Abstract

The coronavirus disease 2019 (COVID-19) response in most countries has relied on testing, isolation, contact tracing, and quarantine (TITQ), which is labor- and time-consuming. Therefore, several countries worldwide launched Bluetooth-based apps as supplementary tools. The aim of using contact tracing apps is to rapidly notify people about their possible exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and thus make the process of TITQ more efficient, especially upon exposure in public places. We evaluated the Norwegian Google Apple exposure notification (GAEN)-based contact tracing app Smittestopp v2 under relevant “real-life” test scenarios. We used a total of 40 devices, representing six different brands, and compared two different exposure configurations, experimented with different time thresholds and weights of the Bluetooth attenuation levels (buckets), and calculated the true notification rates among close contacts (≤2 m and ≥15 min) and false notification of sporadic contacts. In addition, we assessed the impact of using different operating systems and locations of the phone (hand/pocket). The best configuration tested to trigger exposure notification resulted in the correct notification of 80% of the true close contacts and incorrect notification of 34% of the sporadic contacts. Among those who incorrectly received notifications, most (67%) were within 2 m but the duration of contact was <15 min and thus they were not, per se, considered as “close contacts.” Lower sensitivity was observed when using the iOS operating systems or carrying the phone in the pocket instead of in the hand. The results of this study were used to improve and evaluate the performance of the Norwegian contact-tracing app Smittestopp.

Highlights

  • Until March 9, 2020, all the cases of the coronavirus disease 2019 (COVID-19) in Norway were associated with travel or contact with a confirmed case [1]

  • The results indicate that notification rates would be significantly (p < 0.05) lower when using the iOS operating system compared with Android (Table 2)

  • We aimed at optimizing the precision of the Google Apple exposure notification (GAEN)-based contact tracing app Smittestopp v2 under “reallife” scenarios to target close contacts

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Summary

Introduction

Until March 9, 2020, all the cases of the coronavirus disease 2019 (COVID-19) in Norway were associated with travel or contact with a confirmed case [1]. The response was based on “test, isolate, trace and quarantine (TITQ);” test suspected cases, isolate confirmed cases, identify and quarantine close contacts [2]. Based on the last 3 months of 2020, when the testing capacity allowed testing everyone with symptoms or suspected exposure, the source of exposure was unknown or missing in 20% of the reported cases [3, 4]. This indicates that a significant proportion of cases and contacts were not identified through manual contact tracing or did not follow-up the advice given, as reported by other countries [5]. With the introduction of new more contagious virus variants [variants of concern (VOC)] in winter 2021, the importance of efficient contact tracing strategies has been further stressed [6]

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