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There has been a lot of interest in leveraging smartphone apps for contact tracing, a public health strategy that involves tracking people who are COVID-19 positive to identify disease hot spots. Traditionally, this is done by foot workers and over the phone, and we know that this labor-intensive method works – it has helped eliminate smallpox and slow the spread of sexually transmitted infections. However, the effectiveness of the application-driven method is still unknown.
Unfortunately, the pressure to ease the blockages has led to a mad race to develop and use such apps for COVID-19, resulting in a wildly different range of options. Since public health departments are forced to follow suit, we must be careful about the technologies we adopt.
Several dozen states and companies have already started developing and using digital tools. In the spring, Utah launched an app, called Healthy Together, that was created by a social media startup that used Bluetooth and GPS data to increase in-person contact tracing. While the GPS location tracking feature was shut down for the summer due to poor acceptance and mistrust of the app (only 200 users had chosen to share location data), the app still tracks proximity relative to other users of the app. the application. The result? A serendipitous app that doesn’t retain the ability to identify COVID-19 hot spots, but still tracks some data.
The North Dakota app also uses location data, but unfortunately it was found to be sharing data with Foursquare and the Google advertising system. While the North Dakota app developer updated its privacy policy, your case highlights another important issue. Both the North Dakota and Utah apps require sharing location data with the state department of public health. This centralized storage approach lends itself to the partnership between public health departments and contact tracing applications, but is also invasive and highly vulnerable to exploitation by hackers or misuse by law enforcement agencies. .
When Apple and Google teamed up in April to create an alternative option, a software toolkit called Exposure Notifications, many expected this would finally allow digital contact tracing to take off. The Apple-Google system is supported by many privacy experts because it uses Bluetooth instead of location data, keeps records on people’s phones instead of a central database, and presents periodically deleted data.
However, while decentralized data is likely to be more secure from a privacy perspective, there are still risks with the Apple-Google solution. It requires the use of Bluetooth, a convenient but flawed technology with inherent security risks. Furthermore, these contact tracing applications would not be covered by the privacy laws of the Health Insurance Portability and Accountability Act, as the data would be voluntarily shared with third party applications. Finally, health authorities will only be notified if the individual chooses to submit a positive test result, making this solution highly dependent on the honor system.
Even if all these risks are mitigated, there is still much that is unknown, such as determining how high the false positives can be for these tools. Proximity apps cannot differentiate between healthcare workers wearing personal protective equipment and people at a party. It also cannot distinguish people separated by walls or driving close to each other on roads. This means there is the possibility of a flood of false positives and app fatigue if people start to ignore notifications that are often incorrect.
But simply increasing the accuracy won’t be enough if enough people aren’t willing to download the app in the first place. A recent simulation from the University of Oxford found that 56% of the population (or 80% of all smartphone users) would need to use an app to effectively control the outbreak. Unfortunately, a recent national survey indicates that only 30% of Americans are willing to use a contact tracing app.
In addition, the app’s method excludes people who do not own smartphones, including older patients most vulnerable to COVID-19. Finally, the focus of the US regional contact tracing app has made contact tracing more complicated, rather than less. A state-by-state solution is not very helpful if a person who tests positive on a Virginia application does not trigger an alert in North Carolina.
This does not mean that contact tracing apps are useless and we are making daily progress to overcome the above challenges. In fact, the authors of the original study presented research in September that an installation rate as low as 15%, coupled with traditional contact tracing, could help suppress COVID-19. It’s also encouraging that so far, 10 states have released apps that use technology from the Apple-Google partnership, and at least four will be able to exchange notifications.
What’s next For those of us who choose to download a contact tracing app, it is critical that we pay attention to the technology the app is based on (Bluetooth or GPS) and where the data is stored. For people who develop these types of applications, collaboration and interoperability between states is absolutely essential to optimize the possibilities of effectiveness. More importantly, as a society we cannot fixate on technology at the expense of other more difficult decisions such as social distancing, limiting the size of meetings and wearing masks. Unfortunately, the next few months will be challenging, but if we are intentional about our choices as citizens and communities, we will have the opportunity to create a better and safer tomorrow in this crisis and beyond.
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ABOUT THE WRITER
Dr. Lochan Shah ([email protected]) is a resident physician in internal medicine at Johns Hopkins.
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