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In the spring of 2020, the first versions of the covid-19 exposure notification systems were made public. These systems promised to slow the spread of the disease by giving automatic warnings to people who came in contact with the virus. Now, a year later, more inhabitants 50 countries—Including half of the U.S. states — can choose from these systems.
But the big question remains: how well has this technology worked? Some research suggests answers, but despite being so widespread, it is difficult to assess whether exposure notifications were able to stop the spread of covid-19. This is especially true in the U.S., where many states launched their own applications — a decentralized approach that reflects the fragmented pandemic response in America.
In an effort to find out how the MIT Technology Review had technology in the U.S., the MIT Technology Review launched a digital contact tracing system and addressed reviews of applications left by anonymous Americans to all departments of public health. We asked two questions: who really uses this technology, and how do people feel about it?
The final result of this analysis paints a picture of untapped potential. Many of the country’s exposure reporting applications are underused, misunderstood, and unreliable — and yet this technology will come into its own as a public health tool for future disease outbreaks.
How technology works
Exposure notifications were first introduced as a complement to the traditional contact tracing. According to the traditional manual approach, researchers looking for people who may be infected ask patients where they are by phone and interviews and follow up on activities. Rather than a small set of diseases, the new technology promised to be a scale to automatically cover the entire population – a significant advantage for the rapid spread of the disease.
You might remember the friend you met for lunch, for example, but not the stranger you had been queuing with in the grocery store for 15 minutes. An exposure notification system reminds you to anonymously record the record of nearby phones via Bluetooth and alert you if one of these phones is associated with a positive test result.
The first wave of this system was designed by developer cooperatives, and most ended up working with Apple and Google to create a uniform standard. The Apple-Google system prioritized privacy for users, anonymized their data, and did not track user locations. Backed by the world’s two largest phone platforms, this system is the most widely accepted, and is used by most U.S. states.
The effectiveness of these systems has been very difficult to evaluate. Investigations have just begun applications in the UK and Switzerland, for example. In the US, the assessment is even more difficult because each state basically does its own thing. But our analysis has some takeaway:
- U.S. systems were launched relatively late in the pandemic — especially when the country’s fall / winter rise was in full swing.
- The technology has not been very widespread, although some states are doing better than others
- The public’s lack of trust in new technologies — along with the lack of resources in public health agencies that care for that technology — hindered adoption rates and how people used the systems.
Who uses this technology?
We tracked exposure notification applications spread across 25 states and the District of Columbia. Virginia was the first state to make the technology publicly available in August 2020 in August 2020, while others are yet to begin. Massachusetts he began testing his application with a pilot in two cities In April 2021, South Carolina is currently conducting a pilot program at Clemson University. The state began working on its system in May 2020, but legislators he banned the public health department from the work of tracing any digital contacts last summer, due to privacy issues, maintaining development
Even in states where such applications are available, no one can use them. Exposure notifications are only available for smartphone users; and about 15% of Americans do not have a smartphone, According to the Pew Research Center. However, more than half of the U.S. population can now enter. Another issue is whether they choose to join these systems.
Since most states do not publicly disclose user data, we turned directly to the state’s public health departments to ask how many people have chosen the technology.
Twenty-four states and DCs have shared user estimates, and 36.7 million Americans have chosen notifications in early May. Hawaii is covered by the largest part of the population, about 46%. In the other four states, more than 30% of the population chose it: Connecticut, Maryland, Colorado, and Nevada. The other seven states cover more than 15% of the population.
This proportion is important: modeling studies they determined that if approximately 15% of the population were elected to the system, the number of cases, hospitalizations, and deaths in a community would be significantly reduced. Under that metric, 13 states (representing about a third of the U.S. population) have seen some form of protection thanks to exposure notifications.
The remaining 11 states with exposure notification applications do not meet this benchmark for success. Of those 11, three states cover less than 5% of the population: Arizona, North Dakota and Wyoming. South Dakota, a state that has not responded to the press request, shares the use of the Care19 Diary app with low-activation states in North Dakota and Wyoming.
