That delay continues despite work from Austin, Texas-area grassroots technology developers as well as two of the world's largest tech companies, Google and Apple.
Apple and Google recently released a jointly developed application programming interface — essentially, a tool set that programmers can use in helping them create software products and platforms — that they called Exposure Notification API. Google has a team of employees in Austin working on the project.
The API would allow developers in U.S. states and countries across the world to make phone apps for contact tracing purposes and would allow users to opt-in to that software on their phones. But those who specialize in traditional, analog contact tracing and tech developers say the effort by Apple and Google won't be effective without widespread voluntary adoption.
They also say that the software itself could be too limited to have much impact in the U.S., even if people did embrace and use an app chosen by the federal government or state governments.
The delay is a marked contrast to efforts in countries such as Australia and Singapore where phone-based contact tracing has been helping fight COVID-19 for weeks or months.
Missing the Window
Tarun Nimmagadda, one of the founders of Austin app maker Mutual Mobile and current CEO of the construction logistics company Ruckit, said he's frustrated by the pace of adoption of contact-tracing tech in the United States.Nimmagadda is also executive director of a coalition that is working an app called CoronaTrace. The app is being developed as an open-source project by employees from companies Mutual Mobile and Task Us, which has offices in Austin and San Antonio.
Nimmagadda said the team of volunteers had a rudimentary version of the app ready to go in early April.
"But then Apple and Google threw that curveball and said these apps have to come from government and, honestly, it would be great if the (Centers for Disease Control and Prevention) just stepped up and built an app for the whole country," he said.
Instead, state governments will more likely incorporate the Apple/Google technology into their own apps, which could mean different apps will be released at different times, and projects such as CoronaTrace would need to be approved as the official state contact tracing app in order to utilize the API.
Nimmagadda said the team's workaround has been to build two versions of the app. One version would utilize the Apple/Google technology. The second version would not use that tech, and instead would utilize GPS location information, something the Apple/Google API doesn't do.
Instead, the Apple/Google API relies on phone Bluetooth connections and randomly generated keys that are encrypted on each device. Apple and Google will not allow states or health agencies to access any location data from smartphones or any other identifying data about a person tied to the COVID-19 status. This could make the API ineffective for determining virus hotspots or using the data to track demographic trends around COVID-19.
The caution about privacy is not unwarranted. In Qatar, where citizens were required to install a contact-tracing app that uses Bluetooth and GPS, the personal data of about 1 million people was exposed, according to a report from Amnesty International.
Jeffrey Kahn, director of the Berman Institute of Bioethics at Johns Hopkins University, was involved in a recently published report on digital contact tracing. He said that while privacy is an important consideration for contact tracing technology, it's not the only consideration.
"There are many public values at stake and privacy is an important but not the single value at stake," Kahn said. "Public health success is a value that the public also cares about, and the balance among the various values at stake need to be something the public has a voice in deciding, along with tech companies, governments and public health authorities."
Kahn said he thinks contact tracing apps should allow some controls for individuals, "but only within acceptable parameters of collection, use and storage of data."
"The parameters need to be set by government," he said.
As for how successful digital contact tracing could be in the United States, Kahn said: "We really won't know the answer until there are apps introduced and used, which is a main point of our report. We need to learn as we go since we're undertaking a big experiment in trying to understand how best to create technology aids that will work, that people will use, and that have the right values embedded in them and how they work.
Fragmented Response
The fragmented state-to-state response on contact tracing could trickle down to individual cities such as Austin and Houston as they try to certify their own Apple/Google-API apps. In April, the city of Austin rolled out a COVID-19 platform from Plano-based NTT Data Services, but it is primarily focused on testing information. The platform's contact tracing component is a questionnaire that is sent to health officials with an infected patient's permission.Similarly, the state's Texas Health Trace online system is an information portal and database that people who believe they may have been exposed to COVID-19 can sign up for to possibly get contact by a traditional contact-tracing team. The Texas Trace website doesn't mention any app-based efforts for contact tracing.
Experts in the tech industry say Apple and Google are being cautious with their contact tracing API due to years of blowback each company has received over phone privacy concerns.
In this case, Nimmagadda said, "I don't think that what Apple and Google are doing strikes the right balance in terms of privacy versus saving lives and livelihoods. They put a lot of hamstrings on it because they're trying so hard to be private, but they're not letting the apps do the best they can."
