Getting on top of the C-19 pandemic has seemingly challenged the resources and capabilities of our apparently developed nation. Lots of excuses are offered, many hinging on the argument that people are basically irresponsible or in denial, but my experience of trying to use the system we have in place to handle the outbreak raises more questions than answers.
When I developed symptoms I, like many others I am sure, tried to figure out what I had. I checked online for comparisons with flu, wondered if my headache was severe or mild, checked to see if I had any taste and so forth. Unsure what I learned here, I waited a day or two, hoping for the best but the symptoms persisted, I felt awful and decided I needed a test.
At our university we’ve made repeated public pronouncements of the commitment we make to our students, staff and faculty. There’s an app you can download to monitor your condition, register for quick test and find treatment advice. We have quick walk-in test options and a clearance option to register when you are on campus. All well and good, until I tried to use it.
I downloaded the app to my phone and very quickly realized it is one of the least usable apps I’ve experienced in some time. Problem #1. Clunky in terminology and navigation, the effort involved in engaging meaningfully with the app is significant, not the type of interaction experience one wants under stress. I tried to register for a test and was stymied. It became obvious, even with the app, that if you have symptoms you require a different protocol than if you just want clearance to be on campus. Unfortunately, exploring my options as a symptom-showing user kept returning me to the same dead end on the app. I gave up using it and called my doctor, which. as it turns out, is what you are supposed to do.
So, progress. By now it’s Friday. I’ve been feeling poorly since Wednesday. I call the doc’s office and ask if I can get tested for coronavirus. No, I am told. That is not how it works. Apparently only the doctor can authorize me for a test. Problem #2. OK, I suppose the number of calls for tests is high, the testing options are limited (what was that you said Mr Trump?) and the doctor serves as a clearing agent to avoid the apparent waste of sick or healthy people trying to figure out if they have it. So, put me through to the doctor please. Problem #3. My doc was not available and would not be able to see me (in the figurative sense since appointments were online) before Monday afternoon. Wow, ok, I’ll take the appointment but who knows if I’ll live that long.
Monday afternoon, after a quite awful weekend of symptoms that in my somewhat confused state can be nothing other than C-19, I chat with the doc via some web conference software and in two mins she tells me, yes, I should have a test. Thanks, how hard was that. She booked me one for the next day (so now, if you’re keeping count, its 6 days from first symptom to test date). And just in case, she tells me to test for flu as well. Next day I duly drive to test facility, am in and out in five minutes, and return home to lie down, wasted.
Now, it turns out, I tested negative, and so bewildered by this were the doctor and I that she suggested a re-test three days later. But none of that matters much. I recovered. What the experience showed me is that the reduction of Covid treatment to a numbers game (how many tests have we got? How many vaccines and when will we have them?) is really not solving the problem. Yes we need a vaccine but the vaccine alone is not the solution, its the vaccination. Getting the treatment to the person is a challenge not of medicine but of social science.
The test and vaccine concerns are legitimate but they are insufficient. Once we have the supply, they have to be delivered. People have to be able to receive swabs and injections. An access network that forms a bottleneck on delivery through sequencing of permissions, and information apps that confuse rather than assist troubled individuals is a recipe for slow uptake of preventative and treatment options. In this, the vaccine recipient is forced to work through a series of communication channels to determine how and where to gain access. Throw in misinformation about the situation, false promises of easy access to tests and treatment, partially confused messaging about how some people rather than others should proceed, and the need to have the time, persistence and ability to navigate this network raises serious questions about how well designed is our response to this pandemic.
Yes, it is a design challenge and frankly, one that casts our user-centered design skills in a poor light. Better apps would be a start, apps that recognize the context of use for Covid is stressful, personal and driven by a desire for help. But a better app is only a start. We need to recognize that information is a resource that exists at multiple levels, from the physical to the social, and only by considering people as actors at all levels, as users of devices and members of networked communities within a broad social structure, layers that have competing goals sometimes, differing power structures, and incomplete understanding of actors in differing roles, can we hope to create a seamless and humanly usable response to this situation. Yes, our IT in a time of covid is a highly contingent socio-technical system and unless we proceed to tackle the problem with this in mind, I foresee more roadblocks ahead.