"It's shocking," says Otago University public health professor Nick Wilson.
He's talking about the final report of the Contact Tracing Assurance Committee, led by Sir Brian Roche, released by the Ministry of Health yesterday.
The academic is not criticising Sir Brian's work. He says the report's recommendations on contact tracing are sensible.
They include stress testing the current system as soon as possible, moving all 12 public health units involved onto common standards, and increasing capacity from 350 cases per day with surge capacity for 500 (as of the end of July) to being able to handle 1000 cases per day.
But he does have a beef with the report's narrow remit.
Why did it only focus on manual contact tracing, Wilson asks.
The Otago academic thinks any state-of-contact-tracing in NZ should have looked at four areas:
1. Manual contact tracing
2. Bluetooth tracing apps and cards
3. The use of telecommunications data to track people's movements
4. Overseas models we can learn from
And he says another technology option recently put forward by entrepreneur Sam Morgan - using simple txt surveys to poll the NZ population en masse about its well being, the better to target where testing stations should be deployed - would also have been worthy of further investigation. It would have the near-universal reach of those emergency txt messages used by Civil Defence, with the cooperation of Spark, Vodafone and 2dgeees, but have a response option.
Wilson stresses he's not anti manual tracking or pro-technology per se . Rather he sees manual contact tracing, Bluetooth tracking and the use of phone data as complementary. We need every piece of the jigsaw for a world-class contact-tracing system. Currently, we only have one, he says - as someone who sees the NZ Covid Tracer app, with its lack of automatic Bluetooth tracing, as essentially an extension of the manual system.
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"You just can't deal with a large outbreak with manual tracing alone," Wilson says.
"And so that's why things like the Covid Card are good. But we've just been so slow as a country. The [private Covid Card] Nelson trial finished in May. And it was only just recently the Government started talking about the Rotorua trial. It's potentially good technology, but we've just got to get on with it."
Apple and Google's tracking technology
Beyond a Covid Card, Wilson said, " I think we've also got to explore what Ireland and Spain are doing with Bluetooth-enabled smartphone apps using the Apple-Google platform, because a recent Spanish trial showed that using those apps doubled the success of contact tracing in a trail they ran on the Canary Islands."
Apple and Google (which makes the Android software that runs nearly every non-Apple phone, recently teamed to create Bluetooth tracing technology that stays on all the time (a key bugbear with tracing apps created by third parties).
Our Government's official tracing app, NZ Covid Tracer, has got more capable, and downloads and scans have both sharply increased since QR code posters were made mandatory for every business. The MoH said earlier this week there are now more than 1.83 million people registered for NZ Covid Tracer, with an average of more than 1 million scans per day over the past seven days. Scans should jump again from next Monday as QR poster appear on public transport.
But Wilson still sees NZ Covid Tracer as essentially a manual digital diary. The government has said it's open to upgrading NZ Covid Tracer for Bluetooth tracking - possibly via the Apple-Google solution - but so far there's been no action.
"From my perspective, it looks like extreme "path- dependency', when an organisation goes down a particular route and it's got an inability to admit that there are better alternatives and to switch. You think in the crisis, there would be a bit more of that ability to be flexible."
Where telecommunications data fits in
Spark, Vodafone and 2degrees can track you via the movements of your mobile, no tracing app requited. They just know where you are on their network (not that its information they ordinarily access, or hand over without a warrant).
Statistics Minister James Shaw signed off on a Statistics NZ trial that used this capability to track the movement of people around the country - one of several real-time data sets that Shaw said will likely replace a manual census (although a 2degrees boycott over privacy issues will have to be resolved first).
The Statistics NZ data is anonymised but, after ensuring a number of safeguards, Privacy Commissioner John Edwards recently signed-off on new regulations that allow emergency services to use your cellphone movement data to track you without your consent - if there is a situation where your well-being is imperilled. For example, you're being held hostage or lost in the bush.
Wilson says this sort of telecommunications tracing data - especially if combined with GPS data - can be vital in combating Covid.
"The gold standard is probably South Korea with its use of telecoms data" he says. Back in April, it was dealing with 800 new cases a day, then it was heading towards elimination before their church outbreaks in the last few weeks."
A similar plan in Israel to use a Mossad system for tracking people via their cellphones faced a popular backlash.
"But South Korea worked through it. They're a democracy and so are we," Wilson says. As a temporary, emergency measure, people could be sold on the benefits.
And he says they could be quite practical.
To his mind, technology - bluetooth-capable smartphone apps, Covid Cards and telecommunications data - have got to be part of the picture.
He wants us to start ASAP with compulsory use for high-risk workers, such as those working at quarantine facilities, or airline crew.
"At the moment, there's nothing to stop a member of an airline crew going to a wedding with 200 people if we go back to alert level 1," he says.
"It would add an extra level of safety were carrying a smartphone with a Bluetooth app or a Covid Card.
"We do need to roll these out to the whole population. But we can learn a lot with these high-risk worker populations.".
It's the speed, stupid
Ian Taylor, a member of a loose-knit group of tech entrepreneurs who have been promoting a Covid and other tech-based solutions, praises contact tracing staff for their "super human efforts."
But he also considers it a certainty their success has been over-stated.
The Ministry of Health recently said, "The key measure we use for contact tracing effectiveness is 80 per cent of people contacted within 48 hours, and for the period August 6 – 12, we have contacted 86 per cent of those close contacts within 48 hours.
But Taylor's point is that manual contact tracing located 86 per cent of the close contacts that people could remember (with a bit of assistance from NZ Covid Tracer app and Hop card data).
