Digital contact tracing is a method of contact tracing relying on tracking systems, most often based on mobile devices, to determine contact between an infected patient and a user. [2] It came to public prominence in the form of COVID-19 apps during the COVID-19 pandemic. [3] [4] [5] Since the initial outbreak, many groups have developed nonstandard protocols designed to allow for wide-scale digital contact tracing, most notably BlueTrace and Exposure Notification. [6] [7]
When considering the limitations of mobile devices, there are two competing ways to trace proximity: GPS and Bluetooth; each with their own drawbacks. Additionally, the protocols can either be centralized or decentralized, meaning contact history can either be processed by a central health authority, or by individual clients in the network. On 10 April 2020, Google and Apple jointly announced that they would integrate functionality to support such Bluetooth-based apps directly into their Android and iOS operating systems. [8]
Digital contact tracing has existed as a concept since at least 2007, [9] [10] and it was proven to be effective in the first empirical investigation using Bluetooth data in 2014. [11] [12] However, it was largely held back by the necessity of widespread adoption. [13] A 2018 patent application by Facebook discussed a Bluetooth proximity-based trust method. [14] The concept came to prominence during the COVID-19 pandemic, [1] where it was deployed on a wide scale for the first time through multiple government and private COVID-19 apps. [15] [16] Many countries, however, saw poor adoption, with the exception of Singapore's digital contact tracing app, TraceTogether, which saw an adoption rate of about 92%. [17] COVID-19 apps tend to be voluntary rather than mandatory, [18] [19] which may also have an impact on the rate of adoption. Israel was the only country in the world to use its internal security agency (Shin Bet) to track citizens' geolocations to slow the spread of the virus. [20] However, cellphone-based location tracking proved to be insufficiently accurate, as scores of Israeli citizens were falsely identified as carriers of COVID-19 and subsequently ordered to self-quarantine. [21] In an attempt to contain the spread of the Omicron Variant, Israel reinstated the use of Shin Bet counterterrorism surveillance measures for a limited period of time. [22]
Apps were often met with overwhelming criticism about concerns with the data health authorities were collecting. [23] [24] [25] Experts also criticized protocols like the Pan-European Privacy-Preserving Proximity Tracing and BlueTrace for their centralized contact log processing, that meant the government could determine who you had been in contact with. [26] [27] [28] [29]
MIT SafePaths published the earliest paper, 'Apps Gone Rogue', [30] on a decentralized GPS algorithm [31] [32] as well as the pitfalls of previous methods. MIT SafePaths was also the first to release a privacy-preserving Android and iOS GPS app. [33]
Covid Watch was the first organization to develop [34] and open source [35] [36] an anonymous, decentralized Bluetooth digital contact tracing protocol, publishing their white paper on the subject on 20 March 2020. [37] [38] [39] [40] [41] The group was founded as a research collaboration between Stanford University and the University of Waterloo. [42] [37] [43] The protocol they developed, the CEN Protocol, later renamed the TCN Protocol, was first released on 17 March 2020 [44] [45] [5] and presented at Stanford HAI's COVID-19 and AI virtual conference on April 1. [46] [47] [48]
NOVID is the first digital contact tracing app which primarily uses Ultrasound. Their ultrasound technology yields much higher accuracy than Bluetooth-based apps, and they are [ as of? ] the only app with sub-meter contact tracing accuracy. [49]
Bluetooth, more specifically Bluetooth Low Energy, is used to track encounters between two phones. [50] [51] [52] Typically, Bluetooth is used to transmit anonymous, time-shifting identifiers to nearby devices. Receiving devices then commit these identifiers to a locally stored contact history log. [6] Given epidemiological recommendations, devices store inputs only of the encountered devices for a fixed time, exceeding a threshold (e.g., more than 15 min) at a certain distance (e.g., less than 2 meters). [53]
Bluetooth protocols with encryption are perceived to have less privacy problems and have lower battery usage than GPS-based schemes. [6] : table. 1 Because a user's location is not logged as part of the protocols, the system is unable to track patients who may have become infected by touching a surface an ill patient has also touched. [6] Another serious concern is the potential inaccuracy of Bluetooth at detecting contact events. [54] [55] Potential challenges for high received signal strength fluctuations in BLE proximity tracing are line-of-sight vs. non-line-of-sight conditions, various BLE advertising channels, different device placements, possible WiFi interference. [56]
Location tracking can be achieved via cell phone tower networks or using GPS. Cell phone tower network-based location tracking has the advantage of eliminating the need to download an app. Location tracking enables calculating user position with certain levels of accuracy in 2D or 3D. The first contact tracing protocol of this type was deployed in Israel. [57] The accuracy is however typically not sufficient for meaningful contact tracing. [58]
