Apple iOS 13.5 Is Ready For Covid-19 Contact Tracing —Are You?

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This article originally appeared on Forbes.com and was published on May 22, 2020.

One of the new buzzwords that has become synonymous with the COVID-19 pandemic is contact tracing. While the concept is not a new one in public health, the way in which it is being used for this novel virus certainly is. Contact tracing, or the process of identifying and monitoring contacts of infected individuals,  has been digitized, globalized and consumerized. Think of it like a combination of investigative journalism and detective work, now augmented by the expansive use of technology. Contact tracing bodes a history of success from previous decades. It has helped eradicate smallpox, reduced venereal disease among American troops in the 1930s and, more recently, helped combat the 2009 H1N1 influenza and the 2014 Ebola outbreak.

Reducing the spread of infection, informing others of confirmed and probable cases and understanding the epidemiology are some of the main goals of contact tracing. The end goal, however, is to essentially “box it in” to help return to normal and curtail the need for expansive lockdowns. According to a guide from PreventPandemics.com, this “box it in” approach consists of four key steps: test widely, isolate those infected, find everyone who has been in contact with those infected, quarantine all contacts for 14 days and repeat as needed. On paper it sounds feasible, but in practice it can prove a much more difficult task.

We’re in uncharted waters amid a global health crisis with many realizing that contact tracing, when aided by technology, can play a critical role, but how it will unfold is yet to be seen. Just as there are many unknowns with the What we do know is that digital contact tracing combined with contact tracers are just two parts of a multi-faceted effort that will help fight the COVID-19 pandemic on a global scale.

It’s Here: A Tech Giant Partnership Unfolds

In April, Apple and Google announced they would join forces to deliver contact tracing technology. On May 20, the companies released their Bluetooth-based contact tracing solution, which has since been dubbed exposure notification. An important distinction to make is that Apple and Google are not creating contact tracing apps, but rather the framework that other apps will be based on. A handful of U.S. states along with 22 countries have expressed interest in using the framework.

In addition to this news, Apple released its iOS 13.5 update complete with notable features such as the exposure notification API and face ID enhancements, including a simplified unlock process if wearing a facemask.   

As with any new tech, there are skeptics on how useful this collaboration and technology will prove to be. A combination of limited capabilities with app updates as well as Apple and Google’s decision not to share the health data collected with local, state and federal agencies are two potential roadblocks. It’s a give and take when it comes to access and privacy, and a fine line to walk. But how much privacy have we already given up through the technologies we use on a daily basis?

The Times Privacy Project uncovered that the movements of millions of Americans are being tracked using smartphone GPS capabilities. In a report obtained by the project, the exact whereabouts of over 12 million Americans were tracked through 50 billion location pings over the course of several months. Without hesitation, over 77% of smartphone owners regularly use navigation apps, allowing dozens of largely unregulated companies to obtain location details. It is worth noting that Apple and Google have chosen to use Bluetooth to identify when two individuals come into proximity with one another, and the framework does not employ location tracking through GPS.

We frequently use our smartphones for storing or transmitting other personal information, like credit card numbers. Statistics on mobile e-commerce from 2019 showed that nearly 80% of smartphone users had made a purchase online within the previous 6 months by using their mobile device. This shows that a large number of Americans in some capacity already trust (even if it’s for the sake of convenience) the internet and their mobile devices with private information.

I would challenge people to consider how sharing info with contact tracing apps is any different.

It’s far too soon to tell how effective (or ineffective) this technology will prove to be and what adoption rates will look like. It’s just one of the many unknowns during this unprecedented global health crisis impacting us all.

Lessons Learned: Contact Tracing Efforts From Around The Globe

There’s no shortage of lesson-rich case studies from around the world on contact-tracing technologies. In short, privacy concerns seem to be the culprit of low-adoption rates regardless of geographic location. It all stems from lack of trust with big tech, an understandable fear, given the history of tech giant mishaps over the years. Plus, when you combine extremely sensitive data — location and personal health — there is an even higher expectation when it comes to privacy protection. But does the global benefit outweigh the potential level of risk? Time will tell, as will a decline in coronavirus cases, if and how digital contact tracing will have an impact.

Here’s a snapshot of what some countries have done and are currently doing which may help set benchmarks and offer valuable learnings. It’s a landscape that continues to rapidly evolve.

England

A contact tracing app from The National Health Service (NHS) in the United Kingdom has recently been tested on the Isle of Wight with 40% of the population having downloaded the app as of May 10. The real verdict is yet to be seen and proving to be an evolving experiment. The initial plan was to use the NHS app, but the country has since started investigating a switch to Apple and Google’s framework in an effort to improve compatibility. According to a study by Oxford University, simulations have suggested that approximately 60% of Britons would have to download the app in order for it to be successful.

India

India launched its own contact tracing app known as India’s Health Bridge app, or Aarogy Setu. It was created by the National Informatics Center and all workers are required to download the government app or face fines. Unlike many other apps using Bluetooth, this platform uses GPS, which opens it up to greater risk for hackers. Families in India have even faced additional stress and discrimination with signs being put outside homes of those infected. This raises the question of who has access to contact tracing data and how can it be used?

Singapore 

The country was praised for its release of the TraceTogether app, which works off of Bluetooth technology, much like the Apple-Google framework. But adoption has been low. Only 12% of those in Singapore, around 1 million, had opted in as of April 1 despite encouragement from their Prime Minister. According to the TraceTogether website, it appears that about 1.5 million people now have the app. Once again, low adoption rates equal less efficacy and gaps in data.

