The UK and some US states have set out plans for easing coronavirus lockdowns. Ultimately, any government that attempts to ease restrictions must keep a close eye on daily infection numbers and the spread of the virus. Ideally, every new case should be traced and managed.
The problem is that most countries lack the resources to test and contact-trace enough people. But our app, which is called the COVID Symptom Study and is based on some 3.4 million users in the UK, US and Sweden logging symptoms daily, could help. In a new study, published in Nature Medicine, we show that this app can estimate whether someone has COVID-19 purely based on their symptoms – with a high degree of accuracy.
The app (formerly known as the COVID Symptom Tracker) was launched by our team at King’s College London in collaboration with the health technology company ZOE (which one of us helped co-found) in March. Users are asked to say whether they are feeling well or experiencing any symptoms related to COVID-19 every day. Within 14 days, with the help of social media, we gathered 2 million users, collecting vital information on the symptoms of coronavirus infection and the spread of the disease across the UK.
For our new study, which has been peer reviewed, we analysed data gathered from just under 2.5m people in the UK who had been regularly logging their health status in the app. Around a third had logged multiple symptoms associated with COVID-19. More than 15,000 people reported having had a test for coronavirus, with nearly 6,500 testing positive. We confirmed the findings with data from around 168,000 US-based users of the app – 2,736 of whom had been tested for COVID-19, with 726 testing positive. US users started participating about one week after UK ones.
We then investigated which symptoms known to be associated with COVID-19 were most likely to predict a positive test. Loss of taste and smell were particularly striking, with two thirds of users testing positive for coronavirus infection reporting them compared with just over a fifth of the participants who tested negative.
Next, we created a mathematical model that can predict with nearly 80% accuracy whether an individual is likely to have COVID-19 based on their age, sex and a combination of four key symptoms: loss of smell or taste, severe or persistent cough, fatigue and skipping meals.
The implications of this are huge: in the absence of widespread, reliable testing for coronavirus, symptom logging through the app is a simple, fast and cost-effective way to help people know whether or not they are likely to be infected and should take steps to self-isolate and get tested.
We’re now further validating our prediction model by working together in the UK with the Department of Health and Social Care’s coronavirus testing programme, offering swab testing to thousands of app users reporting new symptoms every week. In the US, we are planning studies to deploy antibody tests to see if people who reported symptoms in the past were indeed infected with the virus and if antibodies are enough to protect against another infection.
Importantly, our results suggest that loss of taste or smell is a key early warning sign of COVID-19 infection. A loss of appetite and severe fatigue also outperformed the classical symptoms like cough and fever. Focusing on just cough and fever will miss many cases. Although the World Health Organization and the US Centers for Disease Control and Prevention have recently expanded the list of symptoms, many governments like the UK have been slow to change. NHS England still lists cough and fever as main symptoms on its website.
We strongly urge governments and health authorities everywhere to broaden the range of symptoms, and advise anyone experiencing sudden loss of smell or taste to assume that they are infected and follow local self-isolation guidelines.
The detailed symptom data being collected is showing us the enormous diversity of clinical presentations of the virus, such that we are beginning to define distinct clusters over time that have different outcomes and duration. For example, multiple symptoms occurring rapidly have a better prognosis than those coming on more slowly involving fatigue and chest symptoms.
We are also finding many people with symptoms waxing and waning for over a month. Working alongside testing and contact tracing, which most governments are doing to some extent, the COVID Symptom Study app is a potential tool for getting countries out of lockdown more safely. This is especially important as testing resources will remain scarce. Gathering detailed health data from as many people as possible is an essential part of this, while also ensuring that consent and privacy are fully respected.
This data-driven approach relies on millions of people using the app to log their health on a daily basis. Even as we return to our normal lives, we need to stay vigilant - and people need to understand the full range of symptoms. We are asking people to download the app and get in the habit of spending just a minute every day checking in. The app has been endorsed and promoted by charities as well as the governments of Wales and Scotland – but not yet by NHS England.
The rapid roll-out of the COVID Symptom Study app and others like that used in Israel proves the worth of apps like this for real-time epidemiology in the immediate response to a pandemic. There’s an even larger role for the app in research.
Working together with a large team at Massachusetts General Hospital in the US and the charity Stand Up to Cancer, we are producing early data on risk factors across countries like obesity, blood pressure medication and social deprivation. We are also looking at the risk to healthcare workers. Some of this work hasn’t yet been subject to peer review, the process by which experts scrutinise each other’s work.
The COVID Symptom Study app is available to download from the Apple App Store and Google Play Store in the UK and USA as well as Sweden. Daily research updates and data which is shared with the NHS can be found here.
Tesla boss Elon Musk is making a bold stand against local California laws, but the move could very well backfire.
The billionaire entrepreneur has challenged local authorities to arrest him after reopening his California factory in violation of local coronavirus restrictions, The New Daily reported.
“Tesla is restarting production today against Alameda County rules. I will be on the line with everyone else. If anyone is arrested, I ask that it only be me,” Musk said on Twitter.
The company, which had been closed since March 23 to help slow the spread of Covid-19, has summoned employees back to work at its Freemont plant — in defiance of local laws requiring it to stay shut, the report said.
Some hard-pressed residents in Harare have resorted to sharing face masks in desperate attempts to comply with a government directive for citizens to wear protective clothing as part of measures to avoid the spread of Covid-19.
Following the directive, Zimbabwean supermarkets, transporters and other public places are barring those without masks from accessing their facilities.
