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Why Bluetooth apps are bad at discovering new cases of COVID-19

Yesterday we discussed the things that need to happen before we can slowly reopen our cities: the supply of hospital beds fully catches up with demand; testing fully meets the demand; we are developing programs to quarantine new cases and inform their contacts that they may have been exposed to the disease; and the number of cases decreases for 14 consecutive days.

Today, let’s zoom in (not zoom in) on the third point: build systems to enforce quarantine and detect infected contacts. Both are areas where public health officials believe technology can play a role. But I want to describe why that role may be more limited than you assume – and, according to the experts I spoke to, far less important than engaging public health authorities to do the primary work.

First, let’s talk about quarantine enforcement – making sure that people who have ordered the state to stay at home actually do. This is an area where technology can – and plays – a major role. I’ve mentioned Taiwan’s ‘electronic fence’ a few times in this column, but here’s a quick replay of Reuters:

The system monitors phone signals to alert the police and local officials if their home quarantine moves away from their address or turns off their phones. Jyan said authorities will contact those who issue a warning within 15 minutes.

The technology is not particularly complicated here. With the cooperation of a telecom company, you can tie someone’s phone to a single mobile tower. If the phone pings another tower or turns off, the public health authorities will contact you. This approach is invasive, somewhat disturbing, and quite effective in every way. It is not clear to me how a similar program could be implemented without new legislation explicitly authorizing telecom companies to share this type of data – my inbox is full of legislators (rightly so!) Demanding safeguards and supervision of such government oversight. But if the recent stimulus packages are any indication, that would seem to be legislation that can be written and passed very quickly.

Note that technology alone does not solve the enforcement problem. You also need people who call patients whose phones seem to be moving or turned off. You need people who do random checks to make sure that the quarantined person has not just left his phone at the house and gone to church. And you probably need a place to house quarantined people who aren’t with their family the most likely places for coronavirus to spread. In other words, tech is necessary, but not enough.

Now let’s talk about what is perhaps the most challenging piece in the whole stack: contact tracking. Public health experts tell me that contacting people who may have been exposed to a known COVID-19 case is one of the most important steps we need to take to mitigate future outbreaks. But the how it’s complicated. While we’ve seen a Cambrian explosion of contact tracking apps around the world, it remains unclear how good or effective any of them have been. And since U.S. government officials are considering asking large tech companies to consider working on contact tracking solutions – and I’ve been told they’ve already inquired with Facebook – that’s worth keeping in mind.

Let’s go to South Korea to get an idea of ​​how this happened in a country that has done relatively well with the coronavirus outbreak. Derek Thompson has a good piece of contact tracking in the Atlantic Ocean which describes how it played there. The country seemingly completely skipped traditional contact tracing and immediately went on to blow up new coronavirus victims in the new public square – other people’s smartphones:

The government uses various sources, such as mobile phone location data, camera surveillance and credit card data, to monitor citizens’ activities widely. If someone tests positive, local authorities can send a warning, sort of like a flood warning reportedly includes the person’s last name, gender, age, city and credit card history, with a minute-by-minute record of their comings and goings from various local businesses. “In some districts, public information includes which rooms of a building the person was in, when they visited a toilet, and whether or not they were wearing masks,” Mark Zastrow, a Nature reporter, said. wrote. “Even overnight stays in ‘love motels’ have been noticed.”

New cases in South Korea have fallen by about 90 percent in the past 40 days, an extraordinary achievement. But the amount of information in South Korea’s investigative alerts has turned some of its citizens into ambitious armchair detectives, who search the Internet in an attempt to identify people who test positive and condemn them online. Choi Young-ae, the chairman of South Korea’s Human Rights Commission, has said that these harassments have made some Koreans less willing to be tested.

So far, South Korea seems to be an outlier in this approach. Other countries are choosing to build much more targeted interventions by using the GPS and Bluetooth signals from phones to passively track proximity between individuals and inform potential contacts after someone has become infected. Singapore, which has built an app called TraceTogether that monitors Bluetooth activity, “may be the most likely model for the West,” Thompson writes. The country makes TraceTogether available as an open source project.

As far as it has been written so far, these passive tracking apps are generally considered in terms of their privacy implications. Who collects the data? Where is it shared? Can it be linked back to individual patients? How long should that information be kept?

