How Apple and Google are tackling one of the toughest parts about tracking COVID-19 exposures

Here we say that The interface goes out Monday to Thursday, and particularly noisy Friday. Well, today was a particularly noisy Friday. Here is your emergency newsletter …

Thursday evening, I wrote about some of the limitations of using the Bluetooth chip in your smartphone to track the spread of COVID-19. Naturally, on Friday morning, Apple and Google announced what could be the most important collaboration in the history of the two companies – a joint effort to use your smartphone’s Bluetooth chip to track the spread of COVID-19.

Russell Brandom and Adi Robertson had the details in The edge:

The new system, presented in a series of documents and White papers, would use short-range Bluetooth communications to establish a voluntary contact tracing network, keeping a lot of data on phones that are in close proximity to each other. Official applications from public health authorities will have access to this data, and users who download it can report if they have been diagnosed with COVID-19. The system will also notify people who download them if they were in close contact with an infected person.

Apple and Google will present a pair of iOS and Android APIs in mid-May and will ensure that the apps from these health authorities can implement them. During this phase, users will still need to download an app to participate in contact tracking, which could limit adoption. But in the months following the end of the API, companies will be working on creating tracking functionality in the underlying operating system, as an option immediately available to anyone with an iOS phone. or Android.

If you are new to how contact tracing helps stop the spread of disease, start with this explainer from my colleague Nicole Westman. Public health agencies have long dispatched workers, on foot and by phone, to come into contact with people who may have been exposed to someone with an infectious disease. In light of the COVID-19 pandemic, countries around the world have experimented with applications that attempt to use the widespread adoption of smartphones and the signals they receive to identify potential new cases. And as I outlined yesterday, public health officials I spoke with expressed skepticism about the effectiveness of these efforts.

First of all, let me say that I am happy to see big companies working hard on the COVID-19 response and working together. Fast, bold action can save lives, and it’s good that everything that is tried doesn’t work perfectly – or not at all. It is also true that given the number of questions that remain about the Apple / Google collaboration, it is impossible at this stage to say how effective it could be. I hope it is very effective!

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That said, Bluetooth-based approaches to contact tracking have at least three big problems, experts have told me. (Confidentiality, surprisingly, is really not one of them, at least not for me; the concept of confidentiality in the Apple / Google system is quite intelligent. Moxie Marlinspike has a few baffles, howeverThe most important issues are that it is difficult to get people to download a new app, Bluetooth signals can be unreliable, and the focus on technology solutions could reduce the pressure on agencies. public health to hire people to track contacts, although there is much more evidence of the effectiveness of these workers compared to applications for smartphones.

So let’s see how the Apple / Google collaboration seeks to resolve some of these points.

The most important part of the problem that the API project is trying to deal with is adoption, especially in the second phase of the project. Apple explained it to me like this: once you’ve updated your phone to the latest version of the operating system, and activate the contact tracking API, your phone will start sending Bluetooth signals to nearby phones and recording the signals sent to it by other phones. The best part of this system is that it works retroactively – once you download a public health app linked to this system, it will share your “proximity events” from the past 14 days. Adi Robertson details the process here.

By creating a central API on our two main operating systems for smartphones, Apple and Google provide a valuable tool for public health agencies working on contact finder apps that will work in all jurisdictions around the world, even when people start to resume their journey. It’s hard to imagine something like this being done in any way, but at the operating system level; only these two companies could make such a thing possible.

An open question is whether you will get a ping on exposure if you have updated your phone’s operating system but haven’t downloaded a public health app. he seems as the answer is yes, based on what we have seen – which would go further in dealing with the issue of adoption than any other proposition I have seen. If the answer is that you still need to download an app to receive the notification, the basic problem hasn’t really gone away.

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We will see.

What about the reliability of Bluetooth signals? A strong signal has a range of about 30 feet – much further than the 6-foot distance that authorities have asked the public to maintain. And the signal is binary, not relative – it can only say “these two phones came close” rather than “this phone was 6 feet from this phone”. This raises the fear that many proximity events recorded by our phones are false positives – cases where you were relatively close to someone who reported an infection, but who may not have been close enough to infect you yourself.

Apple says it is still studying all of this, but notes that public health apps may include the duration of proximity to decide what counts as a proximity event. (The suggested time I heard today was five minutes.) At an interval of five minutes, you would be less likely to trigger false positives from someone who jogged on the street.

Which begs the question, what are the circumstances during the pandemic where people are (1) within 30 feet of you, for (2) five minutes or more, that (3) you don’t really know? (If you knew them well, you’d probably also find out they had COVID-19.) Some suggestions I heard today: grocery store workers; people lining up for things (like entering grocery stores); warehouse workers; and public transport. As cities begin to reopen, other use cases may emerge. But it seems to be a passive system that works to inform people in these situations about potential exposures could at least offer some protection level. The question is whether the system ultimately generates more signal than noise – if Bluetooth finds more true positives than false.

We will see.

Finally, does Silicon Valley rely too much on untested software solutions when a proven manual solution might suffice? That’s the argument in an article this week from Duke University’s Margolis Center for Health Policy. Authors Mark McClellan, Scott Gottlieb, Farzad Mostashari, Caitlin Rivers and Lauren Silvis write:

Ideally, when a new case of COVID-19 is identified, local public health officials will ensure that the affected individual is isolated and that their close contacts are identified and invited to quarantine. However, the existing local public health capacity for such intervention activities is very limited, and many jurisdictions have abandoned contact tracing in favor of mitigation measures at the community level. To enable a return to case-based interventions as the incidence decreases, these capacities need to be strengthened. Capacity development will be most effective if it is coordinated with health care providers, health systems and health plans and supported by timely electronic data sharing. Mobile phone-based applications that record proximity events between individuals are unlikely to have adequate discriminatory capacity or adoption to achieve public health benefit, while introducing serious privacy, security and privacy concerns. logistics. Instead, timely contact tracing can be achieved through an enhanced investigation of public health cases, enhanced by technology and collaborations at the community level.

But other researchers have argued that COVID-19 simply spreads too easily to make manual contact tracking a workable solution to the problem. Something passive and automated is needed to counter the baud rate, according to a March article Science. Luca Ferretti, Chris Wymant, Michelle Kendall, Lele Zhao, Anel Nurtay, Lucie Abeler-Dörner, Michael Parker, David Bonsall and Christophe Fraser write:

Traditional manual contact tracing procedures are not fast enough for SARS-CoV-2. However, a delay between confirming a case and finding contacts is not inevitable. More specifically, this delay can be avoided by using a mobile phone application.

Perhaps the best way to think about the Apple / Google announcement is that in a world without a coherent federal response to the ongoing disaster, we must instead rely on a patchwork of partial solutions. In such a world, I have no objection to Apple and Google trying to track contacts, although I fear people expect too much. I am also, as always, ready to be pleasantly surprised.

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We will see.

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