For years, epidemiologists have been using contact tracing as a useful tool to help track the transmission and spread of deadly diseases. But just as COVID-19 has thrown medical experts for a loop in a myriad of different ways, contact tracing has also seen challenges because it’s much more difficult to track a respiratory pathogen with a delayed onset of symptoms—as opposed to diseases that are transmitted through sex or blood.
Early into the pandemic, many experts believed that smartphone apps might be key for successfully implementing contact tracing measures. In April, longtime rivals Apple and Google even put aside their differences to announce a partnership to develop Bluetooth contact-tracing technology that would help public health officials track the disease in the United States.
Though some countries, most notably South Korea and Taiwan, have released early reports of successful mobile tracing technology, the U.S. has yet to see any viable progress on these fronts, now more than three months into the pandemic.
Here are some of the biggest issues.
Lack of federal guidance
A lack of a cohesive nationwide plan has been a major setback when it comes to contact tracing apps, as individual states have largely been implementing their own coronavirus prevention measures which are often hampered by a lack of federal funding.
Neither the White House nor the CDC, run under the Trump administration’s Department of Health and Human Services, have endorsed contact tracing app technology.
By mid-June, three states—Alabama, South Carolina, and North Dakota—had only announced vague plans to implement the technology that had been developed by Apple and Google, with no launch dates yet announced. Business Insider recently reported that 19 states were considering using contact-tracing apps, and 17 states have no plans to create or use smartphone-based contact tracing whatsoever.
Tarun Nimmagadda, the founder of the nonprofit Corona Trace app, told NBC News that he’s given up trying to work with state governors and is now attempting to sell his software to a for-profit company. “The CDC and Google and Apple should have gotten together and built an app,” said Nimmagadda. “Instead, we have a state-by-state response.”
A potential flaw in states developing their own individual contact tracing apps is that these apps may end up using different Bluetooth protocols, and that could result in data gaps for people who travel across state lines.
“If we have multiple apps per country, and they’re not apps that are interoperable, then we can never reach that threshold,” Ellie Daw, a cryptography consultant, told Business Insider. Daw also serves as a member of the TCN Coalition, a think tank that was founded to address the growing privacy protections and collaboration among the makers of different contact-tracing apps.
One of the key issues that has been plaguing a widespread acceptance of contact tracing apps from the very beginning has been privacy concerns.
Theoretically, these apps—which have since been rebranded as “exposure notification” rather than contact tracing—function by using Bluetooth signals to keep a log of other devices that have come in close proximity. This way, a user can be notified when they’ve crossed paths with someone who tested positive for the coronavirus.
The apps were designed in a way that should have collected a minimal amount of personal information and kept any of this collected data secure. However, the best-laid plans often go awry. As such, early attempts have been discovered occasionally sending data to other apps— even including “unneeded lines of computer code associated with advertising.”
Norway has been forced to suspend the use of one of the first successful national coronavirus contacts-tracing apps after the Norwegian Data Protection Authority raised privacy concerns.
“Smittestopp,” as the app is called, was found to pose a “disproportionate threat to user privacy” by continuously uploading user locations, TechCrunch wrote. The Norwegian Institute of Public Health (FHI) has since stopped the app from uploading user data, which will reportedly be deleted “as soon as possible.”
By June 3, the app had been downloaded 1.6 million times and had around 600,000 active users—just over 10% of Norway’s total population.
“We do not agree with the Data Protection Agency’s assessment, but now we have to delete all data and pause work as a result of the notification,” FHI director Camilla Stoltenberg said in a statement. “With this, we weaken an important part of our preparedness for increased spread of infection, because we lose time in developing and testing the app. At the same time, we have a reduced ability to fight the spread of infection that is ongoing.”
“The pandemic is not over,” she added. “We have no immunity in the population, no vaccine, and no effective treatment. Without the Smittestopp app, we will be less equipped to prevent new outbreaks that may occur locally or nationally.”
A newly proposed bill in the U.S., the Exposure Notification Privacy Act, would require all tech companies working on contact-tracing apps to collaborate with public health agencies, as well as mandate that any data collected could not be sold or used for commercial purposes.
The limitations of technology
On the same day that Google and Apple announced their joint plans to build an app, California Gov. Gavin Newsom, a Democrat, initially voiced his support for the idea but never followed through.
“Most of the contact tracing work (notifying people who have been in close contact with an infected person to prevent the disease from spreading to others) can be done by phone, text, email, and chat,” Ali Bay, a spokesperson for California’s Public Health Department, told NBC News.
Bay declined to elaborate on the change in thinking, but the general consensus seems to be that manpower outweighs technology when it comes to contact tracing efforts.
Andy Slavitt, an Obama administration health care official who is chair of the nonprofit United States of Care, echoed those concerns. “The factual analytical assessment is it’s not a high upside,” he said. “The bulk of the investment you need to make is in manpower.”
“Digital tools do not replace the human capacity needed to do contact tracing,” added WHO Director-General Tedros Adhanom Ghebreyesus.
Ryan Calo, a University of Washington law professor and an expert in tech policy and privacy, was an early skeptic that the apps could be effective. “It was something that launched and then sort of fell away,” he told TechCrunch, reiterating the belief that technology cannot outperform humans who “have been effective [at contact tracing] since the bubonic plague.”
Another possible hurdle with the technology is that Bluetooth chips may detect false positives which would muddy the data.
“If I am in the wide-open, my Bluetooth and your Bluetooth might ping each other even if you’re much more than six feet away,” warned Dr. Farzad Mostashari, former national coordinator for health information technology under the Obama-administration Department of Health and Human Services.
“You could be through the wall from me in an apartment, and it could ping that we’re having a proximity event,” Mostashari told the Verge. “You could be on a different floor of the building and it could ping. You could be biking by me in the open air and it could ping.”
Apps struggle with adoption rates
Experts estimate that for smartphone-based contact tracing apps to work effectively, at least 60% of a country’s population must commit to using it. Just one of the issues plaguing Apple and Google’s initiative was a low adoption rate.
Singapore was one of the first countries to roll out a Bluetooth contact-tracing app in March, and COVID-19 cases spiked when only about 20% of the country’s population adopted it.
In addition to obvious privacy concerns, a recent study found that people who think they have had the coronavirus are less likely to download a contact tracing app, even if they were never officially diagnosed.
“The U.K. adopted a public health policy during lockdown of instruction to stay at home if symptomatic of COVID-19 unless [somebody becomes] very unwell with it,” the researchers found, according to the Guardian, which resulted in “a large number of people who believe they have had COVID-19 but without confirmatory testing.”
As a result, these people “may be less willing to participate on account of believing they may have immunity,” as the individual threat of the virus no longer applies to them.
Meanwhile, despite these legitimate concerns, Germany on June 16 became the largest Western country to launch a coronavirus contact tracing smartphone app.
According to a June 10 survey published by the research group Forschungsgruppe Wahlen, only 41% of Germans said they were willing to voluntarily download the app. Another 46% indicated they wouldn’t use it, while 8% claimed they didn’t own a smartphone.
“This is not the first corona app but I am convinced it is the best one,” said Dr. Helge Braun, a trained physician who serves as chief of staff to Chancellor Angela Merkel. “It is a small step for all of us to download the app, but it would be a big step for the fight against the pandemic.”