COVID-19 Tracing Using Mobile Applications

As the number of COVID-19 infections increases globally, some countries have turned to tracing technology in an attempt to contain the spread of the virus. Some governments have had success at it; others have not. This article will explore the use of mobile tracing technology to contain COVID and the reasons for the discrepancy in the success rate.

First reported in Wuhan, China on December 1, 2019, the COVID-19 virus has spread worldwide. As of September 4, 2020, 26,675,646 people have contracted the virus, and 876,411 have died globally (3.28% death rate overall). The U.S. accounts for 6,371,809 cases, or about 24% of the global total. Here, 191,689 people have died (3% death rate). U.S. cases amount to 22.6% of the global number, and the states reporting the highest number of cases currently are California, Texas, Florida, and New York (in that order).

The official scientific designation for this strain of the virus from the International Committee on Taxonomy of Viruses based on a phylogenic analysis is, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2 for short). Most researchers believe that the virus is a spillover of an animal coronavirus that “jumped” to humans and then morphed to have the ability of human-to-human transmission. It spreads rapidly, is highly contagious, and continuously evolves in its human hosts. COVID-19 is the fifth pandemic since the Spanish Flu of 1918 (1918 Spanish flu H1N1, 1957 Asian flu H2N2, 1968 Hong Kong flu H3N2, and 2009 Pandemic flu H1N1, which caused an estimated 50,000,000, 1,500,000, 1,000,000, and 300,000 deaths, respectively) and it is the seventh strain of coronavirus to infect humans.

Efforts to decipher the genome of the SARS-CoV-2 began in January, and the first vaccine trials in humans 2 started months later in March. Obviously some trails have, and will, fail, but a few show promise in stimulating the immune system to produce effective antibodies. The typical vaccine testing process from lab to clinic involves 5 steps:

1. Preclinical testing on animals to check for an immune response.
2. Phase I safety trials where a small number of people receive vaccinations to test safety, dosage, and immune response.
3. Phase II expanded trials where hundreds of people receive the vaccine across different demographics, such as age, to note any differences in the way the different groups respond.
4. Phase III efficacy trials wherethousands of people are vaccinated. Researchers determine how many become infected compared with volunteers who received a placebo. The FDA has announced that a coronavirus vaccine would have to protect at least 50% of vaccinated people to be considered effective.
5. Approval where regulating authorities in each country in each country review the trial results and decide whether to approve the vaccine. During a pandemic, a vaccine may receive emergency use authorization before getting formal approval.

With approval of the FDA in the United States, drug manufacturers are expediting the process by combining some of the steps. Presently, 165 SARS-CoV-2 vaccines are in development, 27 of which are in the human trial stage. Readers interested in tracking the drug and vaccines’ progress can find that information here.

While progress in the development of a vaccine and drugs to treat infected patients is promising, the other significant concern is about containment. Many countries are attempting to contain SARS-CoV-2 by tracing. This containment method relies on tracers who are akin to “coronavirus detectives.” They interview infected people to collect the names of friends, relatives, and others who have been within six feet of them for more than 15 minutes. Then the tracers collect phone numbers and emails, and advise the potentially exposed to get tested.

Unfortunately, many tracer initiatives are failing to contain the pandemic. Consistency of approach has been one major impediment. In California, for example, only 28 of the 38 California counties with surging cases of COVID-19 report that they are attempting to investigate everyone infected and trace everyone they expose. However, 7 counties aren’t, and another of the 38 is asking all people with the virus to notify their contacts themselves. Often, regulators cite lack of staff as a reason for the inconsistent approach. In Melbourne, Australia, a doctor at a Department of Health and Human Services (“HHS”) testing site said parents at the Gladstone Park Secondary College first notified parents to have their children tested several days after a student tested positive for the virus. When parents complained of the lag time in notification, the Department of Health and Human Services (“HHS”) advised that the school should do its own contact tracing because HHS was too busy. To compound the problem, parents alerted by their school or workplace of an outbreak in Melbourne cannot have a COVID-19 test unless they have symptoms. Other reasons that tracing hasn’t worked in various countries include poor communication, lack of training for the tracer staff, availability of, and requirements for, testing (up to 40% of infected people are asymptomatic for some or all of their infectious period), delayed test results, and a refusal to participate based on privacy concerns.

Some countries have been successful in their tracing initiatives. South Korea is a good example.  That nation was able to suppress transmission with minimal economic fallout by employing a more targeted strategy that mandated tracing combined with isolating or quarantining infected individuals, quarantining people exposed to carriers of the virus, and mandatory wearing of face masks. Another is New Zealand. When New Zealand had only eight confirmed cases of COVID-19 in mid-March, it banned gatherings of 100 people or more. A few days later, it shut its borders and employed tracing. With one of the strictest and earliest responses to the pandemic, New Zealand was able to drive new infections to zero within about 80 days.

Technology can improve tracing, but the critical success factor is that people must use it. Stanford researchers have developed a COVID Watch that enables wearers to notify others of exposure directly. The University of Arizona has provided a smartphone app to students and staff members who will return to campus this fall, enabling them to notify the school community of potential exposure. Germany, Italy, France, and South Korea are employing similar tracing app technology with the public at large. The main objection to using these technologies centers on privacy. Critics express concern that users' personal health data – and even their social activities -- can be accessed and potentially exploited. In the end analysis, any technological solution is only effective if used.