As the WHO keeps emphasising, the key to controlling a Covid-19 outbreak is to ‘Test, test, test’. The UK have said in multiple press conferences that they are doing their best to rapidly increase the country’s testing capacity. However, the numbers of tests that are being conducted each day are simply inadequate: priority is given to NHS workers, politicians, and those who have the disease in its most severe form, leaving those who have mild to moderate symptoms in the dark. Thousands of people could be self-isolating without needing to, whilst thousands of others are still going out for their daily exercise and to buy groceries whilst they carry the virus unknowingly. To mitigate the effects of Covid, we must be more aware of the outbreak in different communities. There are numerous apps already created which aim to trace contacts of people who have tested positive for the virus. These kinds of apps have sparked rebuttal across the globe, with people worrying about their privacy and the ways in which their data will be used. Here's why I believe there is an opportunity to release a new app, where the aim is not to control people and restrict their freedom even more, but to research the virus and understand it better.

Everyone who lives in countries affected by Covid-19.

Without adequate testing capacity, we must think of another way, based on people in the community, to understand the spread of the virus. There is already an NHS app being developed which looks to trace contacts of people who have been tested positive for the virus. This has been developed in order to try and control the second peak of infections once lockdown rules are lifted and restrictions are eased. However, it currently operates on an opt-in basis. This will be ineffective – how are we going to get a realistic vision of infections in the community if only those who want to be included in research are included?

The idea is to make it compulsory for EVERYONE to log their symptoms daily on an app. It doesn’t matter if people think that they are asymptomatic or completely healthy, because some people are minimally affected and have very minor symptoms. People must log how they are feeling every day, regardless of if they’re feeling ill or not. Symptoms such as tiredness, energy levels and gastric movements should all be logged onto the app. This is because the virus presents itself very differently in different people; some people will suffer from gastric coronavirus, which is an irritation of the bowels, and some will not notice any symptoms apart from a sore throat or muscle stiffness. We must eliminate the idea that SARS-CoV-2 simply causes a high temperature and a cough. Unfortunately, these are the narrow guidelines that the government use to advise people to self-isolate, but the truth is that symptoms vary greatly from person to person, and so positive cases could be easily dismissed as something else. For example, it is very likely that people will dismiss muscle soreness as DOMS from a workout the previous day, or link their unusual fatigue back to a bad night’s sleep, when actually it could be Covid-19.

Logging symptoms across the community would give a more realistic vision of the outbreak, eradicating any blanks where testing was not logistically or economically viable, thus helping the government to make decisions regarding the gradual lifting of lockdown. It could also help the government to understand the progression of the virus better: some people might not notice their symptoms until they get serious, by which point the case could be a week into infection. This kind of information will be unbelievably valuable to people in foreseeing whether they will develop more serious symptoms, and how the outbreak is progressing in different parts of the country. So, this app should be automatically downloaded onto everyone’s mobile devices, with daily reminders mechanised to tell people to log their symptoms that day. Everyone should be assured that the app does not trace their location or use data about their contacts in any way.  The sole aim is to learn about people’s health during this pandemic, in order to predict community based outrbeaks of the virus. Yes, it’s true, testing is the most reliable way to understand the outbreak across the country – confirmed positive cases are the most reliable source of information. However, it’s been proven through lack of testing capacity and funding that it simply isn’t feasible or achievable to test every individual displaying symptoms. Therefore, we must turn to strength in numbers, and trust that people will be honest about their symptoms, so that we can research the virus more effectively.

The goal is to create a new app to accommodate a daily log of symptoms from everyone nationwide, before having it automatically downloaded onto everyone’s phones in the UK. Any ethical concerns should be set aside – it is unethical to force people to stay inside for the best part of two months, but it was a necessary and effective method introduced by the government to halt the spread of the virus and alleviate suffering. In the height of this pandemic, the app’s main purpose would be to understand and trace the virus’s progression (or regression) in communities, but once Covid-19 has subsided, it has the potential to remain a very helpful tool for the NHS. For example, from a nationwide point of view, the app could be used to predict the time and severity of annual flu epidemics. From an individual’s point of view, it’s very possible that the app could be of use in understanding cancers, as they vary from person to person. For instance, if a patient is diagnosed with some form of cancer, and has been logging their symptoms on the app daily, the medical team will have access to the patient’s personal history and will be able to gage how long the cancer has been suspected, and make informed decisions about what treatment will be effective and when. This is just an example of the app’s long term possibilities.

Participants should, however, be assured that their personal health information will not be used by anyone other than the researchers behind the app. Their information will remain private and anonymous, until it is needed for personal use (such as aiding a diagnosis, at which point the app would be used by the NHS to help understand a patient’s history).

Given that the idea is for a symptom logging app, resources aren’t a particular burden on the project. Any resources associated with it are all technological things such as data caches – although creating these things may seem complicated, there are plenty of individuals and companies who are perfectly capable of doing so with the necessary IT and coding skills. I detail on this further in the technological section of the implementation plan.

