Digital Contact Tracing Apps Research Articles

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A Review of COVID-19 Mobile Contact Tracing Applications and Their Impact on Privacy

Contact tracing is a well-established process that has been utilized for years to assist in the effort to control the spread of contagious diseases. The rapid onset and spread of COVID-19 brought about the need for digital solutions which would help to speed up the collection and analysis of relevant health information. With the proliferation of mobile devices, the development of mobile device-based digital contact tracing applications appeared to be the solution. As countries around the globe created digital contact tracing applications for use by their respective populations, a variety of factors allowed for success for some and resulted in failure for others. This review highlights example countries with respect to their unique COVID-19 digital contact tracing solutions, the success or failure of the applications employed on mobile platforms, and the factors which have contributed to the success or failure of these solutions. Additionally, a review of research around data privacy and security in digital contact tracing apps is included.

The Impact of Digital Contact Tracing Apps Overuse on Prevention of COVID-19: A Normative Activation Model Perspective.

During the COVID-19 pandemic, many countries have used digital contact tracing apps (DCTAs) to implement contact tracing. Although the use of DCTAs has contributed to the prevention and control of COVID-19, there are doubts in academia about their actual effectiveness. In this study, the role of DCTAs in the prevention of COVID-19 was analyzed in terms of both the responsibility and inconvenience to life in a large-scale DCTA overuse environment, based on the normative activation model. The findings suggest that the overuse of a DCTA activates people’s personal norms by triggering awareness of the consequences and ascription of responsibility, leading people to consistently cooperate with the government to prevent COVID-19. However, the inconvenience of living with DCTA overuse weakens the effect of the awareness of consequences and ascription of responsibility and the role of the ascription of responsibility in influencing personal norms. These effects may bear on people’s willingness to consistently cooperate with the government to prevent COVID-19. The results of this study confirm the effectiveness of DCTA in counteracting pandemics from a social responsibility perspective in a large-scale environment where DCTA is used, enriching the literature on DCTA research in the COVID-19 pandemic. The results of this study can also help governments develop and improve policies to prevent COVID-19, as well as improve the DCTAs’ operating patterns.

An evaluation of privacy policies used in digital contact tracing apps for COVID-19

Background: After coronavirus disease 2019 (COVID-19) spread across the globe, quarantine regulations were supplemented by digital contact tracing initiatives in the form of mobile applications and other surveillance. This paper examines digital contact tracing on a global scale using English privacy policy information from mobile digital contact tracing applications (DCTAs) compared to guidelines on digital proximity tracing from the World Health Organization (WHO) published in May 2020.

A methodology for evaluating digital contact tracing apps based on the COVID-19 experience

Controlling the spreading of infectious diseases has been shown crucial in the COVID-19 pandemic. Traditional contact tracing is used to detect newly infected individuals by tracing their previous contacts, and by selectively checking and isolating any individuals likely to have been infected. Digital contact tracing with the utilisation of smartphones was contrived as a technological aid to improve this manual, slow and tedious process. Nevertheless, despite the high hopes raised when smartphone-based contact tracing apps were introduced as a measure to reduce the spread of the COVID-19, their efficiency has been moderately low. In this paper, we propose a methodology for evaluating digital contact tracing apps, based on an epidemic model, which will be used not only to evaluate the deployed Apps against the COVID-19 but also to determine how they can be improved for future pandemics. Firstly, the model confirms the moderate effectiveness of the deployed digital contact tracing, confirming the fact that it could not be used as the unique measure to fight against the COVID-19, and had to be combined with additional measures. Secondly, several improvements are proposed (and evaluated) to increase the efficiency of digital control tracing to become a more useful tool in the future.

