Contact tracing is not a new concept — manual contact tracing is a proven, effective method of general epidemic management used in past outbreaks such as HIV and Ebola.
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Contact tracing is not a new concept — manual contact tracing is a proven, effective method of general epidemic management used in past outbreaks such as HIV and Ebola. But digital contact tracing, and the technology and challenges that come with it, is an entirely new, automated approach that is largely untested. In order to support governments in need, U.S. Digital Response (USDR) has reviewed digital contact tracing applications, contributed to a data privacy rights framework to inform buyers and protect users, and is available to advise and share learnings.
Governments seeking guidance regarding contact tracing can connect directly with USDR for assistance. We can work alongside your teams to evaluate, integrate, and scale any proposed solutions. We are also working with partners across jurisdictions to document and share best practices for reopening communities.
In what follows, we define contact tracing; propose a privacy-preserving approach to its adoption; and make key recommendations for governments considering deploying the tool.
Contact tracing is the process of identifying those who have come into close contact with an infected person and taking actions to prevent them from further spreading the disease. This could mean connecting people with public health officials for testing, recommending self-quarantine, and/or providing access to care and treatment.
Manual contact tracing (MCT) requires public health officials to interview infected patients in order to create a history of who they’ve been in close contact with. States working with their local health departments already have a way to trace contacts through a COVID-19 specific investigation form passed from the Centers for Disease Control. This process was used with HIV, Ebola, and Tuberculosis, and is a proven way to control outbreaks. However, due to the fast growth of COVID-19, existing MCT processes have been unable to scale quickly enough. Furthermore, a large percentage of COVID-19 cases are asymptomatic, making contact tracing especially important as communities relax shelter-in-place guidelines.
In order for MCT to work, governments must dramatically increase their capacity of tracers, help them be effective, and provide enough tests to ensure infections are accurately tracked. The State of Massachusetts recently released its plan to hire 1,000 people to staff MCT. This sounds like a lot, but if there are 1000 daily cases, each case has 10 contacts on average, and (according to protocol) contacts are monitored for 14 days, then at any given time 1000*10*14 = 140K people need to be monitored. In other words, with 1000 tracers, each tracer needs to monitor 140 people! Their team is working with Partners in Health to hire and train contact tracers, and leveraging tools such as RedCap and Salesforce to manage and scale the operational team. Other organizations like NextTrace and Resolve to Save Lives are working on digitizing the MCT process to increase efficiency.
Digital contact tracing and exposure notification (DCTEN) uses information shared via mobile devices to notify people who might have had contact with an infected individual. While MCT can take time due to the need for individual interviews, DCTEN makes it possible to identify hundreds or thousands of at-risk persons extremely quickly. This is usually done by logging “close contact” events between mobile phones. Whenever someone is reported to be sick, their log of contact events is used to alert anyone they’ve contacted within a certain time period. Note that if the application only goes so far as alerting potentially affected individuals, and does not assist with interviews, testing, and follow-up monitoring, it’s better described as “Exposure Notification”.
DCTEN apps use different technologies to track proximity, store, access, and report any close contact events.
How apps can determine when you’ve been in contact with someone:
How apps can identify you as a user:
How apps store and access your data:
To better inform developers and potential users of this technology, USDR worked as part of a new global coalition alongside privacy researchers, technologists, and epidemiologists to co-develop a bill of Data Rights for Exposure Notification. These principles emphasize the importance of efficacy, privacy-preservation and interoperability. They limit data access only to specific use cases that protect users — notifying individuals that they may have been exposed, providing anonymized, aggregate data to public health officials, and verifying whether an individual is healthy or sick, with their explicit consent.
Google and Apple also recently announced their new Exposure Notification API that uses Bluetooth technology on mobile devices, which is expected to be released in mid-May. We expect to see prototype apps (some included below) available for download soon.
Classifying Applications using Data Rights for Exposure Notification
To reiterate, contact tracing is just one part of a much broader solution, and digital contact tracing exposure notification technology will likely play a small part in a public health effort. Scaling manual contact tracing operations is of paramount importance, and will only be effective alongside widely available testing, case monitoring, supported isolation, and thoughtful, data-driven policies.
If you are considering using a digital contact tracing and exposure notification system, applications will need to reach 60%+ adoption, be interoperable, privacy-preserving, utilize decentralized data storage and Bluetooth technology, and be well-integrated into your broader public health strategy in order to be effective.
We are in touch with governments across the country and are standing by to help whichever stage a team is in. We can provide technical evaluations of new vendors, work alongside government teams to integrate and scale selected tools, and will continue to share best practices as we hear of them from other jurisdictions.
Request assistance and our Government Partnerships team will be in touch within 24 hours.
To learn more, visit www.USDigitalResponse.org or contact info@usdigitalresponse.org.