Smartphone GPS logging solutions are more private than Bluetooth based solutions because the smartphone can passively record the GPS values. The concern with Bluetooth-based solutions is that the smartphone will continuously emit an RF signal every 200ms, which can be spied on. On the other hand, digital contact tracing solutions that force users to release their location trails to a central system without encryption can lead to privacy problems. [58]
Another method of tracking is assigning a venue or a place to a QR code and having the people scan the QR code by their mobiles to tag their visits. By this method, people voluntarily check in and check out from the location and they have control on their privacy, and they need not download or install any app. Should a positive COVID-19 case be identified later, such systems can detect any possible encounter within the venue or place between the positive case individual and others who might have visited and tagged their visits to the venue at the same time. Such method have been used in Malaysia by Malaysian government and also in Australia and New Zealand by private sector under QR-code visitor check-in systems. [59] In Australia [60] [61] and New Zealand, [62] respective local governments have later sought to centralize contact tracing by requiring businesses to use the state's QR-code system.
Using ultrasound is another way to record contacts. Smartphones emit ultrasound signals which are detected by other smartphones. NOVID, which is the only digital contact tracing app with sub-meter contact tracing accuracy, primarily uses Ultrasound. [49]
CCTV with facial recognition can also be used to detect confirmed cases and those breaking control measures. [63] The systems may or may not store identifying data or use a central database. [64]
One of the largest privacy concerns raised about protocols such as BlueTrace or PEPP-PT is the usage of centralised report processing. [65] [26] [27] [66] [28] [29] In a centralised report processing protocol a user must upload their entire contact log to a health authority administered server, where the health authority is then responsible for matching the log entries to contact details, ascertaining potential contact, and ultimately warning users of potential contact. [6]
Alternatively, anonymous decentralized report processing protocols, while still having a central reporting server, delegate the responsibility to process logs to clients on the network. Tokens exchanged by clients contain no intrinsic information or static identifiers. Protocols using this approach, such as TCN and DP-3T, have the client upload a number from which encounter tokens can be derived by individual devices. [67] Clients then check these tokens against their local contact logs to determine if they have come in contact with an infected patient. [68] Inherent in the fact the government does not process nor have access to contact logs, this approach has major privacy benefits. However, this method also presents some issues, primarily the lack of human in the loop reporting, leading to a higher occurrence of false positives; [6] and potential scale issues, as some devices might become overwhelmed with a large number of reports. Anonymous decentralised reporting protocols are also less mature than their centralized counterparts as governments were initially much more keen to adopt centralized surveillance systems. [69] [70] [68]
Ephemeral IDs, also known as EphIDs, Temporary IDs [71] or Rolling Proximity IDs, [72] are the tokens exchanged by clients during an encounter to uniquely identify themselves. These IDs regularly change, generally ever 20 minutes, [6] and are not constituted by plain text personally identifiable information. The variable nature of a client's identifier is needed for the prevention of tracking by malicious third parties who, by observing static identifiers over a large geographical area over time, could track users and deduce their identity. Because EphIDs are not static, there is theoretically no way a third party could track a client for a period longer than the lifetime of the EphID. There may, however, still be incidental leakage of static identifiers, such as was the case on the BlueTrace apps TraceTogether and COVIDSafe [73] [74] [75] [76] before they were patched. [77] [78]
Generally, there are two ways of generating Ephemeral IDs. Centralized protocols such as BlueTrace issue Temporary IDs from the central reporting server, where they are generated by encrypting a static User ID with a secret key only known to the health authority. [6] Alternatively, anonymous decentralized protocols such as TCN and DP-3T have the clients deterministically generate the IDs from a secret key only known to the client. This secret key is later revealed and used by clients to determine contact with an infected patient. [68]
During the unfolding COVID-19 pandemic, reactions to digital contact tracing applications worldwide have at times been drastic and often polarized. Despite holding the promise to drastically reduce contagion and allow for a relaxation of social distancing measures, digital contact tracing applications have been criticized by academia and the public alike. The main issues concern the technical efficacy of such systems and their ethical implications, in particular regarding privacy, freedoms and democracy. [25] [90] [91]
The US non-profit, ForHumanity, called for independent audit and governance of contact tracing [92] and subsequently launched the first comprehensive audit [93] vetted by a team of global experts, known as ForHumanity Fellows [94] on privacy, algorithmic bias, trust, ethics and cybersecurity. NY State Senate Bill S-8448D, which passed in the Senate in July 2020, calls for independent audit of digital contact tracing. [95]