Extending the Unified Theory of Acceptance and Use of Technology for COVID-19 Contact Tracing Application by Malaysian Users

The Malaysian government has mobilized its strength to confront the current COVID-19 pandemic and has sought to develop and implement a digital contact tracking application, making it an integral part of the exit strategy from the lockdown. These applications record which users have been near one another. When a user is confirmed with COVID-19, app users who have recently been near this person are notified. The effectiveness of these applications is determined by the users’ willingness to install and use them. Therefore, this research aims at identifying the factors that would stimulate or slow down the adoption of a contact-tracing app. It proposes solutions to mitigate the impact of the factors affecting the user’s acceptance of COVID-19 Digital Contact Tracing Apps. A quantitative approach was followed in this research, where an electronic survey was spread in Malaysia, for the objective of data collection, considering the previous discussion of the results. Then, using PLS-SEM, the collected data were analyzed statistically. The findings of this study indicate that the unified theory of acceptance and use of technology (UTAUT) factors (Performance Expectancy, Effort Expectancy, Social Influence, Facilities Condition) were significant predictors of MySejahtera application adoption among citizens in Malaysia. On the other hand, the factors of app-related privacy concern were found to be insignificant for MySejahtera application adoption.

A Cluster Analysis of the Acceptance of a Contact Tracing App-The Identification of Profiles for the Italian Immuni Contact Tracing App.

Digital contact tracing apps have been introduced by governments as a strategy to limit the spread of the COVID-19 pandemic. Digital contact tracking is an alternative to traditional contact tracing performed by human tracers who have to reconstruct each contact an infected person had in the recent past by means of interviews. The Italian government proposed the Immuni digital contact tracking app as a solution. Immuni uses Bluetooth technology to anonymously register all close contacts a person had: if she tests positive for COVID-19 then all registered contacts are notified. The main aim of the paper is to propose a cluster analysis of some factors concerning the possible acceptance of the Immuni app to build behaviour profiles that explain and predict the possible behaviours of the respondents. The factors considered referred to three different pillars: the technological pillar, investigated by considering factors from the technology acceptance models family; the health pillar, where variables of the health belief model were used; and the sociopolitical pillar, where some values of the respondents were considered as possible barriers to or facilitators of the acceptance of this technology. As a result of the cluster analysis, three behavioural profiles were built: the ProApp profile, the Hesitant profile, and the AntiApp profile. The first is the profile grouping the respondents who intend to use the contact tracing app; the second is more about people who are favourable of the use of the app, but some issues such as privacy reduce the strength of their intention; the last profile is about people who are less favourable to use the app. We are confident that the behaviour profiles found would be useful to build more tailored communication campaigns to help promote the use of the app by managing factors that could either be facilitators or barriers.

Effectiveness of Ehteraz digital contact tracing app versus conventional contact tracing in managing the outbreak of COVID-19 in the State of Qatar

IntroductionContact tracing is an integral component of the overall public health strategy for controlling the outbreak of infectious diseases such as COVID-19. In addition to the conventional contact tracing, Qatar...

DIMY: Enabling privacy-preserving contact tracing

The infection rate of COVID-19 and the rapid mutation ability of the virus has forced governments and health authorities to adopt lockdowns, increased testing, and contact tracing to reduce the virus’s spread. Digital contact tracing has become a supplement to the traditional manual contact tracing process. However, although several digital contact tracing apps are proposed and deployed, these have not been widely adopted due to apprehensions surrounding privacy and security. In this paper, we present a blockchain-based privacy-preserving contact tracing protocol,“Did I Meet You” (DIMY). The protocol provides full-lifecycle data privacy protection on the devices as well as the back-end servers to address most of the privacy concerns associated with existing protocols. We have employed Bloom filters to provide efficient privacy-preserving storage and have used the Diffie–Hellman key exchange for secret sharing among the participants. We show that DIMY provides resilience against many well-known attacks while introducing negligible overheads. DIMY’s footprint on the storage space of clients’ devices and back-end servers is also significantly lower than other similar state-of-the-art apps.

Digital Contact Tracing Apps for COVID-19: Development of a Citizen-Centered Evaluation Framework.

