With only 11% of Britons thought to be self-isolating when told to, the new contact-tracing app may be less effective than hoped. Rebecca Forman and Lucy Thompson (LSE) says poor public messaging, the fear of losing jobs and wages, and problems with getting essentials are major reasons for failing to comply.
The UK government has finally launched its contact-tracing app – four months behind schedule, and unfortunately coinciding with the highest number of daily COVID-19 cases since the peak of the pandemic in April. For the dozens of countries around the world that have created them, the success of these contact tracing apps relies on as many downloads and as much active engagement as possible. With the exceptions of China, Qatar and Singapore, Ireland’s app has one of the world’s best adoption rates; 37% of the population downloaded it in its first week. Germany’s Corona Warn-App, meanwhile, has been downloaded by more than 20% of citizens and has received international praise – so much so it is now helping other governments to develop their own. Switzerland’s app is being used by 1.6 million people (out of a population of 8.5 million).
Despite these success stories, global downloads are lagging behind effective levels. Modelling from the University of Oxford carried out at the start of the pandemic found that it would take around 60% of smartphone users to download, use and stick to the guidelines issued by a contact tracing app to “stop” the pandemic. Sixty percent may therefore sound ambitious – and even more so if we consider that the test, trace and isolate system relies on people following the rules.
A recent paper suggests that, in the UK, just 11% of people are isolating when told to do so by the system. Comparative data on adherence is still emerging, but the UK’s rate is among the lowest. Australia is also struggling to impose its rules; in the state of Victoria in Australia, one in four people with coronavirus were not at home when door-knocked. In Norway, adherence with isolation dropped from 66% in April to between 33 and 38% from May – July of this year.
Why are people taking the risk of being caught and of infecting others? This may in part be down to changes in risk perception and because people are simply fed up with a socially distanced life. Recent research from past pandemics also reveals a number of factors that are crucial to people’s adherence to isolation and quarantine measures. Clear messaging around the benefit that isolating or quarantining will have on public health is highly influential. The UK government’s messaging around COVID-19 restrictions has caused public confusion on several occasions, beginning as early as May; soon after people had been warned to stay at home to save lives, government sources raised the prospect of new freedoms ahead of a sunny Bank Holiday weekend. The Eat Out to Help Out scheme encouraged them to dine at restaurants and in pubs during August. More recently, Boris Johnson has been forced to retract his push to get people back to working from the office, as COVID-19 infection rates have risen dramatically across the country.
A clearer, consistent communication strategy at an earlier stage might have prevented this confusion and fostered trust in government, which is another crucial factor in people’s adherence to the rules. Trust in the UK government crashed from 67% at the beginning of the crisis to just 48% in June and it has dwindled at this level ever since due to a series of failings – the Track and Trace app, testing targets and A-level grading, to name but a few.
We are also apparently getting away with flouting the rules. The written rules on self-isolation are stricter than those required during full lockdown: self-isolators must stay indoors, at a single location, for two full weeks, and cannot even leave home to go to a shop or for exercise. But despite the thousands of people now returning to the UK from abroad (many of them from “risk countries”), the police fined just three people for ignoring the rules in England and Wales, and a further nine for failing to fill out contact forms between the beginning of July and the end of August. It seems reasonable that we will doubt the penalties will be enforced when we neither see nor hear evidence of them being imposed on the general public, nor on those in power like Dominic Cummings and most recently the SNP MP Margaret Ferrier.
A further factor is fear, which prompted many of us to stockpile tinned foods, pasta and toilet roll at the start of the crisis. Now, beyond the practical issue of running out of food, medication or essential supplies, the impending threat of income loss may be keeping many from isolating. Dido Harding, the interim head of the new National Institute for Health Protection, has made no secret of the fact that workers are terrified of losing income or their jobs if they are forced to stay at home. The government has responded with a new wage subsidy scheme to protect jobs, but even Rishi Sunak has warned that the Winter Economy Plan cannot hold back a wave of redundancies, increasing people’s fear of losing their livelihoods.
To encourage people to stick to the rules, policies must be clear and communicated in such a way that the entire population can understand them. They should also be flexible to allow for adjustments, rather than u-turns. In France, the 14-day isolation period has now been revised to seven days after infectologists advised “most of the contamination occurs in the first five days”. Furthermore, French policy requires that people must be adequately reimbursed for financial losses that arise from self-isolation, and helped with shopping, prescriptions and caring responsibilities. Perhaps this is something the UK could learn from.
Test, trace and isolate systems are paramount to coping with the COVID-19 pandemic. But these new and deepening cracks in the UK’s public health strategy suggest they may be too late. Only time will tell if the introduction of the app will be enough to undo the damage caused by confusion, lack of trust and fear.
This post represents the views of the authors and not those of the COVID-19 blog, nor LSE.