We Need An “Army” Of Contact Tracers To Safely Reopen The Country. We Might Get Apps Instead.

  1. tech
  2. Coronavirus

Without enough human contact tracers to identify infected people, the US is barreling toward a digital solution, and possible disaster.

ByCaroline Haskins and Stephanie M. Lee and Megha Rajagopalan and Pranav Dixit

In the absence of any kind of national effort, Google and Apple have attempted to create a framework for app developers that will provide the kind of compatibility that has been lacking.

Earlier this month, the companies announced that — in an unprecedented move — they were working together to create software updates for iOS and Android devices that make contact tracing more interoperable, accurate, and privacy-focused.

Most developers and privacy advocates have proposed using Bluetooth beacons — or radio signals that most smartphones use to send small files between each other at a short range — so that devices can log whom their owners have been near. This is, essentially, what the two tech giants have been developing.

Yet while Apple and Google are leading the development of the underlying technology necessary to make digital contact tracing tools — which they now refer to as “exposure notification” to distinguish from traditional methods — they have declined to develop actual contact tracing apps, fearful of losing public trust by overstepping privacy, according to sources at Apple. Instead, they’ve announced that they are delegating the development of the actual contact tracing apps to public health authorities and have been approaching local health departments about how to get apps up and running. Their solution, which sources at the companies and health agencies tell BuzzFeed News is still rapidly evolving, will be a two-phase system with phase one rolling out as soon as this week.

Initially, the system will require people to download apps from public health departments to do this exchange of information. Later, this exposure notification system will be built directly into phones’ operating systems. But it will work similarly in both cases, automatically notifying people that they have been around another individual who has self-identified as having tested positive for COVID-19.

It’s an ingenious system with three key features: decentralization, automated notifications and interoperability, a computing term which basically means different systems can exchange information. Because Apple and Google have provided a way for people’s phones to communicate with each other, it means that someone from one place can be notified if they’ve come into contact with an infected person from another — regardless of which apps they have on their phone. Think of it as being able to get a notification about a hot new TikTok, even if you only use Instagram.

Decentralization means there is no computer sitting somewhere that has a list of everyone who has tested positive and everyone they have been in contact with in recent weeks. Instead, data is anonymized and stored on people’s phones. This is important to privacy advocates wary of tracking by state actors or even, say, internet marketers or insurance companies. Finally, this anonymized exchange allows for automated notifications. Instead of a call from a contact tracer, you get a notification on your phone.

Yet this emphasis on privacy comes with a trade-off. Because the apps will not be capable of tracking location, or who exactly has tested positive, they will be unable to perform many of the very basic epidemiological functions that traditional contact tracers do. They would not, for example, provide the kind of data that would allow public health officials to interview everyone in an apartment building where a hot spot was flaring up to determine why some were infected and others were not. This is one reason the effort has been recast as “exposure notification” rather than “contact tracing.”

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There is also a lot that is still just up in the air. When asked if people would only be able to submit verified COVID-19 test results, or if they have the option to self-report symptoms, company representatives for Google and Apple said that features like that would be determined by the public health authorities who actually release apps. But we don’t know which authorities will actually be in charge of these apps, whom they will contract with to build them, or if basic features will vary, say, from county to county or state to state.

Company representatives said in press calls that they would only release the the apps’ programming interfaces to verified public health authorities, but could not say whether these public health authorities would be at the federal, regional, state, or local levels.

A Senate aide briefed by Google told BuzzFeed News there’s a reason the companies won’t say which authorities will be developing the tools: They don’t know.

“They don’t know if there’s gonna be city- and county-level health apps, state apps, a federal app, or a US Red Cross app,” the Senate aide said. “They just don’t know yet.”

Volunteers with Unidos en Salud (United in Health) go door-to-door urging and pre-registering residents in the Mission neighborhood of San Francisco for free mass COVID-19 testing.

While tech companies, government officials, and civil liberties watchdogs debate the best way to protect privacy while fighting the pandemic, San Francisco, one of the first cities in the US to experience the coronavirus outbreak and a global hub for tech startups, is pursuing contact tracing the old-fashioned way.