BackgroundThe silent transmission of COVID-19 has led to an exponential growth of fatal infections. With over 4 million deaths worldwide, the need to control and stem transmission has never been more critical. New COVID-19 vaccines offer hope. However, administration timelines, long-term protection, and effectiveness against potential variants are still unknown. In this context, contact tracing and digital contact tracing apps (CTAs) continue to offer a mechanism to help contain transmission, keep people safe, and help kickstart economies. However, CTAs must address a wide range of often conflicting concerns, which make their development/evolution complex. For example, the app must preserve citizens’ privacy while gleaning their close contacts and as much epidemiological information as possible.ObjectiveIn this study, we derived a compare-and-contrast evaluative framework for CTAs that integrates and expands upon existing works in this domain, with a particular focus on citizen adoption; we call this framework the Citizen-Focused Compare-and-Contrast Evaluation Framework (C3EF) for CTAs.MethodsThe framework was derived using an iterative approach. First, we reviewed the literature on CTAs and mobile health app evaluations, from which we derived a preliminary set of attributes and organizing pillars. These attributes and the probing questions that we formulated were iteratively validated, augmented, and refined by applying the provisional framework against a selection of CTAs. Each framework pillar was then subjected to internal cross-team scrutiny, where domain experts cross-checked sufficiency, relevancy, specificity, and nonredundancy of the attributes, and their organization in pillars. The consolidated framework was further validated on the selected CTAs to create a finalized version of C3EF for CTAs, which we offer in this paper.ResultsThe final framework presents seven pillars exploring issues related to CTA design, adoption, and use: (General) Characteristics, Usability, Data Protection, Effectiveness, Transparency, Technical Performance, and Citizen Autonomy. The pillars encompass attributes, subattributes, and a set of illustrative questions (with associated example answers) to support app design, evaluation, and evolution. An online version of the framework has been made available to developers, health authorities, and others interested in assessing CTAs.ConclusionsOur CTA framework provides a holistic compare-and-contrast tool that supports the work of decision-makers in the development and evolution of CTAs for citizens. This framework supports reflection on design decisions to better understand and optimize the design compromises in play when evolving current CTAs for increased public adoption. We intend this framework to serve as a foundation for other researchers to build on and extend as the technology matures and new CTAs become available.

SwissCovid in the Perspective of Its Goals

SwissCovid is the Swiss digital contact tracing app, which was deployed to help fighting against the COVID-19 pandemic. After a year of activity, it is high time to evaluate how effective it has been in its mission. At the highest peak, about 22% of the Swiss population was actively using SwissCovid. The activity of SwissCovid follows the curve on the number of COVID-19 cases. However, performances are rather poor. About 1% of the cases may have been discovered by SwissCovid and much less than 2% of SwissCovid alerts may have been useful, while SwissCovid generates 5% of the quarantines. The measure of the proximity of each encounter and its duration are also imprecise. It further comes with security and privacy issues: adversaries can inject false alerts for SwissCovid users and users can be tracked. On top of that, SwissCovid contributes to strengthen the monopoly of Apple and Google and to make users and their data captive of these giants. It also digs the digital divide. Contrarily to the original plan, the implementation is not open source and the law was twisted to fit the constraints by Apple and Google. Therefore, SwissCovid did not meet its goals.

Learning from the initial deployment of digital contact tracing apps

Learning from the initial deployment of digital contact tracing apps

Effectiveness evaluation of digital contact tracing for COVID-19 in New South Wales, Australia

BackgroundDigital proximity tracing apps were rolled out early in the COVID-19 pandemic in many countries to complement conventional contact tracing. Empirical evidence about their benefits for pandemic response remains scarce. We evaluated the effectiveness and usefulness of COVIDSafe, Australia's national smartphone-based proximity tracing app for COVID-19.MethodsIn this prospective study, done in New South Wales (NSW), Australia, we included all individuals in the state who were older than 12 years with confirmed, locally acquired SARS-CoV-2 infection between May 4 and Nov 4, 2020. We used data from the NSW Notifiable Conditions Information Management System, the national COVIDSafe database, and information from case interviews, including information on app usage, the number of app-suggested contacts, and the number of app-suggested contacts determined by public health staff to be actual close contacts. We calculated the positive predictive value and sensitivity of COVIDSafe, its additional contact yield, and the number of averted public exposure events. Semi-structured interviews with public health staff were done to assess the app's perceived usefulness.FindingsThere were 619 confirmed COVID-19 cases with more than 25 300 close contacts identified by conventional contact tracing during the study period. COVIDSafe was used by 137 (22%) cases and detected 205 contacts, 79 (39%) of whom met the close contact definition. Its positive predictive value was therefore 39%. 35 (15%) of the 236 close contacts who could have been expected to have been using the app during the study period were identified by the app, making its estimated sensitivity 15%. 79 (0·3%) of the estimated 25 300 contacts in NSW were app-suggested and met the close contact definition. The app detected 17 (<0·1%) additional close contacts who were not identified by conventional contact tracing. COVIDSafe generated a substantial additional perceived workload for public health staff and was not considered useful.InterpretationThe low uptake of the app among cases probably led to a reduced sensitivity estimate in our study, given that only contacts who were using the app could be detected. COVIDSafe was not sufficiently effective to make a meaningful contribution to the COVID-19 response in Australia's most populous state over a 6 month period. We provide an empirical evaluation of this digital contact tracing app that questions the potential benefits of digital contact tracing apps to the public health response to COVID-19. Effectiveness evaluations should be integrated into future implementations of proximity contact tracing systems to justify their investment.FundingNew South Wales Ministry of Health (Australia); National Health and Medical Research Council (Australia)