The app is a resource that would greatly help both the government and the National Health Service in dealing with the pandemic, and it’s safe to assume that both these bodies have the capacity to create a successful app. So, to be simple, we must have a team of IT professionals to help us create and develop the app, in order to get it up and running successfully and faultlessly. After all, if this app is to carry the weight of our entire population’s daily symptoms, it must be powerful and effective enough to do so.

At the end of the day, the most important team in this project is our nation’s population. It is their co-operation that will ensure this app’s success, and so we must emphasise that only through teamwork and commitment to this app will it be successful. In order for the app to be used in the best way and for us to gain as much as possible from it, there are a few teams of people we would need to get involved. First of all, in terms of enforcing mandatory symptom logging, the government has to be willing to back the idea. Australia, India and China are already turning to technology and apps to find ways of researching into Covid-19. There is no reason why the UK shouldn’t be able to do the same. After all, the country readily applauds the NHS every Thursday evening – I would like to think that they would be just as keen to help their healthcare service for a minute each day, in order to potentially personalise and improve their own care for when the time comes.

Once the app is in use, and people are logging their symptoms daily, we would need experienced statisticians to analyse the data in order to communicate it to health experts, who can apply the information in the best way possible. Both these groups of people regularly work together in the status quo, and have strong ties to the government, meaning that the teamwork between these two teams would be easily achievable.

An advertising or communications team would be key in implementing this idea; in order to receive the public’s support, we must inform them in a clear and concise way of what is expected of them. We must create short explanation videos and advertisements, which would come on screen when the app is auto-downloaded for the first time, to explain to the public exactly why we need their help. If this is done as truthfully as possible, and that the benefits of this activity being mandated are heavily addressed, I don’t doubt that we will gain the necessary support from the public. We must also reassure them that they will not be named at all, or traced for that matter, and that their symptom logging is simply for research.

It’s key that we begin to implement this idea as soon as possible, whilst this pandemic is still going on. It would help the UK government with easing restrictions, as they’d have a better vision of the virus’s progression in different parts of the country. The implementation phase would need to include a trial of the app in a specific part of the country, in order to understand its strengths and weaknesses once released. I intend on implementing this idea by the 1st of June, at which point lockdown and restrictions might start to loosen in the UK. Having this app up and running by that point would allow the UK to monitor the R value of the virus more carefully. At the moment, the virus’s R value is calculated on the basis of current confirmed cases, and further predictions and mathematical models. There is much room for error here, because factors such as eligibility for a Covid test, and then the delay of getting the results back, and then the test result itself’s reliability must be considered. If everyone logs their symptoms daily, and this is mandated, the government and their scientific advisers would have a much more reliable and realistic platform of evidence on which to make decisions regarding the lockdown exit strategy.

To conclude, I envisage this app to be in its implementation phase by June 1st. 

The boldest and most unique thing about this idea is the fact that it is mandatory. It is intended that this will be a universal activity, in that the app will be automatically downloaded to all, and that the public health campaign would explain that mass participation is key to providing the necessary data for the NHS and Public Health Wales to tackle the next stages of the pandemic and direct resources . Clearly there would be no plan to waste time and money in enforcing punitive legal action against members of the public who refuse to log symptoms (and of course data given under coercion would very likely be false), but see below for the reasons why we believe that sufficiently large numbers of the public would support this action, both for communal and personal reasons. So, the expectation is that everyone must participate and log their symptoms in their app daily. I’m aware that this would spark questions from the public about data protection and the ethics of using personal health data. However, I must emphasise that this is not a contact tracing app; no GPS signals or details about contacts will be used in this project. The sole objective is to better understand the virus and its progression in different people, in terms of age, sex and ethnic minority, and in different areas of the UK. This would be highly beneficial in both the short term, whence it will be used to mitigate the virus’s effects on the community, but also in the long term, if this virus mutates into a similar strain and causes another wave of infections. More ambitiously, but entirely realistically, this app has the potential to become a helpful tool with longevity. The NHS could use this app to their advantage, in order to improve the efficiency of their healthcare system. As the objective of modern medicine rapidly moves towards preventative medicine, this app, if it proves successful, could play a huge part in our modern healthcare system.

For the time being, though, we must focus on it lessening the social effects of the Covid pandemic. This app will be easy to use, comprehensive, and simple. The main unique selling point is that it is compulsory – it should pave the way to revolutionising healthcare. The weekly street claps for the NHS have been fantastic, and the gratitude shown towards this admirable organization is a symbol of how the pandemic has brought people together. We must ask the people of Britain to do one thing – if they would like to see their NHS survive, they must all do their part to help. A minute at the end of each day to click a few buttons on their screens is all we ask. Its positive effects will be clear to see.

