horrific,” he said at a briefing.

But new evidence from Hong Kong has prompted a reconsideration of the role of face masks since, which is set to prompt a big change in advice. And the WHO is pragmatic and changing its position in line with what science is saying.

Research voids

The scale of global research efforts to counter Covid-19 is awesome. Most effort is concentrated on generating vaccines, treatments and enhanced/quicker testing ability for the virus, and for antibodies post infection.

Accurate/quick antibody tests will soon become critical in countries that have blunted that rising cases curve because it will determine to what extent lock-in may be eased and when medical workers can return to frontline care.

What is truly amazing is how speedily teams of scientists all over the world are engaged to evaluate collectively options with best potential – in a scenario where there is no cure for coronavirus.

One glaring gap has emerged; lack of understanding of psychological and social impacts caused by pandemics.

Researchers at the University of Sheffield and Ulster University are addressing this by surveying 2,000 people, and hope their findings will help inform better management of future public health crises, including how quarantining people may affect their mental health.

“This is one of the first studies of the ‘psychology of epidemics’ during perhaps one of the biggest existential threats the world has faced this century,” explained Dr Jilly Gibson-Miller, a specialist in health psychology.

A rise in depression, anxiety, paranoia and authoritarian views, and reductions in people’s sense of trust and control over their own lives, is anticipated.

“We know what an important role human behaviour plays in the spread of an epidemic,” she adds, “I’m particularly interested in the extent to which people are carrying out protective behaviours, such as hand-washing and social distancing, and whether they feel they have sufficient motivation, opportunity and capability to do so”

Grounds for optimism

Community action delivers: Contact tracing associated with confirmed Irish cases of Covid-19 shows infected people in early March had contact with 20 others on average. Curtailments forced that down to 5 by last week – and to just 3 in recent days coinciding with a near lock-in scenario. A stunning achievement by ordinary people but that darn curve has not been flattened yet.

Pharma heavyweights make progress: Johnson & Johnson have a potential vaccine that could be available early next year while Abbott Laboratories are launching a rapid test kit. The US government is to invest $1 billion in J&J's candidate. Abbott's test could take as little as five minutes and be run on a portable machine the size of a toaster.

Testing enhancement: Scientists at the EU's Joint Research Centre (JRC) have designed a new "control material" that labs can use to check the correct functioning of coronavirus tests.

A positive control material guarantees laboratory tests are working correctly and are harmonised. It is used to prevent a test giving a negative result even if the person is positive. In this case, it is a synthetic, non-infectious part of the virus.

The JRC identified a potential gap in management of the pandemic and immediately set to work to fill that gap. It has the potential to improve capacity to respond and avoid valuable resources being wasted by inefficient tests.