Experts have raised the idea of using GPS bracelets to better track people isolating and quarantining. Photo / 123rf
New Zealand has been beefing up its tech solutions to fight Covid-19. Science reporter Jamie Morton looks at some of the areas where smart solutions are already playing a role - and could make a bigger difference.
As our contact tracing teams are again finding with Auckland's latest community outbreak, tracking down all known close contacts of an infected case can be an exhausting, time-consuming process.
How do you recall every person you might have infected - or been infected by - three or four weeks ago?
That very problem means investigators will likely never know the true source of the new outbreak.
It's where Bluetooth-powered proximity systems like New Zealand's new CovidCard can make a difference, by automatically recording all close contacts that meet a certain definition, such as being within 2m of someone for more than a minute.
Last week, the Government announced the credit card-sized card would be used by managed isolation and quarantine staff, ahead of a wider roll-out.
Developed with the help of TradeMe founder Sam Morgan, the card doesn't use location data, nor requires any user engagement – other than simply wearing it.
On a global scale, Google and Apple have joined forces for a comprehensive solution that includes application programming interfaces, or APIs, and operating system-level tech to help contact tracing.
Tim Chambers, a senior research fellow in Otago University's health, environment and infection research unit, said such systems helped fill gaps left by low take-up of tracing apps.
While the Government's NZ Covid Tracer app has now been downloaded more than 1.6 million times, as at last week, only one exposure notification had ever been sent from it.
Chambers cited a recent MIT review of 31 countries, which found public use of these apps was generally abysmal, with an average uptake of 15 per cent.
"Additionally, there has been strong equity arguments around who has access to these solutions," he said.
"Countries like South Korea have legislated the use of telecoms data to monitor citizens movements via GPS technology, which, considering the resistance to the Covid Tracer App and CovidCard in New Zealand on privacy grounds, is unlikely to be politically or publicly palatable," he said.
"Low-tech options like the CovidCard address some of these concerns but there are still questions around public acceptance and privacy that are being considered.
"For New Zealand, if these concerns are addressed, Bluetooth proximity solutions provide the best option for public health effectiveness."
Otago University epidemiologist Dr Amanda Kvalsvig said the CovidCard addressed another big contact tracing blindspot - that not all Kiwis had a smartphone.
"So older people and people on low incomes are less likely to be identified as contacts, but they are the very people who are the most at risk in a Covid-19 outbreak," she said.
"A key point of difference about the technology used by the CovidCard is that it's potentially accessible to all.
"It will be very interesting to see how the card performs in the tests and it will be important to check that people who might be particularly at risk of Covid-19 find it easy and acceptable to use."
Studies are increasingly highlighting how early in an infection Covid-19 can pass from one person to another.
One estimate even suggests half of new infections may be transmitted from a person who's either pre-symptomatic, or not showing any symptoms at all.
Here, Chambers saw an opportunity for a much-hyped area of tech, better known for training elite athletes - wearable technology.
"Data from wearable fitness devices, Fitbits and Oura rings, have been used in real epidemic scenarios to try to detect Covid-19 before people develop symptoms," he said.
"Essentially, physiological data on heart rate, breathing rate and blood oxygen levels from these devices are used in a machine learning algorithm to detect signs to Covid-19 before symptom onset – the device knows your sick before you do."
So far, results have been limited, but nonetheless promising.
One small study carried out at Stanford University showed they accurately predicted Covid-19 before and at symptom onset in 85 per cent of 24 cases observed.
"For New Zealand, this could be a useful tool in our managed isolation and quarantine facilities as we could effectively quarantine people before they have an opportunity to infect other guests and importantly, staff members that move in and out of the real world."
Kiwi researchers have been exploring a similar solution in a matchbox-sized body sensor that can be worn under the arm to monitor whether someone has a fever.
The temperature-reading device, dubbed "Nightingale", is designed to protect those most at risk and avoid cluster outbreaks of Covid-19 in places like rest homes.
