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SCIENCE

CONTACT TRACING APPS PROMISED BIG AND DIDN’T

DELIVER
Emphasizing privacy makes data collection difficult
By Nicole Wetsman Dec 11, 2020, 10:52am EST

C
alifornia rolled out a COVID-19 contact tracing app this week, and officials
— including Apple CEO Tim Cook — touted it as an advancement that
would help slow their ongoing surge in cases. Using the app will be easy.
Measuring whether the app can deliver will be harder.

Nine months after Apple and Google first announced their partnership, contact
tracing apps’ role in reducing viral transmission is still difficult to measure.
Relatively few people have downloaded the apps, and because of the apps’ focus
on privacy, it may be nearly impossible to quantify how well they’re actually able to
help prevent disease.

“It seems to me that it’s incumbent upon those who are behind these efforts to
show evidence that they’re having some effect,” says Ryan Calo, law professor
and a director of the Tech Policy Lab at the University of Washington. “So far, I’ve
personally been unconvinced that there’s been any kind of significant showing of
efficacy.”

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“I’VE PERSONALLY BEEN UNCONVINCED THAT THERE’S BEEN ANY KIND OF SIGNIFICANT
SHOWING OF EFFICACY”
States each spent hundreds of thousands of dollars to develop these contact
tracing apps, rebranded over the summer as exposure notification apps. New
York’s cost $700,000, for example, while Virginia’s had a $229,000 price tag. The
apps were designed to supplement state efforts to manually track and stop the
spread of COVID-19. Anyone who tested positive for the coronavirus would still,
ideally, get a phone call from a contact tracer. Contact tracers would ask who
they’d interacted with during the time they may have been contagious, and ask
those people to quarantine or be tested for the coronavirus.

Manual contact tracing isn’t perfect — contact tracers can only find the people
that a sick person knows they were in touch with, and the process can be slow.
That’s the gap automated contact tracing apps aim to fill. In theory, they would let
someone who tested positive alert strangers they stood by on a long subway ride
or grocery store employees they interacted with that they’d been exposed to the
virus. And it would happen fast: telling the app you’d tested positive would
automatically notify those contacts, without waiting for a tracer to call.

There’s one major catch: that entire scenario relies on lots of people downloading
the app. Those strangers on the subway have to use it in order for them to get any
benefit from an alert. If only a handful of people turn on exposure notifications, the
chances that the random people who they interact with in their daily lives will also
have the system running is fairly low.

In many states, uptake has been slow. In New York, for example, only around 5
percent of people have downloaded COVID Alert NY, which launched at the start
of October. Fewer than 3,000 of the 180,000 people who tested positive since the
app launched had it installed, and only around 800 people were notified of an
exposure. Nevada’s app was installed by around 4 percent of the population, a
spokesperson told The Verge. Around the same percentage of Michigan’s
population uses MI COVID Alert, and only 142 people have reported positive test
results, according to a spokesperson.

Virginia, the first state to launch an exposure notification app, has seen more

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success: around 10 percent of the population, and around 20 percent of the

population between the ages of 18 to 65 who own smartphones, uses the app, a
health department spokesperson told The Verge. Colorado’s app is also more
popular — 20 percent of the population uses it, according to a statement from the
state’s Emergency Operations Center.

The numbers reported by states are still far below the levels needed to make a
dent in the pandemic, analysis suggests. It would take around 60 percent of a
population using a digital contact tracing system to stop transmission of
COVID-19, according to a study by a team at the University of Oxford. Other
studies found that it would take that level or higher of adoption, along with other
public health measures, to control outbreaks.

“WE WOULDN’T BE EXPECTING A HUGE EFFECT”

“We wouldn’t be expecting a huge effect based on the kind of 20 or 30 percent
uptake. It would be a small effect,” says Isobel Braithwaite, a clinical fellow in
public health at University College London and author on a review of automatic
contact tracing. It’s not all or nothing, she says — a small effect could still nudge
transmission down a few percentage points and keep people from getting sick.
Another still-unpublished study from Google and the University of Oxford found
that if 15 percent of people in a Washington state county used an exposure
notification app, infections could go down by 8 percent.