In terms of new health regulations, anyone found in public without a face mask faces up to one-year imprisonment or a $500 fine. For fear of falling foul of the law, some locals now share masks in order to access supermarkets.
A Harare resident said government should assist some poor locals with the protective material.
"Some people are sharing face masks to travel to places where they are required to wear them.
"We need free face masks from the government because we are at great risk of the Covid-19 pandemic," said one Harare resident.
However, some creative locals have turned old clothing into home-made masks.
"I have no money to buy face masks. In fact, I do not even have anything to eat with my children.
"I have cut this T-shirt so that we do not get into trouble with the law when we go out," said one Debra Moyo, a resident of Mabvuku high density suburb.
Taking advantage of the requirement, some people are now in the business of picking some used face masks from dumpsites and reselling them to desperate and unsuspecting locals at prices they can afford.
Disposable masks are meant to be used once and be discarded.
Credit: New Zimbabwe
Governments across the world are responding to the COVID-19 pandemic. Alongside the mountain of related challenges, fake news has become a source of frustration. Some are now referring to this fake news phenomenon as a ‘disinfodemic’.
Purveyors of fake news are disseminating propaganda and disinformation. This has increased panic amongst the public and slowed the progress of the fight against the new coronavirus pandemic.
The ‘disinfodemic’ has resulted in misinformed behaviours such as drinking alcohol and applying heat to kill the virus. Some people were led to believe that the virus only affects white people, that testing kits are contaminated, and that vaccines are being tested on Africans while the truth is that a vaccine has not yet been discovered in Africa.
Other fake news purveyors purported that shaving makes face masks more effective, made up riots, and made fake claims with falsified video evidence about Nigerians burning Chinese-owned shops in response to cases of harassment of Africans in China.
These instances are just the tip of the iceberg and governments have had to adopt and implement strict measures to combat the ‘disinfodemic’. Many have been able to contain fake news by warning or arresting those spreading it.
For example, in Mauritius, a man who falsely claimed that riots had erupted after the prime minister announced the closure of supermarkets and shops, was arrested under the Information and Communication Technology Act.
In South Africa, authorities arrested people spreading the news that the virus was being spread by foreigners. And in Kenya, a 23-year-old man was arrested after he published false information with the intent to cause panic.
But these strict controls are also affecting the freedom of expression of people on the continent.
Fake news versus freedom of expression
Even before COVID-19, many African countries used libel and defamation laws, and internet shut downs to limit the freedom of expression of citizens and the media. Some are examples are Cameroon, Ethiopia, Chad, Egypt and Uganda.
With the advent of the new coronavirus, the pandemic is now being used as an excuse to further limit freedom of expression. In Tunisia for example, two bloggers who criticised their government’s response to COVID-19 were arrested.
In Mauritius, a woman who published a sarcastic meme against the government was arrested for spreading fake news. And in countries such as Ethiopia, Egypt, Nigeria, Kenya, Somalia and Zimbabwe, there are increasing cases of arrests and attacks by law enforcement and security agencies on journalists covering the pandemic.
These incidents act as a limitation to the freedom of expression of Africans, including that of the press. In this regard, on World Press Day – 3 May – the UN Secretary General emphasised the role of the press as an ‘antidote’ to the ‘disinfodemic’.
Since the outbreak of COVID-19, international organisations such as the World Health Organisation and Human Rights Watch have adopted guidelines and checklists regarding the protection of human rights. This includes the freedom of expression as COVID-19 measures are implemented.
There are also many laws at the global and regional level that require countries to uphold freedom of expression even in times of pandemics. That freedom can only be limited with justification for instance where news is proven to be fake.
Many of the arrests and attacks that are being made by government officials in different African countries are contrary to international conventions.
Article 19 of the International Covenant on Civil and Political Rights protects the universal freedom of expression but provides for limitations. Measures to contain fake news during COVID-19 are permissible under the protections of public health. However, these limitations do not apply when citizens critique the measures their governments have taken as long as they do not spread fake news.
The United Nations Special Rapporteur on Freedom of Opinion and Expression published a report last month on disease pandemics and freedom of opinion and expression. The Special Rapporteur emphasised that freedom of expression is critical to meeting the challenges of the pandemic.
The report recommended that states must still apply the test of legality, necessity and proportionality before limiting freedom of expression even in cases of public health threats. This recommendation can still be used to combat fake news as long as the impact on freedom of expression is minimal.
At the continental level, freedom of expression is protected by Article 9 of the African Charter on Human and Peoples’ Rights. The Special Rapporteur on Freedom of Expression and Access to Information in Africa issued a recently press statement expressing concerns about internet shutdowns in African countries in the time of COVID-19.
The statement recommended that states guarantee respect and protection of the right to freedom of expression and access to information. This would be through access to the internet and social media services. The Special Rapporteur emphasised that states must not use COVID-19 as “an opportunity to establish overarching interventions”.
And the African Commission recently published its Revised Declaration on Principles of Freedom of Expression and Access to Information in Africa. According to the Declaration, freedom of expression is an indispensable component of democracy. It states that no one should
be found liable for true statements, expressions of opinion, or statements which are reasonable to make in the circumstances.
Thus, African nations must ensure that they protect freedom of expression even in times of a pandemic. This must be the case unless governments are genuinely containing fake news.
African states should adopt regulations that clearly define what constitute fake news in relation to COVID-19. They must allow the citizens and the media to express themselves. The measures being taken in response to COVID-19 must be debated without fear of frivolous charges.
Finally, African governments must not use fake news during this pandemic as a shield to violate the freedom of expression of its citizens, or settle old scores with the press.