Voluntary adoption of digital contact tracing has fallen short of some estimated thresholds for efficacy. This has been referred to as a "trust-gap" [96] and advocates for digital contact tracing have endeavored to identify ways to bridge the gap. Independent Governance suggests that contact tracing authorities and technology providers do not have adequate trust from the traced populace and therefore requires independent oversight which exists on behalf of the traced for the purposes of looking after their best interests.[ citation needed ]
Independent audit borrows from the financial accounting industry the process of third-party oversight assuring compliance with existing rules and best-practices. The third party auditor examines all details of digital contact tracing in the areas of ethics, trust, privacy, bias and cybersecurity. The audit provides oversight, transparency and accountability over the authority providing the digital contact tracing.[ citation needed ]
The effectiveness of digital contact tracing depends on the degree to which it reduces the probability of transmission and hence the effective reproduction number. This is equal to the product of failure rates at six stages: installation by the primary case, installation by the secondary case, detection of exposure, timely diagnosis of the primary case, rapid triggering of notifications following diagnosis, and behavior modification of the secondary case that prevents transmission to tertiary cases. [97] In most countries, opt-in voluntary usage was insufficient to achieve large reductions in the effective reproduction rate, with Singapore a notable exception. [98] However, even more modest reductions could accumulate substantial epidemiological impact over time. [99]
Some smartphone-based digital contact tracing applications have system requirements such as Android/iOS version, Bluetooth enabled, GPS enabled, while others require users to scan QR codes. Smartphones stop receiving software updates a few years after release (2–3 years for Android, 5 years for iOS). Improvements to this ecosystem would benefit the adoption rate of future digital contact tracing applications.[ citation needed ]. Hardware tokens can be used to bypass smartphone limitations.
Other than having doubts about the technical effectiveness of smartphone-based contact tracing systems, publics and academia are confronted with ethical issues about the use of smartphone data by central governments to track and direct citizen behaviour. [100] The most pressing questions pertain privacy and surveillance, liberty, and ownership. Around the world, governments and publics have taken different positions on this issue.[ citation needed ] [101]
On privacy, the main problem about digital contact tracing regards type of information which can be collected from each person and the way related data is treated by companies and institutions. The type of data which is collected, and the approach being used (centralized or decentralized) determine the severity of the issue. In other words, a privacy-first approach that sacrifices data for privacy or a data-first approach that collects citizen data in exchange for private information from citizens. [102] Moreover, critics point out that claims of anonymity and protection of personal data, even if made by institutions, cannot be verified and that individual's user profiles can be traced back in several cases. [103]
Closely related to privacy, comes the issue of surveillance: too much personal data in centralized governmental database could set a dangerous precedent on the way governments are capable of “spying” on individual behaviour. The possibility that a wide-ranging adoption of digital contact tracing could set a dangerous precedent for surveillance and control has been abundantly treated by media and academia alike. [103] [100] In short, the main concern here relates to the tendency of temporary measures, justified by an emergency situation, to be normalized and extended indefinitely in a society. [104] [105] Concerns of normalizing exceptional surveillance practices were raised Israel, where existing cellphone surveillance measures used for counterterrorism purposes were employed for COVID-19 contact tracing purposes. [106]
Electronic waste may result from the need to purchase a new smartphone to meet the system requirements of smartphone-based digital contact tracing applications.[ citation needed ]
In public health, contact tracing is the process of identifying people who may have been exposed to an infected person ("contacts") and subsequent collection of further data to assess transmission. By tracing the contacts of infected individuals, testing them for infection, and isolating or treating the infected, this public health tool aims to reduce infections in the population. In addition to infection control, contact tracing serves as a means to identify high-risk and medically vulnerable populations who might be exposed to infection and facilitate appropriate medical care. In doing so, public health officials utilize contact tracing to conduct disease surveillance and prevent outbreaks. In cases of diseases of uncertain infectious potential, contact tracing is also sometimes performed to learn about disease characteristics, including infectiousness. Contact tracing is not always the most efficient method of addressing infectious disease. In areas of high disease prevalence, screening or focused testing may be more cost-effective.
