Paul Franks is a professor in genetic and molecular epidemiology at Lund University. When Covid-19 began to spread globally Franks engaged in the integration of the COVID-Symptom Study-app within Sweden.
The app is available in Sweden since the end of April 2020. It has the aim of studying the spread of Covid-19 and currently has around 178.000 users in Sweden. Swedish App Scene was able to arrange an interview with Franks to talk more in-depth about the effect of the app within Sweden.
The App was originally launched in the UK. How did it arrive in Sweden?
COVID Symptom Study was originally launched by company called Zoe Global Limited which specializes on precision nutrition. Zoe initially developed an app which records information about food and health. Once COVID-19 started to spread within Europe Zoe repurposed its resources to develop an app which is aimed at providing information about symptoms related to COVID-19.
Franks had a pre-existing relationship with Zoe because he had been an advisor on their nutrition studies. When Zoe launched COVID Symptom Study in the UK, Franks began working on implementing the app in Sweden as well. It took only one month from when Franks pitched the idea to ZOE until the app was launched in Sweden.
That process required a lot work and resources and included a big team of lawyers, ethicists, and medical doctors, Franks said. As some might know, a month is not a long time to implement an app of such scale. “My team has been working flat out for basically two months now on this project. They are extremely motivated people. We are working weekends, red days, late into the evening”, Franks shared with us.
Why has the name of the app been changed from “COVID Symptom Tracker” to “COVID Symptom Study”?
Franks stated that there are essentially two classes of apps which have been developed with regards to the spread of COVID-19. The first class of apps tries to map symptoms and risk factors related to the virus. The second class involves tracking apps which track the movement and interaction between people through Bluetooth and GPS features. There are a lot of privacy issues connected to this second class of apps.
COVID Symptom Study does not belong to the second class as it does not track people’s movements in any way. Instead, it belongs to the first class and is not engaged in any commercial activity. Specifically, nobody is permitted to make any money from the data of COVID Symptom Study which is anchored within a legal contract. “We have very tight privacy policies around the use of data”, Franks said. “We have received criticism from some people that they feel that the data is accessible to anyone who wants it. It really is not set up like that, it is very tightly controlled who can have access to the data and how it is stored and handled”.
The privacy of the information gathered through the app is, amongst others, protected through the Central Ethics Committee in Sweden and data protection lawyers who make sure that information is “secure and private”. Changing the name from “COVID Symptom Tracker” to “COVID Symptom Study” was a way of making sure to improve information and communication about what the app intends to do.
It is important that people who download the app use it on a daily basis, Franks argued. If people download the app and only sign the consent form the participation within the study would be “more or less useless”. However, Franks shared that half of the study population enter data daily, and around 99% put in data once a week.
What parts of the population use the app?
Since its launch, the app has been able to engage more and more elderly parts of the population to participate in the study. However, younger parts of the population are not as committed to contributing to the study as the COVID Symptom Study-team would like. A reason for why that might be the case is “probably because the perception of risk is less”, Franks said.
Additionally, he let us know that women engage more and are better at putting in the data more regularly than men. In that respect the team behind the app hopes to encourage more young men to get engaged. That is because one “cannot draw a lot of conclusions when essential data is missing”.
What is the benefit for the individual user when downloading the app?
When thinking back to March when COVID-19 began to really unfold in Europe, Franks remembers being “extremely concerned about the prognosis for Sweden and other countries. I worried about what it would mean for Sweden. I also worried about what it would mean for those who I love around me, my friends, my family. Were people going to die who are close to me?”
Many other people have the same worries as Franks and want to contribute to fighting the spread of the virus. However, they might think to themselves: I am not a doctor, I am not an epidemiologist, I am not a virologist, so what can I do? The participation in the study is what gives everyone the opportunity to help fight the virus.
How can the data gathered through the app be translated into government strategy?
According to Franks there are essentially two ways the data can be used. Firstly, to allocate resources. The app data helps predicting when an area in Sweden will have a peak of cases a week in advance. That way resources can be allocated accordingly. This is important in Sweden as it is one of the countries with the lowest amount of intensive care units per capita in Europe, Franks said.
The second way in which the data can be used is to allocate testing capacities. Testing effectively is important as many countries do not have endless resources for testing. “You need to target your testing to the right people, in the right place, at the right time”, Franks said. The app data can be very powerful in guiding testing within Sweden.
Has the app been able to determine symptoms related to an infection with COVID-19?
One of the findings through the app is that anosmia, the loss of taste and smell, is a quite significant symptom for COVID-19. This finding through the app even led to changes of the WHO’s list of symptoms related to COVID-19.
Scientists around the world are working on a vaccination for COVID-19. What does the future of the app look like if there is a vaccine?
“I think the app would be especially relevant if we get a vaccine coming out”. A vaccine has to be working on different sub-groups of a population. This is hard to determine and the app can help with that.
Moreover, there might be people who either do not want to get vaccinated. These people might still be logging their data into the app. That will help the continuous study of the spread of COVID-19 in Sweden.
“You have all these uncertainties about whether a vaccine is really going to work and how well it can be deployed in a population, which will then influence the impact of COVID-19”. The app would be able to help with that.
Furthermore, COVID Symptom Study will also aid in understanding immunity. “We do not know how long immunity will last”. The app can be informative when vaccines might be deployed in the future. If immunity is followed by a resurgence of infections, it might suggest that people’s immunity is wearing off. “So there are all these factors that you would still want to keep monitoring within the population for COVID-19.”