Taiwan

Taiwan’s combination of technology and manual efforts seem to have had a positive impact from the early days of the outbreak. Although not quite contact tracing, the government used cell phone signals to ensure those quarantined were in fact staying inside. As of early April, 55,000 individuals were being tracked; this was combined with calls from the public health office to check up on people’s health status.

Interoperability And Contact-Tracing Tech

With various applications popping up worldwide and different apps within the United States, it raises questions around interoperability, privacy and how all of this data should be shared and streamlined to help the greater good during this public health crisis.

Utah released its own app called Healthy Together, which combines Bluetooth, GPS and location data. Georgia is piloting an app in three metro Atlanta areas, and North and South Dakota launched its Care19 app. With so many disparate apps and processes, this begs the question of interoperability and the ongoing patient matching dilemma.

“Health plans are playing an important role in the contact-tracing equation,” adds Jacob Sattelmair, DSc, MSc and CEO of Wellframe, who is an epidemiologist by training. “Many plans have both the resources and technology already in place to help them identify, engage, and understand vulnerable populations. Coupled with their broad reach and unique data insights, they are well-positioned to support patients, providers, and public health agencies in implementing and monitoring contact tracing efforts.”

While technology has great potential and reach, the human element of contact tracing is indispensable.

Career Change: Contact Tracers Are In High Demand

With U.S. unemployment currently hovering around 15% and over 26 million applying for unemployment benefits, the need for jobs is hitting record highs. While many jobs have gone on hiatus, one of the new jobs on the market is becoming a contact tracer. Entrepreneur Mark Cuban is a proponent of this strategy and showed support for the potential it holds via a tweet.

Dr. AnnMarie Lattanzi is hopeful when it comes to the power contact tracing holds. “It’s incredibly important for local, state and federal governments to invest efforts in contact tracing to help propel our economy forward. Contact tracing is just one of the pillars in helping us return to society as we knew it or at least help us in transitioning to the new normal. In the absence of a vaccine, contact tracing is a more readily available solution, but we need buy-in and support to get a robust program up and running at scale. We should look to states who are taking the right steps, Massachusetts serves as a great model,” explained Dr. Lattanzi.

According to an article from the Association of State and Territorial Health Officials (ASTHO), the United States needs about 184,000 contact tracers. The Fitzhugh Mullan Institute for Health Workforce Equity (Mullan Institute) has released the Contact Tracing Workforce Estimator tool to demonstrate the need for contact tracers at the state and county level. There are even full curriculums and training materials, such as this one from ASTHO, and Johns Hopkins is offering a free, 5-hour course.

So what skills are needed to become a contact tracer? It can be akin to an art form. One must possess the right combination of trainability, discretion, empathy and approachability paired with cultural and social sensitivity, all while being able to interview, educate and persuade others to stay at home. While a formal degree may not be needed, and the foundation can be learned through online courses, some of these soft skills can’t just be taught overnight. 

Some states have pushed back on technology-enabled contact tracing tech, and are opting to focus efforts on the human-to-human approach. However, the combination of apps and human contact tracers may prove more powerful together. Gaining another’s trust and seeing another human as your ally is something technology won’t be able to simply replace but can help augment.

New York is focusing heavily on contact tracing recruiting efforts. According to Governor Andrew Cuomo, they will unleash an “army of people to trace each person who has tested positive” and are planning to recruit 17,000 contact tracers. The state is working closely with Michael Bloomberg and Johns Hopkins School of Public Health on initiatives. While there is an app in the works, the main focus will be on leveraging human contact tracers.

What Does The Future Of Contact Tracing Look Like?

A Washington Post-University of Maryland poll uncovered that 3 in 5 Americans have expressed that they are either unwilling or unable to use the contact tracing system that Google and Apple have developed. Plus, 1 in 6 Americans don’t have access to a smartphone, another limiting factor, especially since a large percentage of those without one are over the age of 65. Of the 82% of those with smartphones, it’s a 50/50 split between those who say they may use it versus those who responded that they probably or definitely would not. If trends like this continue, the effectiveness of such technologies will be greatly diminished. Like the saying “the more the merrier,” the same rings true for effectiveness of contact tracing efforts.

It also begs the question if other tech and data powerhouses like Facebook will create a system of their own or join forces with existing efforts. With over 2.54 billion (yes, billion) active users globally, the social media platform already offers a safety check feature when dangerous events like natural disasters take place—a feature users have grown accustomed to. However, the platform has endured some negative publicity with respect to protecting individuals’ privacy. Understandably so, this could make individuals uneasy with self-reporting COVID-19 symptoms if Facebook goes down the contact-tracing path. This does raise the question of if and how social media could be a valuable asset to aid such efforts.

Like with most technology when it first enters the market, there is an inherent risk and reward and many unanswered questions and unforeseen challenges to solve. But does the potential reward of technology-enabled contact tracing apps outweigh the risks? For the good of public health, should we all consider giving away a bit more of our privacy?

A coordinated international effort combined with mass user adoption and interoperable systems will be needed to help make digital contact tracing as impactful as possible. But is this asking too much? The results will speak for themselves in the coming days, weeks and months ahead.

Joe Harpaz

Joe Harpaz

President and Chief Operating Officer

Joe Harpaz serves as President and Chief Operating Officer of Modernizing Medicine. In his role, Joe leads growth and scale at Modernizing Medicine as the company aims to deliver best in class product and customer experience to make a true difference in healthcare tech.

Joe has over 20 years of experience in building and leading high growth B2B software businesses that operate in complex and regulated industries. He’s known for his ability to lead and inspire large organizations while driving innovation and growth at scale. Learn more about Joe here. 

 

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