Victoria was not fit to deal with COVID-19 and 'misguided' in choosing IBM health tracing

A parliamentary inquiry into Victoria's contact tracing system and testing regime has found that the state was not fit to deal with any escalation of cases, which eventually led to significant errors during its second wave of the pandemic.

This finding, made by the Victorian Legislative Council Legal and Social Issues Committee, came with 46 others along with 19 recommendations that were published in a 260-page report [PDF] on Monday morning.

According to the report, the Victorian government's communicable diseases track and tracing system, called the Public Health Event Surveillance System (PHESS), experienced an unprecedented volume of data during the pandemic, which "affected system performance and reporting timeliness".

This led to the government seeking out vendors to provide automated health tracing capabilities. 

The Victorian government is currently using a Salesforce customer relationship management (CRM) platform that can automate contact tracing steps, such as case allocations, case alerts, contact notifications, and isolation/quarantine messaging, among others. 

The Salesforce instance was only picked in August however, during the peak of Victoria's second wave of cases, the report found.

Salesforce originally offered its contact tracing end-to-end software to the Victorian Government in March, but the offer was declined as the government opted to use IBM's i2 analyst platform instead. 

The i2 platform was purchased as a tool for predictive modelling of COVID-19 data to inform policy and public health decisions, but the government later discovered it did not have the capacity to develop automation for predictive analysis and automated alerts.

The report said IBM ANZ general manager Charles Agee told a public hearing that the i2 platform was designed as "an analyst tool, intended to assist a user in performing their analysis" and further stated that "it is not an AI tool".  

In Australia's National Contact Tracing Review [PDF] published in November, Australia's Chief Scientist Alan Finkel said the automation of contact tracing systems is important to build capacity, especially if positive case numbers rise in a community.

"Automation, where possible, of contact tracing and case management can significantly reduce workload, particularly during periods of high case numbers," he said.

"Automating this process can significantly reduce the elapsed time to notify close contacts and provide more efficient daily management of confirmed cases and close contacts in isolation and quarantine, respectively."

The IBM system is now no longer in use. 

The committee found the engagement with IBM was a misguided and a costly mistake, given the platform's known lack of AI capacity.

The committee also examined Victoria's transition from manual to digital test tracing. According to report findings, Victoria only began piloting its Test Tracker -- a real-time digital tracking of the COVID-19 test from swab to result notification -- in September and October despite having its first COVID-19 case in January.

While Victoria is now rolling out Test Tracker throughout the state, the committee said the eight-month transition was "disappointing and inadequate".

Among the report's recommendations, the committee said Victoria needed to set up regional contact tracing hubs and suburban units so that all metropolitan Melbournians are within 10 kilometres of a fixed-testing site.

In making this recommendation, the committee criticised Victoria's highly centralised healthcare system, saying it "did not have the means to deal with regional cases effectively", which is what led to confusion and delays in contact tracing and test management.

Other key recommendations included establishing a trained reserve workforce for future public health emergencies; embedding general practitioners into the system of management of contact tracing and testing as part of a localised, collaborative, and more person-centred approach; developing clear and accessible guidance for businesses on their obligations for contact tracing record keeping, particularly around setting up and using digital systems such as QR codes; and mandating the use of Test Tracker for all test sites, and develop real-time reporting between Test Tracker and the appropriate databases.

The committee also said in the report that a digital one-stop system would be ideal going forward to further minimise manual contact tracing.

"Certainly we managed to work with PHESS very quickly, within about a day of training and access. We also have an integrated clinical health system, and we have direct access to laboratory testing results, so we are able to integrate them, but a lot of that had to be done relatively manually," it said.

Since picking up the Salesforce CRM platform, the committee said the government has been highly effective in "facilitating rapid contact tracing" and could now handle 500 new cases a day.

"The system has settled down into actually quite a best-practice management structure for the project of the digital transformation and modernisation of the testing, contact-tracing and outbreak management system," Finkel told the committee.

The report added that Victoria's COVID-19 testing regime is now fit for purpose to monitor, identify, record, and communicate up to 15,000 results per day within a 24-hour window, the committee said. 

It also noted that the Victorian government is investing in additional capacity to eventually be able to process 35,000 tests per day.

"Lessons have been learnt by government and the health department about how we deal with emerging threats to public health particularly infectious disease control," Committee chair Fiona Patten said.

"Victoria's processes are robust and have been implemented in response to what has been learnt over the last months. We are now far better prepared should Victoria face a similar situation in the future."

While the committee said it was confident that the Salesforce's CRM platform expanded the state's capacity for dealing with COVID-19 contact tracing, it was unable to ascertain the limitations and difficulties it may face. 

"In essence, the system has not been tested," the committee said in the report.

The committee added that due to the late implementation of the Salesforce platform, it was also unable to determine if the system has appropriate responsiveness and robustness.  

Due to this, the committee has recommended for ongoing modelling to occur on the expected capacity of Victoria's contact tracing system and that the results of this modelling be made public. 

Speaking to the federal government's COVIDSafe app, the committee said the effectiveness of the app for Victoria's contact tracing efforts was insignificant. Despite analysis of the COVIDSafe app being outside the scope of the committee's inquiry, it noted that no evidence has been given to suggest that the app has been effective or contributed to supporting Victoria's public health response.  

Former Australian chief medical officer and now Secretary of the Department of Health, Dr Brendan Murphy, in August told the Senate Select Committee on COVID-19 that Victoria had ditched Australia's contact-tracing COVIDSafe app at the start of the pandemic.

"For a period of time, they were feeling so pressured that they decided not to use the app," Murphy said at the time.

"Because they were so pressured, they kept going without using the app, they have now started using the app again, and we hope to see some of the successes we've seen in New South Wales recently with identifying otherwise unidentified contacts."

Later that month, Department of Health Associate Secretary Caroline Edwards said Australia's COVIDSafe app was only being used by Victoria to double-check manual tracers.

"The app is operating in Victoria to validate contacts and I guess the reason we're going round in circles a bit is because we all accept that contact tracing hasn't worked as well as it should have in Victoria, for lots of reasons, and we've never said that the app was the sole or even the primary contract tracing [tool]," Edwards said. 

The COVIDSafe app was recently updated, with the federal government touting that the changes will significantly improve its capability.

The app will incorporate a new Herald Bluetooth protocol, Minister for Government Services Stuart Robert said, explaining that this would offer "unparalleled app-level Bluetooth performance and contribute to better identification of potential close contacts".

Australia's tech community has testified that, instead of a rework, the whole app be scrapped and replaced with the Apple/Google Exposure Notification Framework, which the New Zealand government adopted last week. 

At the time of writing, Victoria has seven active COVID-19 cases, with one being a returned traveller from overseas. 

Since the start of the pandemic, Australia has recorded 28,031 confirmed cases and 908 deaths.

HERE'S MORE

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• DTA still backing COVIDSafe despite only picking up 17 contacts
• Australia's COVIDSafe contact tracing story is full of holes and we should worry
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• 10 million Aussie patients have taken up COVID-19 Medicare telehealth services
• COVIDSafe's problems aren't Google or Apple's fault despite government claims