If most of us were wearing a Bluetooth-enabled Covid Card on a lanyard around our neck, the actual number of close contacts would probably be revealed as many times more.
The Animation Research founder doesn't think it would be logistically possible to bring on thousands of more staff for manual tracking.
But even if it was, he would favour completing the current manual tracking system with Bluetooth tracking instead - ideally through a Covid Card to get around the problem of not everyone having a smartphone, the many and varied-strength Bluetooth standards used by different phones, many not downloading an app, or not always having it enabled. Wearing it on a lanyard around your neck is for clear transmission - unlike a smartphone in a handbag or jeans pocket.
It would lead to a more accurate and complete list of close contacts, Taylor says but, more, faster contact tracing.
Take the man who was diagnosed with what turned out to be community transmission - precipitating the current Level 3 lockdown in Auckland.
If he had been wearing a Covid Card, a health professional would have been able to download its data of other card wearers he had been in close contact. "And a contact tracing team would have been able to have got all of that information within half an hour - including all the people he couldn't remember being in close contact with, or didn't even know about."
He adds, "Looking at that day, he tested positive at 2.30pm, the Prime Minister was informed at four o'clock and by seven hours later, all they could tell us was four people in South Auckland were infected. With a Covid Card, we would have had every contact for that guy for the last three weeks."
As things stand, Taylor says manual contact tracing efforts have been heroic, but they still haven't identified "patient zero" in the current Auckland outbreak.
Sam Morgan, who funded the development of a Card Card, trialed at Nelson Hospital earlier this year, says adoption needs to be around 80 per cent for effective automatic tracing. For those who are dubious about compliance, he the government successfully nudged us into staying at home for six weeks over March and April, and nearly all of us carry a driver's licence.
The Trade Me founder had essentially written off the Covid Card's chances, however, when contacted by the Herald earlier this month. Rather than being please the government had announced its own Covid Card in Rotorua, he saw it as a "political sop". In his view, the MoH had no real interest. "We don't see any will to do it," he said.
Government ministers respond
Communications Minister Kris Faafoi referred questions on the status of the Rotorua Covid Card trial to the Ministry of Health, where a spokesman said:
"The CovidCard trial is currently partway through the design phase. We expect to complete the trial around the end of September, with a report to Cabinet by the end of October. Work to date has included engaging with community leaders, Iwi, PHUs, DHB, DIA, MBIE, NZCT as well as a wider team of people covering technology, policy, legal, data, market research and other key elements of the work."
Earlier, the MoH did say it was open to Morgan's idea of a Daily Health Check survey.
It won't won't consider it in Morgan's desired low-tech, far-teaching txt message format (think how those emergency message txts reach most).
"However, the daily health check-in is being actively considered for a future update to the NZ COVID Tracer app. The Ministry had considered including the function earlier but decided to concentrate in the first instance on major functionality such as the ability to manually add locations and the exposure alert, which is critical to contact tracing," a ministry spokesman said.
Asked why the Roche report was largely restricted to an assessment of manual contact tracing, Health Minister Chris Hipkins sent a statement which essentially skirted the question and instead looked ahead.
"I am encouraged by the way the contact tracing system has responded during the recent outbreak but the Government has not wavered in our view that we need to continuously find ways to improve it. Getting access to rapid and quality data is an important part of that," Hipkins said.
"We have and will continue to update the tools we have now but have never said they are the only options.
"We also need to be very clear here that, while we are watching and learning from technology developments overseas and are trialling new technology in New Zealand, no country has yet found a silver bullet approach.
"The best solution for New Zealand will have to take into account our culture and norms and the wide range of available consumer platforms. It will involve a mix of technology - and we are agnostic on where it comes from - a regularly-updated Tracer App and manual processes.
"There is no doubt this remains a critical workstream."
Taylor said he had been told Faafoi would not be presented with any Covid Card test results
"The other day, Kris Faafoi said, 'We're looking at some interesting technologies overseas, but I don't imagine I'll be presenting anything on a Covid Card before Christmas.
"It's so frustrating. My image is Nero fiddling while Rome burns. And Rome is on fire. We can't have Faaroi sitting around playing his fiddle."
But on the upside, if New Zealand does get its act together and embrace a Covid Card, we could be world leaders - and licence it around the globe, Taylor says.
Things hang in the balance.
POSTSCRIPT: The scope of manual tracing
How many people are on the case for manual tracing?
The National Investigation and Tracing Centre (NITC), based at the Ministry of Health in Wellington backs up and supports the great work being done by Public Health Units and DHBs around the country, a MoH spokesperson says.
Staff numbers in our NITC vary depending on the number of cases and close contacts identified. During the recent response we had mobilised up to 700 callers to undertake contact tracing and follow up calls. However, the number required was much lower than this, the spokesperson said.
The NITC currently has capacity in place to make up to 10,000 calls per day if required.
Calls are generally made within the hours of 8am - 8pm 7 days per week.
Public Health Units have capacity in place to manage up to 350 cases per day with surge plans to scale to 500 cases per day if needed.
The Ministry of Health is also building case investigation capacity through training of staff from across All of Government. A training programme is underway to manage up to 500 additional cases by the end of September.
By this morning 2475 close contacts had been identified in the Auckland cluster, of which 2433 have been contacted and are self-isolating," the spokesperson said. "And we are in the process of contacting the rest. This includes those managed by the NITC and PHUs."
Locating 98 per cent of close contacts is impressive on the face of it, but proponents of a larger technology element in tracing point out it can help locate close contacts more quickly - and uncover contacts people had forgotten, or never been aware of (see main text for more).