Page 40 - FCW, May 2021

Health IT
the level of detail we use in other programs,” he said.
But knowing 785,000 residents have downloaded the app, officials can assume those people are more likely to be cautious, he said. ”There are a lot of soft outcomes to this that we can’t really measure.”
Most state health departments con- tacted by Stateline said digital contact tracing complements manual contact tracing.
Wyoming, for example, had about 7,000 people use the app at its peak, but only about 75 of them have used a code to broadcast potential exposures, according to Kim Deti, a spokesper- son for the Wyoming Department of Health. Instead, she said, the state relies primarily on in-person tracing.
“We have continued to consider phone interviews by trained epidemi- ologists with cases to identify those at high risk of exposure, followed by direct notification of an exposure by an epidemiologist, to be the gold stan- dard of response,” Deti wrote in an email message.
There are other barriers. One in five U.S. adults don’t own a smartphone. Of Ohio’s decision not to make an app, “Equity concerns were a factor, as a person must own a smartphone to use these apps or services, possi- bly leaving vulnerable Ohioans with- out access,” said Ohio Department of Health spokesperson Alicia Shoults in an email message.
Health departments in Mississippi and Texas cited privacy and accuracy concerns in deciding not to use digital contact tracing.
The one-two punch of politicized pandemic restrictions and early pri- vacy concerns likely turned state offi- cials away from digital tracing, said Brian Ray, a professor at Cleveland- Marshall College of Law and director of the school’s Center for Cybersecu- rity and Privacy Protection.
“I’m pretty confident even the per- fect app would have failed,” he said. “There was this sort of vicious conver-
gence of both broad, widespread con- cern on the left and the right over sur- veillance generally, which was legit. Despite the fact that Google and Apple created an entirely privacy-protective model, but one that doesn’t work that well, they still got hammered on the privacy concerns. Politically, it was too dangerous.”
Apps of the future
Still, even a year into the pandemic and with vaccine distribution expand- ing, some experts say it’s not too late to launch these apps and that they may be even more important now.
New Mexico and Oregon plan to release apps soon. Arizona’s app, which was developed through a pilot project at the University of Arizona, is available to the public but has not yet been marketed.
Joanna Masel, a professor of ecol- ogy and evolutionary biology at the University of Arizona, said the value of exposure notifications only increases as coronavirus case numbers fall. “If there are 10 cases and you quarantine one, you reduce the risk by a tenth,” she said. “Each little bit of information you get is worth more.”
Masel is a consultant for WeHealth, a research-based technology platform for public health that helped develop Arizona’s app. In that role, she hopes to work with states to develop sys- tems that would track locations — still as an opt-in function but designed to collect more data. She thinks the tech- nology would be useful for ongoing strains of this coronavirus or even for a future pandemic.
“It could be good for vaccine boost- ers with strains,” she said. “It inte- grates everything — whether you’ve been infected before, whether you’ve been vaccinated. It’s sort of a guide for people to navigate the pandemic.”
Some state health officials have a similar future in mind. As more people prepare to travel, the exposure notifi- cations will continue to work across state lines. The Association of Public
Health Laboratories, which represents state and local health labs, hosts a national server to support all states with apps.
“As people get vaccinated, as we hope to return to more, quote, unquote, ‘normal life,’ I think the tech- nology can play a bigger and bigger role,” said Katherine Feldman, direc- tor of the Contact Tracing Unit at the Maryland Department of Health. She still urges people to opt in to the state’s exposure notifications system.
In a preprint of a University of Oxford study from September, research- ers determined that all levels of expo- sure notification had the potential to “meaningfully reduce the number of coronavirus cases, hospitalizations and deaths.” (Google researchers co- authored the study.)
The Google and Apple system is in use in 36 other countries. A Febru- ary report from the United Kingdom’s National Health Service estimated that alerts from the app helped prevent approximately 600,000 COVID-19 cases since September. A peer-reviewed Janu- ary study of the app’s use in Spain last summer determined that the app iden- tified nearly twice as many COVID-19 exposures as human contact tracers did.
But Ray said the urgency for making apps work in the United States during the COVID-19 pandemic has been lost. “Who cares right now? Vaccines are on the way,” he said.
In the future, though, he thinks peo- ple would be willing to adopt technol- ogy to help their health. Many already do, through fitness applications and wearable devices.
“It’s got to be linked to people’s spe- cific individual interest in their own health,” Ray said. “I think the trick will be that we need tech that will do all the potentially powerful things that contact tracing apps could have done and just not call it that.” n
This article was first posted on State- line, an initiative of the Pew Chari- table Trusts.
38 May 2021 FCW.COM