COVID-19 surveillance involves monitoring the spread of the coronavirus disease in order to establish the patterns of disease progression. The World Health Organization (WHO) recommends active surveillance, with focus of case finding, testing and contact tracing in all transmission scenarios. COVID-19 surveillance is expected to monitor epidemiological trends, rapidly detect new cases, and based on this information, provide epidemiological information to conduct risk assessment and guide disease preparedness.
COVID-19 apps include mobile-software applications for digital contact-tracing—i.e. the process of identifying persons ("contacts") who may have been in contact with an infected individual—deployed during the COVID-19 pandemic.
Aarogya Setu is an Indian COVID-19 "contact tracing, syndromic mapping and self-assessment" digital service, primarily a mobile app, developed by the National Informatics Centre under the Ministry of Electronics and Information Technology (MeitY). The app reached more than 100 million installs in 40 days. On 26 May, amid growing privacy and security concerns, the source code of the app was made public.
Pan-European Privacy-Preserving Proximity Tracing (PEPP-PT/PEPP) is a full-stack open protocol designed to facilitate digital contact tracing of infected participants. The protocol was developed in the context of the ongoing COVID-19 pandemic. The protocol, like the competing Decentralized Privacy-Preserving Proximity Tracing (DP-3T) protocol, makes use of Bluetooth LE to discover and locally log clients near a user. However, unlike DP-3T, it uses a centralized reporting server to process contact logs and individually notify clients of potential contact with an infected patient. It has been argued that this approaches compromises privacy, but has the benefit of human-in-the-loop checks and health authority verification. While users are not expected to register with their real name, the back-end server processes pseudonymous personal data that would eventually be capable of being reidentified. It has also been put forward that the distinction between centralized/decentralized systems is mostly technical and PEPP-PT is equally able to preserve privacy.
BlueTrace is an open-source application protocol that facilitates digital contact tracing of users to stem the spread of the COVID-19 pandemic. Initially developed by the Singaporean Government, BlueTrace powers the contact tracing for the TraceTogether app. Australia and the United Arab Emirates have already adopted the protocol in their gov apps, and other countries were considering BlueTrace for adoption. A principle of the protocol is the preservation of privacy and health authority co-operation.
TraceTogether was a digital system implemented by the Government of Singapore to facilitate contact tracing efforts in response to the COVID-19 pandemic in Singapore. The main goal was a quick identification of persons who may have come into close contact with anyone who has tested positive for COVID-19. The system helps in identifying contacts such as strangers encountered in public one would not otherwise be able to identify or remember. Together with SafeEntry, it allows the identification of specific locations where a spread between close contacts may occur.
The (Google/Apple) Exposure Notification System (GAEN) is a framework and protocol specification developed by Apple Inc. and Google to facilitate digital contact tracing during the COVID-19 pandemic. When used by health authorities, it augments more traditional contact tracing techniques by automatically logging close approaches among notification system users using Android or iOS smartphones. Exposure Notification is a decentralized reporting protocol built on a combination of Bluetooth Low Energy technology and privacy-preserving cryptography. It is an opt-in feature within COVID-19 apps developed and published by authorized health authorities. Unveiled on April 10, 2020, it was made available on iOS on May 20, 2020 as part of the iOS 13.5 update and on December 14, 2020 as part of the iOS 12.5 update for older iPhones. On Android, it was added to devices via a Google Play Services update, supporting all versions since Android Marshmallow.
