19 March, 2020 - 22:44 By News Desk

Cambridge mystery – the missing cases of COVID-19

Without a comprehensive testing program, the use of Big Data and help from large high technology companies efforts to permanently suppress COVID-19 will be limited to random – and in some cases highly destructive – stabs in the dark.

Schools are now closed and with them a window of opportunity to use mass testing for COVID-19 to build a model of how the virus has been exploiting gaps in our knowledge to spread by stealth,writes Cambridge technology innovator Peter Kruger

At some point, if we are to protect ourselves from this virus and its derivatives we must carry out comprehensive testing and develop intelligent computer technology to process the results.

The advantage of schools, from the point of view of disease monitoring is, thanks to OFSTED, their uniformity of operation and a standard interface with the local community. 

Employees of a hairdressing salon in Hartlepool will interact with each other differently than the staff of a restaurant in Reading. However, teachers and pupils interact in much the same way no matter where in the country their school is located. Also, when it comes to viruses, a school acts much like the canary in the coal mine, being responsible for one of the two or three degrees separating everyone in its catchment area.

Why might Britain need to test large numbers of people showing no obvious signs disease and who are not considered to be of risk? Perhaps to solve a puzzle which suggests COVID-19 may be unique in the way it is transmitted.

Cambridge, as far as the virus is concerned, has proved something of an enigma. The city was still receiving large numbers of Chinese tourists, many who came to see the tree referred to in China’s most well-known poem, Xu Zhimo’s ‘Farewell To Cambridge Again.’ 

The city’s university and its various hi-tech and biotech hubs all have close links with companies and institutions in China, many in or close to Wuhan, the epicentre of the COVID-19 outbreak. Despite this, when the virus was first detected in Britain, there were no cases in Cambridge and even now the number of people found to be infected in the city and surrounding area is less than towns such as Watford and on a par with York. 

The number of Cambridge residents tested positive is far less than in similar sized towns in Italy which have fewer direct links with China. Cambridge has not so much dodged the bullet as stood in the rain for two months without getting wet. 

The analysis and, perhaps more importantly, the testing, which might throw some light on the mystery is either partially incomplete or completely absent.

On the 16th of March Imperial College produced a report on the impact of non-pharmaceutical interventions to reduce COVID-19 mortality and healthcare demand: basically what action can be taken, in the absence of a vaccine, to prevent the NHS being overwhelmed. 

It was based on this report that the Government decided to backtrack on creating herd immunity by letting the virus rip in Britain – a plan which seemed to have been inspired by Stanley Kubrick’s Dr Strangelove.

To explore the scenarios for the progression of COVID-19 in Britain, Imperial College used a modified transmission simulation model developed to support influenza planning. 

Assumptions as to how the virus is passed on in schools have been used in this model, including how likely it is for someone to pass on the virus if they exhibit no symptoms. 

However, children with COVID-19, unlike children with influenza, all seem to be asymptomatic. The importance of wide-scale testing to come up with a more reliable model has been highlighted by Imperial’s own work in the small Italian town of Vò where blanket testing detected up a number of asymptomatic spreaders.

Returning to the enigma of Cambridge there are many factors which may have suppressed the progression of the COVID-19 in the city. 

Cambridgeshire has a young demographic who tend to communicate with each other electronically rather than face to face, even when in the same room! Visitors from China also tend to fall into this younger demographic cohort.

It could be with such a young native population and youthful visitors the virus never encountered enough of the 14 per cent of the population aged over 65 to gain traction. (It obviously had more success in Italy where 22 per cent of the population is aged 65 and over.) 

Genetic unpicking of the virus may reveal it was not carried directly to Britain from China but instead bounced around Europe; from Munich to Milan and then to London. Basically, we are working with too many of what Donald Rumsfeld described as ‘known unknowns.’ 

The testing in hospitals, while important to protect health workers, tells us little about the virus spreads; the results are prone to distortion, the converse of survivorship bias. Consequently, we are still fighting crocodiles rather than draining the swamp.

Eventually the swamp will need draining because even if peak COVID-19 is delayed, the absence of that herd immunity will see us under attack again; most likely shortly after returning to work and our children are back in school. This will be as true in China as in Britain and the rest of the world. 

When, or if, we reach the stage China is at now we should carry out those large-scale tests because rather than having been beaten the virus will have merely switched into stealth mode; carried only by asymptomatic spreaders.

Once the data on the asymptomatic carriers has been collected it should be analysed with the help of technology companies such as Google, Microsoft and Facebook, who could provide anonymised tracking, friends and family data generated by people within the catchment area of the schools where tests take place. 

AI software should be used to create transmission models robust and accurate enough to allow us, in lieu of a vaccine, to hold COVID-19 in check. Already South Korea is making moves in this direction.

At some point in the future, our smartphones will inform us if we have recently been in contact with someone infected with new strain of coronavirus. We will be asked to use the phone to take our temperature and either a swab our mouth and smear a sample across the biochip on the rear of the handset or, alternatively, breath into the microphone. 

This was how, 15 years ago, we saw the smartphone evolving. At that time the company I worked for produced a report called 101 Uses for a Mobile Phone in Healthcare: disease monitoring was 92 on the list. 

Perhaps inevitably health took a back seat to entertainment and taking selfies with high resolution cameras was more fun than measurement of vital signs with a so-called ‘lab on a chip.’

Technology is partially responsible for the globalisation and universal connectivity that a new generation of diseases exploit. At some point we will need to develop devices and write software that removes this vulnerability rather than resorting to firing cannons at plague ships attempting to dock in San Francisco harbour. 

COVID-19 has transformed our world into a laboratory and is providing test data that will enable this development to take place; best we use both wisely.

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