Explaining citizens’ resistance to use digital contact tracing apps: A mixed-methods study

Governments worldwide are using digital contact tracing (DCT) apps as a critical element in their COVID-19 pandemic lockdown exit strategy. Despite substantial investment in research and development, the public’s acceptance of DCT apps has been phenomenally low, signaling resistance among potential users. Little is known about why people would resist using the DCT app, a useful innovation that can potentially save millions of human lives. This study explores the determinants and consequences of citizens' resistance to use DCT apps using a sequential two-stage mixed-methods approach. The preliminary qualitative study analyzed interviews of 24 Indian smartphone users who chose not to use or discontinued the DCT app after an initial trial. In the quantitative stage, an integrated model based on innovation resistance theory and distrust theory was tested using the survey data collected from 194 non-adopters of the DCT app from India. The findings revealed that the factors, distrust, value barrier, information privacy concerns, and usage barrier predicted the resistance to the DCT app, and resistance, in turn, predicted intention to use. Additionally, distrust was found to be a key mediator between innovation barriers and resistance. The insights from this study could help the developers and policymakers formulate strategies for implementing DCT interventions during future disease outbreaks.

Understanding the perceptions of UK COVID-19 contact tracing app in the BAME community in Leicester

Purpose Digital contact tracing technologies are critical to the fight against COVID-19 in many countries including the UK. However, a number of ethical, legal and socio-economic concerns that can affect uptake of the app have been raised. The purpose of this research is to explore the perceptions of the UK digital contact tracing app in the Black, Asian and Minority Ethnic (BAME) community in Leicester and how this can affect its deployment and implementation. Design/methodology/approach Data was collected through virtual focus groups in Leicester, UK. A total of 28 participants were recruited for the study. All participants are members of the BAME community, and data was thematically analysed with NVivo 11. Findings A majority of the participants were unwilling to download and use the app owing to legal and ethical concerns. A minority were willing to use the app based on the need to protect public health. There was a general understanding that lack of uptake will negatively affect the fight against COVID-19 in BAME communities and an acknowledgement of the need for the government to rebuild trust through transparency and development of regulatory safeguards to enhance privacy and prevent misuse. Originality/value To the best of the authors’ knowledge, the research makes original contributions being the first robust study conducted to explore perceptions of marginalised communities, particularly BAME which may be adversely impacted by the deployment of the app. By exploring community-based perceptions, this study further contributes to the emerging citizens’ perceptions on digital contact tracing which is crucial to the effectiveness and the development of an efficient, community-specific response to public attitudes towards the app. The findings can also help the development of responsible innovation approaches that balances the competing interests of digital health interventions with the needs and expectations of the BAME community in the UK.

Understanding digital contact tracing app continuance: Insights from India

ObjectivesDigital contact tracing (DCT) was touted as an effective alternative to lockdown and other restrictive measures in controlling the spread of the COVID-19 pandemic. Despite considerable investments in research and development, the usage of DCT apps was found to be phenomenally low across the world. In this context, the current study investigates the factors influencing citizens’ continuance intentions to use the DCT app. MethodsA theoretical framework was developed by extending the Expectation-confirmation model (ECM) of Information system continuance with Technology trust theory and a contextual factor perceived security and privacy to predict citizens’ continuance intentions to use the DCT app. The model was empirically tested using data from a field survey of 206 actual users of a DCT app implemented in India. ResultsThe findings reveal that user satisfaction, trust in government, and trust in technology are significant predictors of citizens’ continuance intention. The model demonstrates high explanatory power by explaining 57.8% of the variance of continuance intention. It also validates the role of perceived security and privacy and trust in technology in determining user satisfaction. ConclusionThe study makes a theoretical contribution by extending the ECM framework to predict DCT app continuance behavior. The insights from the study could be helpful for developers and policymakers in crafting strategies to improve the usage of DCT apps during future disease outbreaks.