“We don’t have a treatment. We don’t have a vaccine,” said Mike Reid, an assistant professor of medicine at UC San Francisco, who has been overseeing the rapid hiring and training of the city’s contact tracing workforce since early April. “So the best thing we can do is: Every time we find a new case, we ask that individual to isolate and reach out to all their contacts and tell them you need to quarantine, not because you have an infection right now but because we worry you might develop an infection.”

San Francisco’s contact tracers now include more than 240 students, doctors, nurses, public health workers, and city employees who have been temporarily reassigned, including librarians, attorneys, and property assessors. Their task is to run down the coworkers, roommates, friends, and relatives of patients who test positive, ask them about their symptoms and living conditions, and enroll them in daily text alerts from public health authorities.

It’s a system that may be replicated across California. Gov. Gavin Newsom has announced he wants to dispatch 10,000 contact tracers across the state, in some cases redeploying existing state workers who have time on their hands because so much of the state is shut down.

As the California effort ramps up, Abascal, the San Francisco tracer who had to break it to the two brothers that they had been exposed to the potentially deadly disease, continues making her painstaking phone calls.

Volunteers Rafael Gonzalez and Laurence Berland go door-to-door urging and pre-registering residents in the Mission neighborhood of San Francisco for free mass COVID-19 testing.

Abascal has a script to follow, but the conversations constantly throw curveballs.

She’s had to be a resource for people who don’t speak English and for a family of 10 crammed into a one-bedroom apartment. Others have asked her questions she can’t answer, from how to sign up for health insurance to how to navigate unemployment.

She was used to stark inequalities in her native Mexico and knew they existed in the US as well — but it has been jarring to come face to face with them here in one of the richest cities in the world.

A key part of the job, Abascal quickly learned, was earning the trust of scared strangers, keeping them on the phone, and reassuring them that she was not a scammer who’s out for their banking information or Social Security numbers. At the same time, the type of information she needs can feel quite personal to the people who answer her calls.

“Imagine if I called you. I know where you live; I know your phone number, but I can’t tell you who gave it to me,” she said. “People are wary about their privacy and information, so that’s an issue.”

Many calls require complex decision-making: Maybe someone’s living situation is unsafe, and the city needs to move them to a hotel to protect them and others — or maybe they need to get tested but have a disability that prevents them from leaving the house. Each situation is a little different.

As she watches tech giants promote the use of smartphones for contact tracing, Abascal is skeptical that they could be a cure-all.

Perhaps, she acknowledges, a Bluetooth-triggered app would be helpful for alerting people if they had been in a public setting, such as a bus or a Starbucks, with a stranger who later tested positive.

But, Abascal said, human contact tracers do something that cannot be totally replaced by an algorithm.

“We’re dealing with people that are scared, people that just lost their job. Many of them have family members in the hospital,” she said. “There’s a big part of the interview that’s conversation: ‘How’s your family doing?’ I don’t know how you would be able to do that computer-automated.”

Many interviewees start out skeptical but by the end of the call, thank the staffer for checking in, she says.

“The idea of having an app being able to do all the work we are doing is hard,” she said. “We’re not therapists, but still, if somebody is really worried, you’re able to tell them, ‘Don’t worry — we’re here to help.’” ●

Medical volunteers test Mission residents for COVID-19 during UCSF’s mass testing study at Garfield Square.

BuzzFeed News Reporter Stephanie K. Baer contributed to this report.

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  1. Google
  2. Privacy
  • Caroline Haskins is a technology reporter for BuzzFeed News and is based in New York.

    Contact Caroline Haskins at [email protected]

    Got a confidential tip? Submit it here.

  • Stephanie M. Lee is a science reporter for BuzzFeed News and is based in San Francisco.

    Contact Stephanie M. Lee at [email protected]

  • Megha Rajagopalan is a world correspondent for BuzzFeed News and is based in the Middle East.

    Contact Megha Rajagopalan at [email protected]

  • Pranav Dixit is a tech reporter for BuzzFeed News and is based in Delhi.

    Contact Pranav Dixit at [email protected]

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