“I’ve come to think about it in terms of a spectrum, where you increase the benefit
with the higher level of uptake. But even at low levels, there’s still some benefit,”
Braithwaite says.

The University of Oxford study does show that even at low levels, there’s some
utility to the apps, says Mike Reid, an assistant professor in infectious disease at
the University of California, San Francisco, who works with the San Francisco
Department of Public Health on contact tracing. “My feeling is that anything that
can help us to reduce transmission has got to be leveraged,” he says. COVID-19
spreads exponentially, so cutting off even one potential infection matters. “Every
time you reach a case and help them understand their need to isolate, you know
you prevent thousands of subsequent infections,” Reid says.

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The challenge is, researchers aren’t able to pick apart whether the apps are
actually preventing those infections. Most of the research on the way exposure
notification technology changes the trajectory of an outbreak is based on
modeling, including the University of Oxford study. Experts use data and estimates
to map out what could happen if a certain number of people download an app,
based on what they know about the way COVID-19 spreads and how contact
tracing typically works. But they don’t track the progress of apps to find out what
actually ended up happening.

The exposure notification app in the UK. | Photo by Yui Mok / PA Images via Getty Images

Google and Apple made a big point of prioritizing privacy and security when
developing the apps. They wanted to minimize concern that the companies were
tracking users’ whereabouts, so none of the information collected by the app is
identifiable. But by reducing the amount of data they collect, there isn’t an easy
way to evaluate how these exposure notification programs actually work once
they’re implemented.

“By the very nature of how they’re done in terms of prioritizing privacy, it’s very

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challenging to truly assess their impact,” Reid says.

The United Kingdom initially attempted to develop its own contact tracing app
outside of the Google and Apple system, which would have collected more
information on usage. “They moved to the more privacy preserving Apple and
Google approach for the wider national rollout, because of political and public
perception considerations,” Braithwaite says. “That makes studying the effect
much, much harder.”

“THAT MAKES STUDYING THE EFFECT MUCH, MUCH HARDER”

Researchers don’t know, for example, how many of the people who receive
notifications on the apps follow isolation guidelines or get tested for COVID-19.
They also don’t know how many of the people receiving notifications are people
who wouldn’t have been flagged by a manual contact tracer. “You have to see if
there are situations where they never would have known,” Calo says. A robust
evaluation would figure out how many times someone was in a situation where they
got a notification from a stranger, actually isolated, and ended up developing
symptoms themselves.

That’s key to evaluating whether apps were worth the investment, Calo argues.
“They never would have quarantined or gotten tested, and we saved a lot of
people that way,” he says. “And then you have to put that number against the
numbers of how much was paid for the app.”

For Braithwaite, even a slight dip in virus transmission would make up for the
millions of dollars it took to develop and roll out exposure notification apps. “We’re
buying a bit more time until the vaccine by suppressing transmission slightly,” she
says. Not having clear-cut evidence isn’t a reason to disregard the apps, she says.
It took time for researchers to study how well masks helped slow the spread of the
coronavirus, she notes, but public health experts still asked everyone to wear them
while that process was ongoing. “We don’t have any evidence that they don’t work,
either.”

THERE’S NO PRECEDENT FOR USING THIS TYPE OF TECHNOLOGY

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There’s no precedent for using this type of technology as part of a public health
response to any disease, Reid says. It’s never been used before and was
developed in the middle of a pandemic. Its use against COVID-19 is, in some
ways, just a trial run. Despite the intense data difficulties, researchers will likely still
try to sort through how effectively they drove down viral transmission — maybe by
comparing coronavirus spread in areas with an app to those without, Braithwaite
says. Having at least a hint toward answers will help public health decision-making
going forward.

“The lessons we will learn will impact how we respond to future pandemics,” Reid
says. “I think evaluating its impact right now, and determining whether this is going
to be part of our plan for responding to future pandemics, is critical.”

Correction December 14th, 10:46AM ET: An earlier version of this article

attributed a research study to the University of Washington rather than the
University of Oxford. We regret the error. ■

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