The University of Auckland physiologist leading its development, Associate Professor Nick Gant, said the tech could also drastically cut the need for physical contact between frontline medical staff and patients such as rest home residents.
Another local collaboration, called the Cocophany Project, is taking low-cost, smart thermal camera systems designed for tracking predators threatening our native birds and repurposing it to monitor crowds from a safe distance.
The project team, from the University of Canterbury, the Auckland Bioengineering Institute and Callaghan Innovation, are working toward a device that can measure forehead temperature to within half a degree – and all without a person having to operate it.
The Government has also announced it will now be using thermal cameras in facilities - not to detect infections, but to alert authorities to escapes.
Recent escapes from MIQ facilities raised questions over whether all people staying in them should be required to wear GPS-enabled bracelets.
As draconian as that might sound, leading public health experts, like Otago University's Professor Nick Wilson, have already raised the idea.
"New Zealand needs to learn all the lessons possible from the apparent failure of quarantine systems in Melbourne," Wilson told the Herald last month.
"New Zealand could also explore the benefits and costs of the use of electronic bracelets for people, as used in Hong Kong."
There, all incoming passengers are required to wear an electronic wristband that has GPS and is linked to a mobile app.
People are required to map their home once they arrive, and if they leave their home, the authorities are notified and can apply severe penalties.
Chambers said that, for New Zealand, it was likely such devices could be used in MIQ facilities to ensure compliance and reduce the number of security guards required.
"It is possible if MIQ facility strategy is abandoned, which is very unlikely, this may be a suitable solution to ensure compliance of self-isolation at home."
Health Minister Chris Hipkins hasn't ruled out the idea, but at the same time wasn't being drawn on their use.
He previously pointed out the all-of-government response had already improved its systems after a man escaped from a facility last month and wandered about central Auckland for a period.
Following the latest outbreak, the Government moved to send all positive cases to quarantine facilities.
Another big change prompted by the Auckland outbreak - and the disturbing revelation that nearly two-thirds of border workers have never been tested - has been an order to ensure all MIQ staff get regular tests for Covid-19.
The importance of that has been under-scored by new modelling by Te Pūnaha Matatini, which found a weekly testing regime doubled the chances of picking up Covid-19 before it could spread further.
The modelling found that early detection of an infected worker could limit an outbreak to fewer than three people, compared with potentially 17 people if it was only picked up in someone who had already been infected.
University of Canterbury modeller Professor Michael Plank said while the 14-day quarantine period remained a crucial defence measure, boosting staff testing was also important.
"Weekly testing of border facing workers gives us a much better chance of detecting cases, like the Rydges maintenance worker, before they have a chance to start a large outbreak."
Another of the paper's lead authors, University of Canterbury researcher Nic Steyn, stressed that messages like isolating when sick, and getting tested if there were any suspected symptoms, remained critical.
"Even with weekly tests there is still a roughly 20 per cent chance it will be missed in the first worker, which is when this becomes important."
How could we improve the quality of testing beyond just requiring more of them?
Scientists at ESR are exploring the potential for saliva tests, which could prove more sensitive and effective than the nasal swabs currently used in New Zealand.
Massey University's Dr Nikki Freed saw border workers as excellent candidates to use rapid and minimally invasive techniques such as the SalviaDirect method developed by Nathan Grubaugh and Anne Wyllie at Yale University in the US.
Recently given emergency use authorisation by the US Food and Drug Administration (FDA), SalivaDirect was well suited for groups of people who needed repeated testing.
"Asking staff who work at the managed isolation and quarantine facilities to submit a saliva sample each day, or every few days, along with routine temperature checks and health questionnaires, could be a way to frequently screen these workers without causing them too much discomfort," Freed said.
"I think the Government is doing an excellent job of continually updating their response and strengthening border controls.
"We knew the possibility of an outbreak was very likely, and it does look as though we have caught the current outbreak in Auckland early.
"The massive levels of testing, contact tracing, and willingness of people in Auckland to stay at home during level 3 has shown it may be possible to stamp out this new outbreak."
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