Comparing states is not perfect, however, because states do not know how states collect or report data, and some may make very different choices about others. For example, while DC reports its “activation of exposure notifications” number Reopen the metrics page, this number is greater than the resident population. A DC Health representative explained that the number chosen includes tourists and people who work at DC, even if they live elsewhere. For our purposes, we analyzed the DC activation rate as part of the population in the surrounding metropolitan area (including parts of nearby Maryland, Virginia, and West Virginia).
Another reason that these rates are difficult to measure is that many states with higher utilization rates manage to renew it. Apple and Google released it in September: Exposure Notification Express or ENX. This framework made it much faster for states to rotate apps and even invited millions of iPhone users to avoid downloading anything. They can activate notifications by setting a switch in the phone settings.
ENX activation is much more convenient and experts say it seems safer than downloading the new app. It has severely boosted the activation rates of the states they use. Hawaii, for example, saw its users more than double from February to May while you are expanding ENX.
The Express system means that we have less specific user data. States can’t track ENX activations directly, and instead have to rely on Apple for numbers.
Beyond numbers
Even when many residents have downloaded an app or activated that switch in their iPhone settings, the system must be used properly to make a difference in covered cases. So we also tried to understand how people used the system.
A final examination found that Americans were hesitant to rely on digital contact tracing technology. However, this finding was based on surveys conducted by most states before launching their applications. As a representative of people’s attitudes toward U.S. statewide apps, the MIT Technology Review scanned and reviewed reviews of apps in the Google Play Store. We only reviewed Google Play reviews (for Android users) for the latest and most consistent data. (Most iPhone users can now activate notifications without downloading an app).
Paying attention to app reviews is not the perfect system. Users who have chosen to review the application of the situation are not a representative sample of the population that activates EN, but rather users who want to share strong opinions about the technology.
Still, here’s what we found:
- Most state applications have average ratings of 3 to 4.
- Michigan has the lowest score, 2.6.
- DC, California, New York, Delaware and Massachusetts have the highest scores, above 4.
Many 1-star reviewers misunderstood how their state’s application works, did not trust the technology, or could not understand how the application was integrated into the broad public health system. This indicates that for many Americans the app did not do its job even though it was technically used.
Lessons from negative feedback
The bad reviews show the common problems and misconceptions the digital contact tracing system had.
Small problems had a big impact.
Again and again, the evaluators stated that they needed an activation code that was tightened. To help protect your privacy, when you test positive for Covid, you do not enter your name or other identifying details into the app: instead, you enter a number string provided by your public health department. Some reviewers have stated that they do not know where to get the activation code after they have been positive or have encountered error messages. We have heard from developers in other countries about this issue.
Some U.S. states and other countries have made the process easier by automating how a code is sent, but in many cases, users have to wait for a contact tracer to call. This waiting period can reduce trust in technology and significantly slow down the digital tracing of contacts.
“Trust” isn’t just about the app itself. It’s wider than that.
Many app reviewers are not distrustful of new technologies, the government, or both. A Pew Research Center survey In July 2020, 41% of Americans found that they probably would not talk to a public health official by phone or text message, and 27% said they would not be comfortable sharing the names of recent contacts — both key elements of contact tracing. process.
Digital contact tracing has similar challenges. Some reviewers felt so strongly about protecting their privacy that they came to the pages of their state application to be proud of their refusal to download this technology. Many repeated the sentiments of this Pennsylvania reviewer: “My wifi, GPS and Bluetooth access open? Awesome. No, thank you, Harrisburg.”
Low use creates a downward spiral of mistrust.
A key aspect of digital contact tracing is that you need to be involved in order to function – at least 15% of the community. but if possible much higher. When people don’t participate, the chances of getting the match are lower – even if the hidden levels are high – so the system won’t send alerts to people in small numbers. do have exposure notifications turned on.
Some reviewers asked the rest of the population in their states to select exposure notifications, reminding other users that greater use leads to greater efficiency in a tone reminiscent of Facebook arguments than an app store.
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