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DENVER (AP) – The app makers had planned pranksters, making sure only people with verified COVID-19 cases could trigger an alert. They had planned for severe privacy reviews, in many cases making functionality as simple as possible. But, as more states deploy smartphone contact tracing technology, other challenges emerge. Namely, human nature.
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The problem starts with downloads. Stefano Tessaro calls it the “chicken and egg” problem: the system only works if a lot of people buy into it, but people will only join in if they know it works.
“The accuracy of the system ends up increasing trust, but it is trust that increases adoptions, which in turn increases accuracy,” said Tessaro, a computer scientist at the University of Washington who was involved in the creation of this state’s next contact finder app. a conference last month.
In other parts of the world, people are taking this necessary leap of faith. Ireland and Switzerland, boasting some of the highest participation rates, report that more than 20% of their populations use a contact tracing app, reports Kaiser Health News.
BERLIN, GERMANY – SEPTEMBER 16: A visitor tries an Apple iPhone 7 on the first day of sale of the new phone at the Berlin Apple Store on September 16, 2016 in Berlin, Germany. The new phone comes in two sizes, one with a 4.7 inch screen, the other with a 5.5 inch screen. (Credit: Sean Gallup / Getty Images)
Americans don’t seem so excited about the idea. As with much of the US response to the pandemic, this country has not had a national strategy. So it’s up to the States. And only a dozen, including the recent addition of Colorado, have launched the smartphone feature, which sends a notification to users if they have crossed paths with another user of the app who then tested positive for COVID-19. .
In these few states, enthusiasm seems low. In Wyoming, Alabama, and North Dakota, some of the few states with usage data exceeding initial downloads, less than 3% of the population uses the app.
The service, designed by Google and Apple and tailored by country, state or territory, appears either as a downloadable app or as a setting, depending on state and device. It uses Bluetooth to identify other phones using the app within a radius of about 6 feet for more than 15 minutes. If a user tests positive for COVID-19, they are given a verification code to enter so that each contact can be notified that they have been potentially exposed. The identity of the person is protected, as are those of the notified persons.
“The more people who add their phones to the fight against COVID, the more protection we get. Everyone should do it, “Sarah Tuneberg, who is leading the Colorado testing and containment effort, told reporters on Oct. 29.” The sky is the limit. Or the population is the limit, really.
But the population could turn out to be a limit. Data from the earliest governments suggests that even those who download the app and use it might not follow instructions at the most critical time.
According to the Virginia Health Department, from August to November, around 613 app users tested positive and received a code to alert their contacts that they may have been exposed to the virus. About 60% of them actually activated it.
In North Dakota, where the outbreak is so large that human contact tracers cannot track, the data is even more dire. In October, around 90 people tested positive and were given the codes needed to alert their contacts. Only about 30% did.
Researchers in Dublin who track app usage in 33 regions of the world have encountered echoes of the same problem. In October, they wrote that in some parts of Europe, fewer people were alerting their contacts than expected, given the scale of the outbreaks and the number of active app users. Italy and Poland rank low. There, they estimated that only 10% of the app users they expected would submit the codes necessary to notify others.
“I’m not sure anyone working in this area foresaw that this could be a problem,” said Lucie Abeler-Dörner, a member of a team at the Big Data Institute in Oxford studying COVID-19 interventions, including looking for digital contacts. “Everyone just assumed that if you sign up for a voluntary application … why not hit that button?”
So far, people on the ground are just guessing. Abeler-Dörner wonders how much this has to do with people going into panic mode when they find out they are positive.
Tessaro, a computer scientist at the University of Washington, asks if the health officials who provide the code need more training on how to provide clear instructions to users.
Elissa Redmiles, a faculty member at the Max Planck Institute for Software Systems that studies what prompts people to install contact tracing apps, worries people will have difficulty entering their test results.
But Tim Brookins, a Microsoft engineer who developed the North Dakota contact tracing app as a volunteer, has a bleaker outlook.
“There is a general belief that some people want to load the app in order to be notified if someone else is positive, in an interested way,” he said. “But if they’re positive, they don’t want to take the time.”
Abeler-Dörner called the voluntary notification a design flaw and said the alerts should instead be triggered automatically.
Even with the limitations of the applications, the technology can help identify new cases of COVID. In Switzerland, researchers looked at data from two studies on users of contact tracing applications. They wrote in an article that has yet to be peer-reviewed that while only 13% of people with confirmed cases in Switzerland have used the app to alert their contacts from July to September, it has prompted around 1,700 people potentially exposed to calling a hotline for assistance. And of those, at least 41 people found out that they were indeed positive for COVID-19.
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In the United States, another unpaired modeling study from Google and the University of Oxford of three counties in Washington state found that even though only 15% of the population uses a contact tracing, it could lead to a drop in COVID-19. infections and deaths. Abeler-Dörner, co-author of the study, said the findings could be applicable elsewhere, in broad outline.
“This will prevent infections,” she says. “If it’s 200 or 1,000 and it prevents 10 deaths, it’s probably worth it.”
This can be true even at low adoption rates if app users are clustered in certain communities, instead of evenly distributed across the state. But prioritizing privacy has forced health departments to forgo the very data that would let them know if users are close to each other. While an app in the UK asks users for the first digits of their postcode, very few US states can tell if users are from the same community.
Some exceptions include North Dakota, Wyoming, and Arizona, which allow app users to select an affiliation with a college or university. At the University of Arizona, enough people are using the app that about 27% of people contacted by campus contact tracers say they’ve already been notified of a possible exposure. Brookins of Microsoft, who created Care19 Alert, the app used in Wyoming and North Dakota, said offering an affiliate option also allowed people who were exposed to get specific instructions. on campus on where to get tested and what to do next.
“In theory, we can add companies,” he says. “It’s so polarizing, no company wanted to sign up, honestly.”
The privacy-focused design also means that researchers don’t have what they need to prove the usefulness of apps and therefore encourage greater adoption.
“There is actually a certain irony here because the fact that we are designing this solution with privacy in mind somehow prevents us from accurately assessing whether the system is working as it is. must, ”Tessaro said.
In states like Colorado, Virginia, and Nevada, built-in privacy protections mean no one knows who turned on contact tracing technology. Are these people who barely interact with anyone, or are they essential workers, regularly interacting with many people that human contact tracers could never reach? Do they intersect and exchange signals with other users of the app or, if they test positive, will their warning silently fall like a tree in an empty forest? Will they choose to warn people?
The Colorado Department of Health said it was issuing thousands of COVID codes per day. 3,400 people used the codes to notify their contacts on Wednesday, he said. An automated system issues codes for positive COVID-19 tests even though infected people do not have the app, making it impossible to know how many users are acting on the codes.
“I hope the vast majority of Coloradans will take this opportunity to give this exhibition notification gift to other people,” Tuneberg said. “I think Coloradans will do it.”
By RAE ELLEN BICHELL
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