Resolve to Save Lives, an initiative launched by global health organization Vital Strategies, released a playbook that describes four essential actions governments need to take to reopen society quickly and safely in the midst of the COVID-19 pandemic:
Test widely—> Isolate infected people—> Find people who have been in contact with infected people—> Ask those people to quarantine for 14 days.
Step three—contact tracing—is crucial for controlling spread of the novel coronavirus and for understanding how it spreads. While tech companies race to develop technology that will help identify at-risk locations and individuals, public health departments and the public are mostly eyeing this technology with caution.
Politics aside, to implement contact tracing technology effectively on a national scale would require somewhere between 50 and 70 percent of Americans’ participation. Given privacy concerns, that’s not an easy ask.
Tracking Paths and Places
Apple and Google’s Exposure Notification API, which health agencies can use to develop contact tracing apps, has gotten global attention as of late. About 22 countries and some U.S. states have already incorporated or received access to the API. Apps using the API can send notifications to individuals who have been in contact with someone who tested positive for COVID-19. However, its latest update bars use by apps that also obtain geolocation information permission, which includes many apps developed by public health agencies.
Meanwhile, SafePaths, an open-source movement led by the MIT Media Lab, encourages adoption of its electronic, privacy-preserving path-tracing technology in both public and private sectors. Safe Paths has two components, Private Kit and Safe Places.
Private Kit is an app available for iOS and Android. The app logs and provides time-stamped records of the user’s location—anonymized, redacted, and blurred—over the past 28 days. No one but that user can access their records without their consent. If they test positive for COVID-19, or if they get a call from a public health official warning them of possible exposure, they can choose to share that data with public health officials. Before sharing any information, users can also edit their log.
Public health officials and employers use the SafePlaces web application to produce files used in contact tracing efforts. Once a contact tracer has a user’s file, they can refer to it during the interview to remind the user where they’ve been to help determine whom they may have interacted with.
Public health officials can upload that information to a central server. By doing so, anyone with an app built on Safe Places can download de-identified paths of infected individuals. The Safe Places app can then notify the user if they may have crossed paths with an infected individual.
Public health officials can also identify hot spots. For example, if an infected person enters an event venue, the venue can take steps to perhaps shut down and disinfect its facility.
SafePaths primarily uses GPS but supports Bluetooth (including the Apple/Google API), WiFi, and Telecom. To encourage widespread adoption, Christopher Kreis, MD, a member of the SafePaths team, says they are in discussions with state agencies, municipalities, the CDC, the World Health Organization (WHO), universities, and large corporations.
“Our goal is to have a product anyone can use, which will be part of a global network that is free and open but also trusted,” said Dr. Kreis. “Anyone who works with us would have to agree to follow our principles of privacy and trust.”
While SafePaths encourages inclusivity and cooperation between agencies, individual states and municipalities are acting independently. Some public health agencies rely on workforce alone, while others incorporate proximity tracking apps to expedite the process.
The City of San Francisco is using CommCare, an app and web interface developed by Dimagi, to allow contact tracers to communicate with cases and contacts via SMS texts. North and South Dakota rolled out Care19, a voluntary app that uses the Apple/Google API.
The State of Utah opted to work with social media company Twenty to develop Healthy Together, a contact tracing app and web portal. However, news reports say the app still doesn’t offer location tracking and only 1.4% of the state’s population has downloaded the app.
No matter how well an app tracks individuals and their contacts, they won’t replace contact tracers—trained professionals who interview and educate dozens of people a day. "There are many ways technology can support this public health function,” said Emily S. Gurley, PhD, an infectious disease epidemiologist at the Center for Global Health at Johns Hopkins Bloomberg School of Public Health, during a COVID-19 media briefing. “It can help them be faster, it can help them organize data. It can help cases and contacts respond in a quick way about their signs and symptoms. But it never takes the place of the personal interaction that will have to happen for [contact tracing] to be effective."
Predicting Future Outbreaks
As developers continue to refine contact tracing apps, additional features may help public health officials, warehouses, and/or large corporations identify future outbreaks sooner. BlueDot, an outbreak risk software equipped with artificial intelligence (AI), sent alerts to clients on December 31, 2019, about unusual pneumonia cases in Wuhan, China. Two weeks later, WHO confirmed a novel coronavirus.
“We see the improvement of digital contact tracing tools as one of the key elements of returning to a semblance of normality prior to a vaccine being available and distributed globally,” said Jason Cottrell, CEO and cofounder of Myplanet, a team of developers that provides AI solutions for Fortune 500 companies. “And we recognize that’s not one month away. That’s a couple years away.”
Cottrell supports Apple/Google’s initiative and agrees that in a free society, data used in contact tracing should remain in the hands of the people. If apps can get past privacy and security concerns, he sees them becoming standard in our mobile devices.
“We see the next wave as an operating system-level integration, so it gets past security prescriptions put in place for third party apps,” says Cottrell. “So they’ll not only have more reach but they’ll be more effective while still maintaining privacy.”
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