COVIDSafe was a digital contact tracing app released by the Australian Government on 26 April 2020 to help combat the ongoing COVID-19 pandemic. The app was intended to augment traditional contact tracing by automatically tracking encounters between users and later allowing a state or territory health authority to warn a user they have come within 1.5 metres with an infected person for 15 minutes or more. To achieve this, it used the BlueTrace and Herald protocol, originally developed by the Singaporean Government and VMWare respectively, to passively collect an anonymised registry of near contacts. The efficacy of the app was questioned over its lifetime, ultimately identifying just 2 confirmed cases by the time it was decommissioned on 16 August 2022.
The Temporary Contact Numbers Protocol, or TCN Protocol, is an open source, decentralized, anonymous exposure alert protocol developed by Covid Watch in response to the COVID-19 pandemic. The Covid Watch team, started as an independent research collaboration between Stanford University and the University of Waterloo was the first in the world to publish a white paper, develop, and open source fully anonymous Bluetooth exposure alert technology in collaboration with CoEpi after writing a blog post on the topic in early March.
Decentralized Privacy-Preserving Proximity Tracing is an open protocol developed in response to the COVID-19 pandemic to facilitate digital contact tracing of infected participants. The protocol, like competing protocol Pan-European Privacy-Preserving Proximity Tracing (PEPP-PT), uses Bluetooth Low Energy to track and log encounters with other users. The protocols differ in their reporting mechanism, with PEPP-PT requiring clients to upload contact logs to a central reporting server, whereas with DP-3T, the central reporting server never has access to contact logs nor is it responsible for processing and informing clients of contact. Because contact logs are never transmitted to third parties, it has major privacy benefits over the PEPP-PT approach; however, this comes at the cost of requiring more computing power on the client side to process infection reports.
NHS COVID-19 was a voluntary contact tracing app for monitoring the spread of the COVID-19 pandemic in England and Wales, in use from 24 September 2020 until 27 April 2023. It was available for Android and iOS smartphones, and could be used by anyone aged 16 or over.
On April 16, 2020, Nodle released The Whisper Tracing Protocol white paper and the Coalition App on Android. The protocol is intended to be a privacy first Digital contact tracing tool developed for the 2020 COVID-19 pandemic. The project has been spun off into The Coalition Foundation. The protocol is being used for the Government of Senegal's Daancovid19 mobile contact tracing app initiative. Daancovid19 is the Senegalese digital response against the coronavirus. It was started by a handful of digital professionals and subsequently brought together nearly 500 volunteer experts from the private, public, and civil society. The respective Coalition App has been promoted by the City of Berkeley, California to their residents.
Covid Watch was an open source nonprofit founded in February 2020 with the mission of building mobile technology to fight the COVID-19 pandemic while defending digital privacy. The Covid Watch founders became concerned about emerging, mass surveillance-enabling digital contact tracing technology and started the project to help preserve civil liberties during the pandemic.
COVID Alert was the Exposure Notification service app for the country of Canada. It launched in the province of Ontario on July 31, 2020, and became available in nearly all Canadian provinces by October of that year, excluding Alberta, and British Columbia.
SwissCovid is a COVID-19 contact tracing app used for digital contact tracing in Switzerland. Use of the app is voluntary and based on a decentralized approach using Bluetooth Low Energy and Decentralized Privacy-Preserving Proximity Tracing (dp3t).
COVID Tracker Ireland is a digital contact tracing app released by the Irish Government and the Health Service Executive on 7 July 2020 to prevent the spread of COVID-19 in Ireland. The app uses ENS and Bluetooth technology to determine whether a user have been a close contact of someone for more than 15 minutes who tested positive for COVID-19. On 8 July, the app reached one million registered users within 36 hours after its launch, representing more than 30% of the population of Ireland and over a quarter of all smartphone users in the country. As of August 2021, over 3,030,000 people have downloaded the app.
PathCheck Foundation is a volunteer-led nonprofit organization founded in February 2020 at MIT that develops COVID-19 apps for digital contact tracing. The organization consists of over 1000 volunteers. In addition, various companies donate employee time to the foundation. The organization was previously known as COVID Safe Paths but was renamed PathCheck Foundation on June 28, 2020.
Software for COVID-19 pandemic mitigation takes many forms. It includes mobile apps for contact tracing and notifications about infection risks, vaccine passports, software for enabling – or improving the effectiveness of – lockdowns and social distancing, Web software for the creation of related information services, and research and development software. A common issue is that few apps interoperate, reducing their effectiveness.
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