Several academics and entrepreneurs are already working on passive tracking apps that try to solve these problems. Bee Wired, Andy Greenberg discusses three such attempts, and they are all absolute Rube Goldberg machines. Here is one of the apps in development:

Covid-Watch uses Bluetooth as a kind of proximity detector. The app constantly sings Bluetooth signals to nearby phones, looking for others who may be using the app within six feet or six feet. If two phones are within range of each other for 15 minutes, the app will consider them a ‘contact event’. They each generate a unique random number for that event, register the numbers and send them to each other.

If a Covid-Watch user later thinks he is infected with Covid-19, he may ask his healthcare provider for a unique confirmation code. (Covid-Watch distributed those confirmation codes only to healthcare providers, to prevent spammers or misdiagnoses from flooding the system with false positives.) When that confirmation code is entered, the app uploads all of the contact event numbers from that phone to a server. The server would then send those contact event numbers to every phone in the system, where the app would check if any of the codes matched their own contact event log from the past two weeks. If any of the numbers match, the app alerts the user that they have contacted an infected person and displays instructions or a video about testing or self-quarantining.

All of these efforts seem to skip the question of whether a ‘contact event’ reported by Bluetooth is an effective method of contact tracking to begin with. Thursday I spoke to Dr. Farzad Mostashari, the former National Coordinator for Health Information Technology in the Department of Health and Human Services. (Today he is the CEO of Aledade, which creates physician management software.) Mostashari recently had that posted a Twitter thread express skepticism about Bluetooth contact tracking and I asked him to work this out.

The first problem he described was that a significant number of people installed the app and made sure it was active as everyone made their way around the world. Most countries have made the installation of apps voluntary and acceptance is low. In Singapore, Mostashari told me that adoption was about 12 percent of the population. If the United States had a similar adoption, you have now placed your big contact tracing bet on the probability that two people passing each other have both installed this app on your phone. The statistical probability of this is about 1.44 percent. (It may be higher in areas of greater population density or where the app is more widely installed.)

The second problem is that when these Bluetooth chips pass at night, you can expect a lot of false positives.

“When I’m out in the open, my Bluetooth and your Bluetooth can ping each other even if you are much more than six feet away,” Mostashari said. “You can be through the wall of mine in an apartment, and it can ping that we have an event nearby. You could be one another floor of the building and it could ping. You could cycle with me in the open air and ping it. ‘

All of this seems really problematic even before you consider asking Apple or Google or Facebook to create a contact tracking app and promote it through their own channels. We spent three and a half years discussing the shortcomings of these companies when it comes to protecting our data privacy; Allowing them to oversee a project as intimate and sensitive as an infection seems like a bad idea. (My own feeling in speaking to Google and Facebook executives in recent days is that they are eager to help with crisis response, and are already doing so in a variety of ways, but are not really interested in this certain part of the reaction.)

Then two questions remain: what should Big Tech do and what should the government do?

Public health experts I spoke to raved about Facebook and Google’s efforts to use aggregated, anonymized data to represent movement patterns – a key measure of home ordering effectiveness. They love Apple’s COVID-19 screening tool and Facebook’s partnership with Carnegie Mellon University to encourage users to report symptoms themselves – at the university, not Facebook. These projects don’t resolve the crisis on their own, but they are good and useful tools to show public health officials something real-time about how the disease is spreading through communities. And if there are other tools they can build – especially those that rely on aggregated and anonymized data, rather than personally identifiable information – I think companies should keep exploring it.

And what about the government? The good news is that our public health infrastructure is already practicing a lot with contact tracking, thanks to our sweet old friend the sexually transmitted infection. Come down with HIV, chlamydia, or gonorrhea, and a good health agency in the county will work with you to reach out to anyone who may have exposed you since you got infected. (Here’s a good piece by Ryan Kost in the San Francisco Chronicle about How the City’s Experience with HIV / AIDS in the 1980s Has Dramatically Improved Public Health Infrastructure, which contributed to the admirably quick response to the threat posed by COVID-19.)

