Last month, before Google and Apple announced their joint effort to enable COVID-19 exposure notifications, I wrote about the trouble with using Bluetooth-based solutions for contact tracing
. Chief among the issues is getting a meaningful number of people to download any app in the first place, public health officials told me. And now that such apps are being released in the United States, we’re seeing just how big a challenge that is.
Utah Gov. Gary Herbert said on April 22
that the app, Healthy Together, would be an integral part of getting the state back on its feet: “This app will give public health workers information they need to understand and contain the pandemic and help Utahns get back to daily life.”
The state spent $2.75 million to purchase the app and is paying a monthly maintenance fee of $300,000, according to contracts obtained by BuzzFeed News. But as of May 18, just 45,000 of the state’s 3.2 million people had downloaded Healthy Together, according to Twenty.
That’s roughly 1.4 percent adoption, well below the 60 percent or so that public health officials say is necessary to make such exposure notifications effective. And it bodes ill for other states’ efforts to distribute their own apps, particularly in a world where the federal response continues to be confused and even counterproductive
But a new reason for hope arrived today, in the form of an official release of the Apple/Google exposure notification protocol. The system, which allows official public health apps to use system-level Bluetooth features to help identify potential new cases of COVID-19, is now available as an update to iOS and Android. Three states are working on projects so far, Russell Brandom reported today at The Verge
Alabama is developing an app in connection with a team from the University of Alabama, while the Medical University of South Carolina is heading up a similar project in collaboration with the state’s health agency.
“As we respond to this unprecedented public health emergency, we invite other states to join us in leveraging smartphone technologies to strengthen existing contact tracing efforts,” North Dakota Gov. Doug Burgum said in a statement, “which are critical to getting communities and economies back up and running.”
In a call with reporters today, Apple and Google said 22 countries have received API access to date. Later this year, an update to iOS and Android will allow people to begin participating in the program even if they haven’t yet downloaded an official public health app.
But as we’ve discussed here before
, the best-designed tech interventions won’t be effective if they’re not supported by contact tracing and isolation of new cases. So let’s check in to see how we’re doing on those fronts.
“Contact tracing” was the name originally given to the Apple/Google initiative, before the companies acknowledged that what they were doing didn’t quite live up to that standard. The term refers to getting in touch with people who may have been exposed to a disease and directing them to testing and other resources, and the current consensus view is that this work is best done by human beings. The Apple/Google system, which has been rebranded as “exposure notification,” is intended to augment the work of human contact tracers.
Around the United States and the world, public health departments are hiring people as contact tracers. Officials estimate that we will need at least 100,000 such workers in the United States, and by April 11,000 had already been hired
. California and Massachusetts began hiring early
, and Texas
are among the states that have followed. There’s clearly much more work to be done, and quickly, but here’s a case where federal inaction hasn’t totally stopped states from developing a response. (More federal money to hire contact tracers would help, though.)
And what about isolating new cases? This is the process whereby people infected with COVID-19 temporarily relocate to government-run facilities to receive care in an environment where they are unlikely to spread the disease to others. Israel
are among the countries that have been using such facilities. San Francisco, in a possible step toward a contact isolation program, has begun paying to house people who were homeless in hotels
as a measure to reduce the spread of the disease.
Lyman Stone makes the case for rapid deployment of contact isolation in the Washington Post
. He imagines a world in which people receive tickets for failing to comply with orders to isolate — but also one in which the facilities themselves are nice enough to get people to go along with the idea voluntarily:
This system also encourages compliance because the centralized facilities would provide isolated individuals with all their basic needs (plus daily supervision so they would get treatment if they become sick). Food and medication can be delivered, WiFi would be free, and governments should provide financial compensation for lost work time. And, since covid-19 is much less dangerous to kids, families could choose for their children to be quarantined with them or separately, whichever they prefer. All of this would require legislation by state governments, but none of it is infeasible.
Alas, contact isolation sounds scary to many people. It conjures images of internment, stigmatization or family separation. But the truth is that the curtailment of our liberties would be minuscule compared with the society-wide lockdowns Americans have been enduring.
At a time when all of us are looking for answers to the pandemic, an approach that combines testing, tracing, and isolation appears to be as close to a sure thing that we have, short of a vaccine. Caroline Chen looked at the research Tuesday in ProPublica
Researchers in the U.K. used a model to simulate the effects of various mitigation and containment strategies. The researchers estimated
that isolating symptomatic cases would reduce transmission by 32%. But combining isolation with manual contact tracing of all contacts reduced transmission by 61%. If contact tracing only could track down acquaintances, but not all contacts, transmission was still reduced by 57%.
A second study
, which used a model based on the Boston metropolitan area, found that so long as 50% of symptomatic infections were identified and 40% of their contacts were traced, the ensuing reduction in transmission would be sufficient to allow the reopening of the economy without overloading the health care system. The researchers picked Boston because of the quality of available data, according to senior author Yamir Moreno, a professor at the institute for biocomputation and physics of complex systems at the University of Zaragoza in Spain. “For other locations, these percentages will change, however, the fact that the best intervention is testing, contact tracing and quarantining remains,” he said.
The Apple/Google collaboration represents a chance to use the companies’ vast size and power to make a positive contribution to public health during a crisis. But it will only ever be one piece of the puzzle — and not necessarily one of the larger pieces, either. The good news is that we increasingly understand how COVID-19 can be brought under control. The open question is whether the United States government, to which we have entrusted the job of keeping us all safe, will do what is necessary to make it happen.