Just to be clear, the public’s likely concerns about anonymity will be addressed, and so I have come to the conclusion that the data logged onto the app will remain anonymous whilst it is being used for research. That is, by logging their symptoms, the user is consenting to their data being used in a general way (in order to view basic trends in Covid infections in their area), but they shall remain unnamed. The only occasion where the subject will be named is if their symptoms develop into potentially harmful ones, at which point the app will notify them that it’s best to consult their GP. This way, we can monitor serious Covid cases more closely, and advise patients on what to do based on their symptoms and not on their background. When that person has been advised to consult with their doctor, they must sign a form which will give the NHS consent to access their symptom journal on the app in order to establish the development of their infection. With this in mind, we will not need to breech people’s privacy by naming them unnecessarily. They will always be asked for consent to look into their individual symptom database, with the sole purpose of improving their care based on their personal needs.

Since I live in Cardiff, the capital city of Wales – a country with a modest population of around 3 million – I plan on implementing and testing this app in my country. This is for multiple reasons; living in the heart of the capital city would enable my team and I to develop the app in the country where it will be utilised first. This would be easiest in terms of logistics. Also, a population of 3 million is realistic to begin to partake in research – it is more than enough to generate a reliable sample, whilst also being small enough for a first trial. As Wales is a country in itself, there are no issues regarding who’s meant to participate in the implementation phase and who isn’t – everyone who is a resident of Wales must partake. Some might say that including an entire country in the implementation phase is too ambitious, but I believe that this would be most effective – beginning the project in specific counties or cities would cause various problems to arise, such as who is included in the trial and who isn’t. Also, one of the main goals of this app is to understand the progression of the virus in various regions of the country, and so limiting it to a single county at first would defy the objective of the research project.

The Welsh government have been handling the Covid-19 pandemic themselves, independently of the UK government; major decisions such as closing schools and extending lockdown were made by the Welsh Government before the UK government. I believe that introducing such a powerful weapon in fighting the virus would help to give Wales more recognition and strength as a nation, and would reinforce the idea that each nation must deal with the virus in their own way.

In an age where we rely so heavily on apps, developing one to help track Covid symptoms is not a problem. In 2019, on average, 1,434 apps were released through the Apple App Store every day. In a modern and technologically advanced era, we are fortunate to have technology at our fingertips.

The wireframe for any app being developed needs to provide clarity and functionality. Here, clarity would come from the questions being asked regarding the symptoms. These should be sequential and framed in a way as to make the development of relevant statistical data as easy as possible. The app would also need to use icons and be as simple and accessible as possible in terms of the text used; the literacy rates for the wider population cannot be taken for granted and must be as user-friendly as possible.

The government will need to override any concerns regarding people’s personal liberty in making sure that this app is auto downloaded whether the smart phone is Android or Apple. They have the capability of making this happen on everyone’s device and ensuring that it remains there. An app on average takes 2-3 weeks to develop and implement. The government should have few problems in engaging the greatest IT minds on the planet in developing a fool-proof app in this respect. Notification settings on the public’s devices would also allow for a constant reminder to be given to the individual to track their symptoms on a daily basis. A dedicated support team would also make sure that any technical problems could be diagnosed and sorted and for anyone without a smart phone they can download and install the app using Google Play store to facilitate its use on a PC or laptop. The data, once uploaded, will be held by federal government on an Amazon Web Services server in each country.

The app would reduce the numbers of Covid tests required by the UK Government at a time when one test costs approximately £47. There has already been $20 million spent on tests that have not succeeded in the UK. Creating an app to track symptoms therefore reduces the demand for these antibody tests. It makes economic sense in that this should save millions for the government daily. Creating the app is a third of the cost of one antibody test, to put things into perspective. No, it’s true that simply logging symptoms will not be as effective as tests for the virus, but by mapping the different symptoms nationwide, the government and NHS should be able to gain a vision into its spread. Logging symptoms also take far less time than tests; by the time a patient would develop symptoms to the extent eligible for a test, they would probably be a few days past the incubation period. In addition to this, test results take around 72 hours to be released from the laboratories, which causes further delays in statistics. Even then, the results aren’t always reliable – the Covid-19 tests have a false negatives rate of 30%, which is astounding.

The development of this app will create important jobs at a time when the Covid outbreak has led to an economic downturn. A dedicated team of statisticians would be required to process and analyse the daily data produced. It would also bring an opportunity to develop a tech-team which would be responsible for running the app and dealing with any teething problems. This same team would then be engaged on a longer-term basis in ironing out any snags and ensuring that improvements are consistently made.

The present lockdown is not economically sustainable. Chancellor of the Exchequer Rishi Sunak’s furlough scheme comes to an end in June. It costs the UK £2.4 billion a day and many companies are reaching the end of their cash reserves, if they have not been forced out of business entirely. The app should facilitate greater economic activity as people would once again be freed to return in some capacity to their everyday working lives and not be dependent on the state for 80% of their wages. The app would therefore play an integral role in the overall exit strategy.