Abstract
The effects of COVID-19 on global societies are profound. The United Kingdom's approach to viral infection notifications and tracking in response to the pandemic can be used as a lesson. More specifically, it can assist in lessons learned in helping identify an alternative approach to improve epidemic containment management. Rather than use the UK's Coronavirus smartphone application, as implemented by the National Health Service's digital arm and Department of Health and Social Care, this study promotes a different approach and justifies the conceptual model pertaining to a distributed test, track, and trace system (DTTTS). By using soft systems methodology, this chapter discusses how the latter can provide a more meaningful and reliable disease surveillance strategy. The study purports that soft systems methodology can break down the defined problem. In addition, applying systems thinking will justify how the DTTTS model could be used in the real world to fulfill data processing and interoperability considerations for epidemic containment measures.
TopIntroduction
The aim of this chapter is to provide logical and nuanced evidence regarding the United Kingdom’s (UK) response to the coronavirus disease (COVID-19) outbreak. More specifically, review the UK’s adoption of e-health and telehealth methods that were directly influenced by the pandemic. Building on publications by Bird (2020a, 2021), this chapter explores an alternative approach to the COVID-19 smartphone application used by the UK National Health Service (NHS) Test and Trace service. This alternative approach can be used to discern how far viral infections have spread across the country, as well as how widespread COVID-19 has infected society itself.
Research Aim
This chapter analyzes the past use-case of the NHS Digital (NHSx) smartphone application (herein referred to as the NHSx app), by applying soft systems methodology (SSM). This research paints a picture of an alternative technology option in which a distributed test, track, and trace system (DTTTS) model can be used instead.
Using evidence sourced from a literature review from many reputable sources this chapter employs the SSM seven-stage model as a means to discern, and make sense, of the existing NHSx app. The seven-stage model is used to scrutinize the real-world problem to identify gaps within the NHSx app ecosystem and uses systems-thinking for problem-solving purposes. The author explores the alternative DTTTS approach proposed in Bird (2020a, 2021) and undertakes a compare-and-contrast analysis to highlight the pros and cons of both the NHSx app and the DTTTS.
The author is able to establish that the DTTTS concept could be a key enabler to help the UK Department of Health and Social Care (UKDHSC) respond more effectively and efficiently to an evolving severe acute respiratory syndrome (SARS) epidemic. Thereby, the DTTTS concept could enable the UK Health Security Agency (UKHSA) rapidly deploy epidemiological surveillance (ES) teams to viral hotspots, and their proximities. Enabling the UKHSA ES teams to select further test subjects for additional testing in order to monitor the spread of infection and by doing so inform UKHSA containment decisions and requisite actions by the UKDHSC. As a consequence, the author is able to justify how the DTTTS conceptual model could provide additional benefits hitherto not realized through the NHSx app.
Background
On July 19, 2021, the prime minister of the UK relaxed England’s legal restrictions used to counter the COVID-19 pandemic (Shearing & Lee, 2021). Contact tracing efforts were conducted in the most part via the NHSx app implemented by the NHSx service organization. The NHSx app formed part of a wider ecosystem for the NHS Test and Trace service. The wider contact-tracing ecosystem also included more person-centric efforts such as calling registered phone numbers assigned to individuals across cellular and public switched telephone networks. Citizens of England, and the devolved nations, were encouraged to download the NHSx app, or variants thereof developed for each of the devolved nations and these were still part of the wider NHSx app system. The NHSx app system was then used to detect whether people had been in contact with or in the proximity of someone who was suspected or had subsequently tested positive for the virus.
Amid the wave of infections in 2021, there was a considerable rise in alerts from the app. This was known as the “pingdemic” (Lynch, 2021). After making several concessions to avoid highly dependent areas of industry from grinding to a halt, the Secretary of State for Health and Social Care, on behalf of the UKDHSC, considered adjusting the sensitivity of the associated NHSx app system (Wearmouth, 2021). While infection rates from the Delta variant at the time were on the decline, hospitalizations and death rates were on the rise due to the first strain of Omicron.
Key Terms in this Chapter
National Health Service (NHS): Is a national healthcare system that is sponsored by the UKDHSC under government administration and is publicly funded by citizens, and people with a right to work in the UK, through national insurance deductions taken from their wages ( Tikkanen, 2023 ).
National Cyber Security Centre (NCSC): This organization is the UK’s National Technical Authority responsible for cyber security matters in line with the National Security Strategy. It provides influence, advice and guidance to stakeholders and practitioners within both public and private sectors.
Polymerase Chain Reaction (PCR) Test Kit: Specialist test kits that are used to take a swab sample from test subjects, which are then stored in a liquid vile and uniquely barcoded for transportation to medical laboratories for processing. The PCR results are considered the most reliable method of testing for SARS-COV-2 because analysis of each test sample is conducted by specialized staff within registered medical laboratories ( National Health Service Test and Trace, n.d. ).
Concept of Operations (CONOPS): Is a documentation set that diagrammatically and descriptively represents the operational use-case for a system. It also contains configuration and support aspects, work flows and modus operandi for its operation by authorized personnel.
Epidemiological Surveillance (ES): Is also known as shoe leather epidemiology in which teams from UKHSA can be deployed into society in order to survey the environs of an infection and utilize several swab testing methods (defined below) to collect samples for analysis. These tests can be used to determine viral spread in the case of the SARS Coronavirus 2 (SARS-COV-2) strains that underly the COVID-19 disease ( Bird, 2020a , 2021 ).
Rapid Lateral Flow (RLF) Test Kit: This type of test is also known as an antigen test which can be self-administered by test subjects who take a swab sample from the back of their throat and mix it with a specially designed solution. The solution is then placed onto a test strip and within 30 minutes the RLF test strip provides a visual indication of whether the test sample is positive, negative or invalid. RLF tests are far quicker, but potentially less accurate, than PCR tests ( National Health Service, 2023 ).
UK Health Security Agency (UKHSA): An organization responsible for the coordination of the UK government’s response to the onset of an epidemic or pandemic. The UKHSA coordinates and receives epidemiological intelligence from the JBC and samples taken by ES teams in the field. The UKHSA primarily replaces the UK’s previous Public Health organizations within each of the four nations across the UK. Based on lessons that had been learned by the UK government, the Public Health organization was restructured into the UKHSA so it can be more effective in its response to epidemics and pandemics ( Bird, 2020a , 2021 ).
Epidemiological Operations Center (EOC): Is a concept based on security operations center precepts in which the dedicated Joint Biosecurity Centre (JBC) team can monitor data using machine learning algorithms to discern clusters of infection hotspots. Trending approaches can be used to notify regional authorities of greater congregations of people with positive test results so more focused and targeted ES activities can be undertaken to detect infection breakouts. Thereby, enabling more informed and effective containment decision-making ( Bird, 2020a , 2021 ).