The Efficacy, Equity and Externalities of Australia’s COVIDSafe App as a Policy Intervention during the COVID-19 Pandemic: Was It Sunscreen or Tanning Lotion?

Digital contact tracing apps, such as the COVIDSafe App in Australia, have been rapidly implemented by many governments as a public policy solution to increase the efficiency of health screening testing during the COVID-19 viral pandemic. This article analyses how the COVIDSafe App’s unresolved efficacy and equity issues and the cybersecurity and privacy externalities it imposes onto Australians have prevented the App from making a significant positive contribution towards reducing the impact of the pandemic in Australia. It attributes some of the failure of Bluetooth-based digital contract tracing apps to their mis-characterisation as a Lessigean ‘code as law’ policy response, arguing instead that such apps are more complex and fragile cyber-physical systems requiring more analysis prior to implementation.

Use and effectiveness of Digital Contact Tracing during COVID-19 pandemic: a systematic review

Abstract Background Contact tracing (CT) is a pillar of infection control during outbreaks and its implementation has been great ally in the context of the COVID-19 pandemic that pressured national health systems. Digital CT (DCT) aids manual CT by logging proximity contacts and timely notifying contacts of positive cases, contributing to greater epidemic. We aim to systematically review and critically appraise the available evidence on adoption, effectiveness, acceptance and barriers to access of available CT apps. Methods We conducted a systematic literature review by means of Pubmed, Embase, Cochrane and Web of Science and applying the PRISMA guidelines. We classified studies according to selected characteristics (eg, original data, mathematical models, policy papers, overview of the experience with national CT apps) in order to better outline our results. Results Our queries yielded 1201 articles, of which 790 remained after duplicates' removal. After applying a priori selected inclusion criteria, 428 (54.17%) were eliminated after screening by title and abstract. 362 records were included in our study: of them 33.7% were original studies, 54.1% were opinion papers not reporting quantitative data, 14.91% were mathematical models, 6% were systematic reviews on DCT-related topics. Among original studies, 11.47% described national experiences and 25.40% discussed adoption dynamics. Conclusions DCT adoption still faces several cultural, normative and technical barriers, ranging from adoption mandates to privacy issues, to device compatibility. Overall, scant evidence is available on the impact of DCT in controlling infection spread and wide heterogeneity persists within studies in term of design and assessed outcomes Future research is needed based on shared evaluation frameworks. Key messages Digital contact tracing apps are a powerful but underestimated tool to counter epidemiological emergencies. Future epidemiological challenges will require a shared implementation and evaluation protocol for digital contact tracing apps.

Positioning Digital Tracing Applications in the Management of the COVID-19 Pandemic in France.

To combat the COVID-19 pandemic, many European countries have developed a public health strategy involving the use of digital contact tracing (DCT) applications to improve timely tracking and contact tracing of COVID-19 cases. France’s independent COVID-19 Control and Society Connection Council (CCL) was established by law in May 2020 to issue advice and recommendations on the national epidemic digital systems. In this paper, we present the recommendations by the CCL, with the objective to increase the uptake and utility of French DCT applications. As the country's most vulnerable population has been subjected to greater virus exposure, a stronger impact of the lockdown, and less access to preventive and health care services, the CCL is particularly aware of health inequalities. The French DCT app TousAntiCovid had been downloaded by 13.6 million users (ie, 20% of the French population) in March 2021. To promote the use of DCT apps, the CCL has recommended that communication about the app’s individual and collective objectives be increased. The CCL has also recommended the introduction of clear, simple, accessible, incentivizing, noncoercive information within the digital tools. In addition, the CCL has recommended improving public health policies to address the needs of the underprivileged. The CCL calls for promoting population empowerment with the use of digital tools, improving public health culture for decision-makers dealing with health determinants, taking social considerations into account, and incorporating community participation.