That same tactic – public health researchers who call and train in the community – seems to be the most effective tool we have for tracking contacts. And the good news is that smart public health departments – like San Francisco’s – are already growing. Here is James Temple in the MIT Tech Review On what he describes as one of the first such efforts in the country:

The Department of Health supplements its own staff with city librarians and dozens of researchers, medical students, and others from the University of California, San Francisco. Healthcare workers in the city have already identified on a small scale, but they plan to scale up efforts significantly in the coming weeks. The team consists of about 40 people and can reach 150.

The working group will interview each patient who tests positive and provide the necessary support to ensure that everyone isolates themselves completely, helping them to find and, if necessary, find shelter. They also expect to reach three to five people that patients have come into contact with in recent days. They warn them that they may have been exposed, ask them to limit their contacts, and encourage them to take a test or carry a test with them. Those who test positive will start additional rounds of interviews and contact tracking.

Experts I’ve spoken to say there are software tools that can help health professionals: a website or app where people affected by COVID-19 can voluntarily upload their contacts, for example, to make tracking easier for the health department. But you still need people to contact them.

Tom Frieden, a former director of the Centers for Disease Control and Prevention, told me a story to illustrate this point. Earlier in his career, when he worked on disease prevention at the New York City Department of Health and Mental Hygiene, his team followed a young man suffering from resistant tuberculosis. The man was put in juvenile detention, but then escaped. He didn’t have a cell phone to track down. But Frieden sent a team to find him and eventually managed to treat him.

The thing was, you can’t design a Bluetooth app that this guy finds.

But you can rent people to find him. Frieden says we need an extraordinary number of people – a whopping 300,000, he says. “You’re talking about something like a hundredfold increase in public health capacity,” said Frieden. “Much can be done via telephone banking. But much involves going outside and knocking on doors. ‘

The ‘good’ news is that there are a a lot of of people who have recently been unemployed and may consider new career opportunities. It seems that one of the best ways we can spend promotional money is to help the state and county health programs expand their capacity to hire people for contact detection.

And we can also continue to explore new technology-driven contact tracking solutions. But for now, it seems worth saying that there is little evidence that phones are good at tracking contacts – and a lot of evidence that people are. As we prepare to reopen society, the biggest investment we need to make is in people.

* * *

What have I missed? What did I leave out? I’m a bit out of my comfort zone here so if I made a mistake in my facts or logic please let me know so I can fix it and share it with everyone in our next issue.

The ratio

Today in news that could influence the public perception of the major tech platforms.

⬆️ Trending up: TikTok pledged $ 375 million to support relief efforts by COVID-19. The support includes $ 250 million in funds, $ 100 million in ad credits and $ 25 million in ad space for public health information.

⬆️ Trending up: Facebook donates another $ 2 million in mental health resources, fearing pandemic will lead to further depression and related problems.

⬇️ Trending down: Amazon workers at a fulfillment center in Riverside, California filed a complaint yesterday asking the state to investigate what they believe are hazardous working conditions that threaten public health during the coronavirus pandemic.


How Zoom CEO Eric Yuan built a conferencing app that suddenly became the social network of the pandemic. “I never thought the whole world would use Zoom overnight,” he says. “Unfortunately, we have not prepared well mentally and strategically.” (Drake Bennet and Nico Grant / Bloomberg)

Elizabeth Warren sent a letter to Zoom CEO Eric Yuan demands information about the company’s privacy policy, especially when it comes to children. The letter describes a number of Zoom’s recent security and privacy issues, including the recent Zoombombing harassment attacks. (Russell Brandom / The edge)

Jeff Bezos paid a surprise visit to an Amazon warehouse near Dallas, where employees work hard to catch a wave of online orders while customers find shelter at home. The move comes amid continuing concerns about worker safety in the company’s warehouses. (Spencer Soper / Bloomberg)

A manager at one Amazon warehouse in Pennsylvania told staff not to touch shipments from another Amazon facility for 24 hours as that facility had seen a cluster of COVID-19 cases. The occupational health and safety administration opens an investigation into working conditions in the warehouse. (Matt Day, Spencer Soper and Josh Eidelson / Bloomberg)

Instacart introduces a few new delivery options in an attempt to deal with the increased demand resulting from COVID-19. Fast & Flexible and Order Ahead are both designed to increase the number of available delivery times depending on whether customers are willing to be flexible with delivery times or plan ahead. (Jon Porter / The edge)

