Technology as a solution: Opportunities and pitfalls of COVID contact-tracing apps

One of the most worrisome aspects of the current opening of the economy and increased mobility is that we have not developed sufficiently the infrastructure for surveillance, identification of clusters, containment, testing, case and contact tracing and isolating. The purpose of the lockdown was twofold; 1) to mitigate community transmission and prevent hospitals from crumbling, and 2) to build the public health infrastructure for testing and tracing required to go back to some level of normality. In Ontario, we made important gains toward the first goal but have done very poorly on the second, which means we are creating a serious risk of another surge. Today, I explore one tool being used in many jurisdictions to help with contact tracing.

Many jurisdictions, including Ontario, are using or considering the use of smartphone apps that can help trace and contact people who may have been exposed to the virus. If the virus’s path can be tracked, even predicted, the hope is that more people will be able to resume at least part of their normal routines — and fewer will need to confine themselves at home.

At their core, the apps are intended to gather information about the movements of people who have tested positive for the virus, alert others who might have crossed their paths, and in some cases make sure infected people stay quarantined. They use smartphone technologies, such as GPS and Bluetooth, to collect and share the data, which make them agile and easy to use but also provide an enticing target for hackers or government surveillance.

This concern about privacy is well-placed. Civil liberties groups have warned that the rush to adopt virus-tracking technologies may entrench new forms of government surveillance and social control even if the apps do not prove effective in fighting the coronavirus.

India is using at least 19 apps to track and trace Covid-19, including Aarogya Setu, an app heavily promoted by the central government. The Aarogya Setu requires a user to provide access to location data at all times and also asks for a user’s name, gender, profession, and countries visited in the last 30 days. This is an “excessive collection and use of sensitive personal data”, according to a centre that works on ensuring digital rights.

Aware of the concerns, Apple and Google announced last month they were creating software that public health authorities could use to make apps. The tool will allow different apps to work together and has the support of many privacy experts. But several technology law scholars expressed concern that even well-intentioned digital surveillance tools could become problematic and are difficult to withdraw.

Even if the privacy and surveillance concerns can be addressed, there is still a question of how effective can an app be for contact tracing. The first problem is getting a meaningful number of people to install the app and make sure Bluetooth is on and the app active when they leave home. If, say, 12% of the population download the app, the likelihood that two people talking to one another both have the app installed is 1.44%. Forcing (instead of recommending) the installation of a particular app by the authorities is unlikely in a democratic state, and most Canadians oppose it.

A second concern is how many false positives the app will elicit, given the limitations of Bluetooth technology (e.g., you were close to a person with a wall or Plexiglas standing in between, but the app is still showing you may have been exposed). A large number of false positives mean thousands of people self-isolating for no reason. A third concern is the lack of sufficient testing. In general, epidemiologists say contact tracing won't be effective without widely available testing.

The implementation of a contact-tracing app in Iceland shows it can be helpful as part of a comprehensive, well-coordinated and well-resourced effort to test, trace and isolate. However, it is not a panacea. When Iceland got its first case on February 28, an entire apparatus sprang into action, and it began rapidly rolling out public testing on a wide scale. A team of contact tracers was put in place to interview those with a positive diagnosis and track down people they’d been in contact with.

Within a few weeks, Iceland unveiled its app. Rakning C-19 was hailed as a way to “make the tracing of transmissions easier” at the time. And it gained traction quickly; it has the largest penetration rate of all contact trackers in the world, having been downloaded by 38% of Iceland’s population of 364,000. But despite this early deployment and widespread use, one senior figure in the country’s covid-19 response says the real impact of Rakning C-19 has been small, compared with manual tracing techniques like phone calls. “The technology is more or less … I wouldn’t say useless,” he said. “But it’s the integration of the two [app-based and manual tracing] that gives you results. I would say it [Rakning] has proven useful in a few cases, but it wasn’t a game changer for us.”

In Canada, the federal, provincial and territorial privacy guardians issued a joint statement calling on governments to ensure that COVID-19 contact tracing applications respect key privacy principles. “If done properly, tracing applications can achieve both privacy and public health goals at the same time. Everything hinges on design, and appropriate design depends on respect for certain key privacy principles,“ says Commissioner Therrien.

Ontario Premier Doug Ford says technology to assist with contact tracing will play a critical role in the province’s strategy as they endeavour to ramp up testing for COVID-19. “We’re coming up with new apps when it comes to contact tracing and testing. It’s absolutely critical that that’s part of it,” Ford said this past Tuesday (May 19th). The province is still in talks over the potential use of new technology for contact tracing, alone and with federal and provincial counterparts, says the ministry of health.

Alberta recently launched a voluntary mobile contact tracing app to assist with public health efforts — which is believed to be the first of its kind in North America. The app, called ABTraceTogether, uses Bluetooth to identify other nearby phones with the same app, and records information when two such phones are within two metres for 15 minutes within a 24-hour period.

On May 22, Prime Minister Justin Trudeau said that he is hoping Canada will adopt just one contact tracing app, based on the Apple-Google technology, with consideration of privacy concerns, to encourage its use across the country to slow the spread of the novel coronavirus.

RNAO’s view: An app approved by the privacy commissioners can be a useful tool in the arsenal required for return to mobility, but it should not detract the focus from one of our greatest failures so far: to build large scale, agile, effective public health capacity for testing, case and contact tracing and isolation. Technology is not a panacea and will not save us from COVID-19.