Apple did not respond to requests for comment.
In emailed comments, Emory Cook, who manages a team of engineers based in Google's Austin office, said the pace at which the development process needed to proceed was a challenge.
"The speed at which we built it was challenging, as well as the fact that it included teams from across the company and world. Our team in Austin was working with people in London and Mountain View and we had to meet often to keep in touch. Finally, we built a number of tools to help validate the safety of the exposure notification system that we had not ever used before," he said. "Going from an idea to something in place in a matter of weeks while the system you are trying to support is changing every day is one of the hardest things to do as a software engineer."
How Digital Contact Tracing Works
Even if U.S.-based notification apps are developed and approved quickly at the local, state or federal level, there are many questions on whether digital contact tracing could help epidemiologists with concurrent analog efforts.Dr. Darlene Bhavnani, who is leading contact tracing efforts at Dell Medical School at the University of Texas in conjunction with Austin Public Health, said she has been closely following stories about how technology could assist contact-tracing efforts, which largely consist of phone calls to individuals who have tested positive for COVID-19 and to those who might have been exposed.
She said digital contact tracing's biggest strength is its timeliness. It could potentially alert those exposed more quickly, warning them to self-quarantine immediately after exposure. And tech-based contact tracing might pick up on exposures that an infected person wasn't aware occurred or doesn't remember, she said.
But Bhavnani said there are potentially huge problems with digital contact tracing that could leave out vital data by not delving any deeper than whether there was virus exposure or not.
"I believe in the value of high-touch, high quality interviews," she said, "There is so much value to that. Are we actually getting all the contacts, the right contacts, the people that need to be notified? I mean, we're disease detectives. There's a lot you can do to jog people's memory."
The calls that Bhavnani and her team of about 70 to 80 trained contact tracers make, she said, aren't just about compiling a list of people to track down and notify.
"We don't just call and say, 'Hi, you've been exposed.' We call and make sure that people are OK," she said. "We ask about difficulties, about self-isolating. We ask about their need for food and hook them up to community resources and make sure they're linked up to care. I just feel like there's no replacement to the human touch."
Apps that rely on up-to-date phone software and new app downloads are likely to leave out those who are underprivileged, those who are dealing with homelessness, children, and many who are elderly or not tech-savvy, Bhavnani said. Digital contact tracing is also ineffective if patients don't self-identify when they have the virus, or if they failed to adopt a contact-tracing app in the first place.
Critical Mass
Giving people a reason to download the app, beyond helping the larger community stop the spread of coronavirus, inspired one Austin entrepreneur to build a monetary incentive to try to solve the problem.Omar Naseef, who works for the city of Austin as a systems architect, recently launched Payta, a startup that seeks to pay users for data they give up about themselves to companies.
Although the bulk of Payta is built around the idea of merchants having better marketing data about potential customers and of users opting in to get some money back for the anonymized data they're giving up, contact tracing came into the picture in April, when the startup began a crowdfunding campaign.
Naseef says Payta will utilize GPS and Wi-Fi and data from its users to help with contact-tracing efforts.
The app will not use the Apple/Google API for this. Naseef says he and his partners, whom he met through a Chicago Booth School of Business program, thought: "Why not do it in a way that lets people get some personal gain from it?"
"We are the ones who generate the value (in data) by sharing our lives, by journaling our interests and the things we like. Yet none of the economic value comes back to us," he said. "With 22 million people unemployed, we feel called to actually do something that makes technology benefit people in a way that is truly tangible."
For digital contact tracing to be effective, a large amount of people have to be using the same technology in order for notifications to go out to those exposed. But there's debate on what percentage of a country's population would need to adopt digital contact tracing for there to be much impact. Some of those estimates range from about 50 percent to 80 percent. It's unlikely that government entities in the U.S. will make opting in to digital contact tracing a requirement for anyone, especially given the fragmented nature of their current development.
That lack of a unified national approach to the digital contact tracing makes it more likely that phone calls from trained contact-tracing staff will continue to be the primary way those exposed will be notified, at least for the time being.
"I think technology can play a role," Bhavnani said, "but I actually don't believe that this can stand alone."
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