Yelp cuts 1,000 jobs and cuts another 1,100 workers amid a massive downturn in business. It is the newest company targeting small businesses and much of its customer base has been decimated during the COVID-19 outbreak and related shutdowns. (Ina Fried / Axios)

A simulation of Belgian researchers showing runners and motorcyclists endangers other people by spreading droplets when they exhale, cough or sneeze has gone viral. But the findings have not been published in a study (not even in a non-peer review). It’s yet another case where an armchair epidemiologist goes viral on Medium with bad science. (Jason Koebler / Vice)

Universities roll out chatbots and virtual assistants whose speed and tone can simulate text conversations, while students continue to learn remotely. Some may help students navigate issues they may have learned during a campus visit, such as planning for orientation and choosing lessons. (Laura Pappano / The New York Times)

Chinese companies are going to great lengths to prevent new outbreaks of the new coronavirus when they open up for business again. They now have to give employees face masks and check everyone’s temperature daily. It is a crucial test of whether a country can keep the infection curve flat after the social distance has been lifted. (Eva Dou / The Washington Post)

The Unicode Consortium, the group behind emoji releases, has announced it will not release new emoji next year. The good news is that the emoji announced earlier this year, such as the olive, the beaver and the plunger, will still be available this fall. (Ashley Carman / The edge)

Microsoft thinks the coronavirus pandemic will change our way of working and learning forever. The company just released a report on remote work habits, noting that demand for Microsoft Teams rose globally last month, from 32 million daily active users to 44 million in just a week. (Tom Warren / The edge)

Webcams are impossible to find because people stay quarantined at home. External resellers have seized the scarcity by marking webcams at ridiculous prices. (Chris Welch / The edge)

A wave of internet usage is taxing our networks. But it also provides a wage for updates and upgrades that make the internet stronger than ever. (Will Douglas Heaven / MIT Technology Review)

The number of phone calls has risen more than the internet use, because people want to hear each other’s voice in the pandemic. It is a trend that has surprised even the largest telecom providers. (Cecilia Kang / The New York Times)

Virus tracker

Total cases in the US: At least 449,260

Total number of deaths in the US: More than 16,000

Reported cases in California: 19,043

Reported cases in New York: 159,937

Reported cases in New Jersey: 51,027

Reported cases in Michigan: 20,220

Reported cases in Louisiana: 18,283

Data from The New York Times.

To govern

2020 politics now look much less ominous for Big Tech. The combination of changing priorities due to the coronavirus pandemic, along with critics like Bernie Sanders and Elizabeth Warren quitting the presidential race, means that the techlash has largely faded. Here’s Eric Newcomer on Bloomberg:

Biden’s attacks never caused the concerns, like those of Sanders and Warren. He has deep ties to the tech industry; his former communications director, Jay Carney, is now Amazon’s chief spokesperson. Biden has also repeatedly labeled his administration as a continuation of the Obama years, and several former Obama officials have settled in Silicon Valley.

While the tech industry rank-and-file was mainly donated to the industry’s antagonists, its executives seemed most excited about younger moderates Pete Buttigieg and Cory Booker. Biden is a happy consolation prize.

Antitrust regulators ordered in France Google to pay publishers to display snippets of their articles on the company’s news service. The regulators gave Google three months to make a deal with publishers. (Gaspard Sebag / Bloomberg)


Facebook is testing a new feature called “Campus” that is only open to students, according to expert app researcher Jane Manchun Wong. The feature requires an .edu email address. Once you enter, you can fill in a profile with your graduation year, major, minor and dorm if you want to find friends. (Mariella Moon / Engadget)

Facebook adds a ‘silent mode’ that mutes most notifications. This feels like a move from a time when we all cared how much we looked at our screens. (Nick Statt / The edge)

Things to do

Stuff to keep you busy online during quarantine.

Watch Sheryl Sandberg Dr. Julianne Holt-Lunstad interviews, who studies the health effects of loneliness, about staying emotionally healthy while physically distancing yourself.

Watch a new video clip of Thao & The Get Down that was made entirely on Zoom. The Oakland band had to turn their plans for a live music video shoot because of the coronavirus pandemic. (Dani Deahl / The edge)

View a new one Saturday Night Live this weekend. The show returns with fresh comedy where everyone works remotely.

And finally…

Talk to us

Send us tips, comments, questions, and your technical solutions for contact tracking: [email protected] and [email protected]