Contact tracing apps face the “chicken or the egg” dilemma

(TNS) — The app builder is planning a prank so that only people with confirmed cases of COVID-19 can trigger alerts. They are planning intense criticisms of privacy, often keeping features to the bare minimum possible. But as more states roll out contact tracing technology for smartphones, other challenges are emerging. In other words, human nature.

The problem starts with the download. Stefano Tessaro calls this the “chicken or the egg” question. This system works only if many people buy it, but only if they know it works.

“The accuracy of the system ultimately increases confidence, but it’s trust that increases adoption,” said Tessaro, a computer scientist at the University of Washington who was involved in creating future contact tracing apps for the University of Washington. Improves accuracy. ” Last month’s lecture.

In other parts of the world, people are taking the necessary leap of faith. Ireland and Switzerland advertise some of the highest intake rates and report that more than 20% of the population uses contact tracing apps.

Americans don’t seem to be so keen on the idea. Like many of the US responses to pandemics, the country had no national strategy. So it depends on the state. And, including the recent addition of Colorado, only about 12 have launched smartphone features, notifying users if they later pass a pass with another app user who tested positive for COVID-19. I will send.

In some of those states, enthusiasm looks dim. In Wyoming, Alabama, and North Dakota, less than 3% of the population use the app in some of the few states that have usage data beyond their initial download.

Services built by Google and Apple and adapted by individual countries, states, or regions appear as downloadable apps or settings, depending on the state and device. Use Bluetooth to identify other phones using the app within about 6 feet for at least 15 minutes. If the user tests positive for COVID-19, they will be given a verification code to enter and can notify each contact of potential exposure. The identity of the person is protected, as is the identity of the notified person.

Sarah Thumberg, who heads Colorado’s testing and containment efforts, told reporters on October 29, “The more people add mobile phones to the fight against COVID, the more we all have. You can get protection. Everyone should do it. ” .. Or the population is the limit. “

However, the population can turn out to be quite marginal. Early adoption According to government data, even those who download and use the app may not follow the instructions at the most important times.

From August to November, about 613 app users tested positive and received a code warning their contacts that they might have been exposed to the virus, according to the Virginia Department of Health. About 60% of them actually activated it.

Data are even more dire in North Dakota, where outbreaks are so high that human contact tracers can’t keep up. In October, about 90 people tested positive and received the code needed to alert their contacts. Only about 30% did.

Dublin researchers are tracking app usage in 33 regions around the world and have encountered an echo of the same issue. In October, they wrote that in parts of Europe, fewer people warned their contacts than expected, given the scale of the outbreak and the number of active app users. Italy and Poland were the lowest ranks. So they estimated that only 10% of the app users they expected had submitted the code needed to warn others.

Lucy Abeler Donner, a member of the Oxford Big Data Institute team studying COVID-19 interventions, including digital contact tracing, said, “People working in this area have problems. I don’t know if I had foreseen that it could happen. ” “Why didn’t everyone wonder why they wouldn’t press that button if they signed up for a voluntary app?”

So far, the people in the field have only speculation. Abeler-Dorner wonders how much it has to do with people who go into panic mode when they find themselves positive.

Tessaro, a computer scientist at the University of Washington, is asking if the health authorities that provide the code need more training on how to provide clear instructions to users.

Elissa Redmiles, a faculty member at the Maxplank Software Systems Laboratory who is studying why to install contact tracing apps, is worried that it may be difficult to enter test results.

But the outlook is bleak, said Tim Brooke-Tayl, a Microsoft engineer who volunteered to develop a North Dakota contact tracing app.

“There is a general belief that we want to load the app so that we can be notified in a self-serving way if someone else is positive,” he said. “But if they are positive, they don’t want to spend time.”

Abeler-Dorner called voluntary notifications a design flaw and said that alerts should be triggered automatically instead.

Despite the app’s limitations, this technology helps identify new COVID-19 cases. In Switzerland, researchers looked at data from two studies of contact tracing app users. They are an unpeer-reviewed treatise, and only 13% of people with confirmed cases in Switzerland used the app to alert their contacts from July to September, but could make a dedicated phone call. He wrote that he urged about 1,700 people. Hotline for help. And at least 41 of them found that they were actually positive for COVID-19.

In the United States, another peer-reviewed modeling study by Google and Oxford University that surveyed three counties in Washington found a decline in COVID-19 even when only 15% of the population was using contact tracing apps. I found that it could be connected. Infectious disease and death. The study’s co-author, Abeler-Dorner, said the findings could be broadly applicable elsewhere.

“It will prevent the infection,” she said. “If it’s 200 or 1,000 and it prevents 10 deaths, it’s probably worth it.”

This can be true even with low adoption rates if app users are clustered in a particular community rather than evenly distributed across the state. However, in order to prioritize privacy, the health department had to give up the data itself, which tells us if users are close to each other. The UK app requires users to have the first few digits of their zip code, but few US states can determine if a user belongs to the same community.

Some exceptions are North Dakota, Wyoming, and Arizona, where app users can choose to partner with a university. At the University of Arizona, a sufficient number of people are using the app, and about 27% of those contacted by campus contact tracers say they have already been notified of potential exposures. Microsoft’s Brookins, who created Care19Alert, an app used in Wyoming and North Dakota, offers a partnership option to give campus-specific instructions on where to take the test and what to do next. Said you can get it.

“Theoretically, you can add a business,” he said. “It’s so polarized that, to be honest, no company wanted to sign up.”

A privacy-focused design means that researchers don’t have what they need to prove the usefulness of the app, and therefore encourage higher adoption.

“The fact that we designed this solution with privacy in mind can actually be ironic because we can’t accurately assess whether the system is working properly,” Tessaro said. ..

In states such as Colorado, Virginia, and Nevada, privacy protection is built in, so no one knows who enabled contact tracing technology. Are they people who interact with almost no one, or are they essential workers who regularly interact with many people that human contact tracers can never reach? Are they crossing the road and exchanging signals with other app users, or if they test positive, do their warnings fall quietly like trees in the empty forest? Do they choose to notify people?

The Colorado Department of Health said it issues thousands of COVID-19 codes a day. As of Wednesday, it said that 3,400 people were using the code to notify their contacts. The automated system issues a positive COVID-19 test code even if the infected person does not have the app, so it is not possible to know how many users are acting on the code.

“We hope that the majority of Coloradans will take this opportunity to give this exposure notification gift to others,” said Tuneberg. “I believe Coloradans will do that.”

© 2020 Distributed by Kaiser Health News, Tribune Content Agency, LLC

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