Managing the Pandemic, digitally

If backed by privacy measures and integrated into health systems effectively, digital contact tracing apps can lead to a substantial reduction in transmission

Over 30 countries have deployed mobile applications for contact tracing during the COVID-19 pandemic. Similar apps were deployed for the management of Ebola and SARS-CoV2. 

With greater smartphone and internet penetration, digital tools can surmount the limitations of manual contact tracing. However, their efficacy depends on how widely they are adopted, and how well they are integrated into existing health systems responsible for COVID-19 testing, diagnosis, and treatment. 

This week, we look at COVID-19 tracing apps implemented across the world, their effectiveness in managing health emergencies, and conditions that make for successful implementation.

Contact tracing during epidemics

To effectively contain the spread of infectious disease, governments must carry out “contact tracing” – a laborious and resource-intensive process wherein trained enumerators scrupulously trace contacts of patients, obtain their contact information, communicate with them in a timely manner, and monitor adherence to quarantine regulations.

While manual tracing is feasible in the initial stages of an outbreak when the few numbers of import cases can be traced to specific entry points, it is almost impossible to implement as the disease distends into community transmission.

Leveraging the power of technology

Digital contact tracing tools typically include the following functions:

• Symptom tracking, risk assessment, and medical reporting, wherein users undertake self-diagnosis periodically, the results of which are reported to health authorities, and basis on which at-risk individuals are notified of quarantine requirements

• Proximity tracking using GPS or Bluetooth technology that tracks movements of users and notifies them of potential contact with diagnosed or at-risk individuals, and

• Communication, providing government officials an easy platform to disseminate official and dynamic information, bust myths and misinformation, and generate greater awareness and adherence to best practices. 

When implemented effectively, digital applications can not only ease the process of reporting and tracking infections but also contribute to the dissemination of accurate information.

Versions of these applications have now been adopted by businesses returning to physical workplaces.

Contact tracing apps: what research shows

A number of independent studies evaluating the effectiveness of contact tracing apps show positive effects. 

A joint study conducted by Oxford University and the Alan Turing Institute estimated that UK’s NHS COVID-19 app averted between 200,000 and 900,000 infections by generating timely alerts to those assessed as “at-risk”.

In 2020, an average of 4.4 quarantine notifications was sent for each user who shared their positive test result through the app. A significant number of alerts went out in December when the new B-117 variant led to a surge in cases. 

Another study led by researchers in the UK, US, and Spain assessed the effectiveness of Spain’s Radar COVID and found that the application was able to detect an average of 6.3 close-contacts per infected individual, over two times higher than the national average detected using manual contact tracing alone.

The author of the study, Dr. Lucas Lacasa was quoted stating, “Overall our results were positive and show that the technology works and if accompanied by appropriate communications campaigns, it should reach the levels of adoption and compliance needed to support other non-pharmaceutical interventions to contain outbreaks”. 

A third study led by researchers at the University of Glasgow simulated the spread of COVID-19 in a multi-layered network to explore the impact of a contact-tracing app in curbing the spread of an epidemic at various adoption rates. The study found that contact tracing apps can contribute substantially to reducing infection rates in the population if it is accompanied by adequate priority-based testing. 

Greater usage of COVID-19 apps can reduce disease transmission

Although independent studies find COVID-19 apps to be effective even at low levels of usage, a recent meta-analysis of 15 studies found that tracing apps require manual intervention and adequate uptake to be effective. 

Whether these apps are still effective at low rates of usage, there is consensus that greater usage can drastically reduce the incidence of cases. 

As Professor David Bonsall, Principal Investigator of the Oxford study states, “Our analyses show that when you compare two areas with similar demographics and ongoing interventions, the one with higher app uptake has significantly fewer COVID-19 cases. The data also suggests that if all areas had reached a usage similar to the areas with the highest uptake, we would have had 200,000 to 400,000 fewer cases on top of those averted already. The NHS COVID-19 contact tracing app is a powerful and sustainable public health tool. It can continue to help reduce the number of infections, especially if further resources are invested to increase usage”.

The study concluded that the impact of the app could be increased if more people used it, estimating a 0.8% – 2.3% drop in cases for every 1% increase in users.

Data privacy and security concerns may hinder usage

Data privacy remains a primary concern hindering citizens from using COVID-19 apps. 

In May 2020, the World Health Organization released ethical guidelines for COVID-19 applications to emphasize the centrality of data privacy, security, transparency, and accountability. It mandates that COVID-19 apps be made voluntary, and written consent be obtained after disclosing data-sharing arrangements with citizens. 

India’s Aarogya Setu, released in April 2020 as a community-led fight against COVID-19 received pushback for lack of transparency and consent from users prior to data collection. A petition was filed against a government order that made refusal to use the app a punishable offense. 

Since the app has been made voluntary, and consent is sought when users create an account. Aarogya Setu is now under the purview of a Data Access and Knowledge Sharing Protocol which permits the collection of only those data that are necessary and proportionate to the implementation of health response. Personally identifiable data collected through the app, including name, location, and contact information will be stored by the National Informatics Centre and shared solely with those government departments that are implementing COVID-19 response strategies. 

Aarogya Setu is currently the most downloaded app on online stores, recording over 169 million users across India.  

The reassurance of privacy measures may help governments boost uptake. However, the efficacy of these apps also depends on how successfully they are integrated into the public health system which includes testing facilities, hospitals, and frontline workers. 

Devender, a 26-year-old businessman, and his wife who tested positive for COVID-19 in September 2020 said they were asked to log in their positive test results into Aarogya Setu. While they did not use the app prior to testing positive for COVID-19, they used it throughout quarantine. They were also advised by government officials to resume public activity only when their status on the app was updated to “Green”. The updating of status is based on patients’ reporting of symptoms and the number of days past diagnosis. 

This is a case of positive integration as the app served as the primary communication tool between patients and public health professionals negating the need for physical follow-ups and manual contact tracing.

The path forward

The evidence shows that Health monitoring apps are an effective tool in combating health emergencies. However, successful implementation will be driven by ethical considerations and public trust in governments. 

Hundreds of COVID-19 tracing apps released by public health institutions and local governments are currently available on Google and Apple play stores. 

As vaccine inoculations kick-off, India has announced the launch of CoWIN, a mobile application that will enable users to register for vaccines. The app will use user information to track vaccine roll-outs across India.