Struggles by HealthPartners to get a COVID-19 crowdsourcing app in broad use reflect the difficulties of using mobile device technology to trace the course of the pandemic across the U.S.
The Bloomington-based health system launched SafeDistance on April 17, relying largely on users to input information that could indicate the risk levels of COVID-19 down to the neighborhood. And it has worked, too, with users anonymously reporting when they have respiratory symptoms, and the app then identifying their neighborhoods as risk zones for others.
“With this crowdsourced data, you can … get ahead and be more predictive of where things are going to develop,” said Brian Krohn, a developer at Modern Logic, which created SafeDistance.
Uptake suffered, though, when HealthPartners was denied permission to offer the app on Google’s Play Store for Android phones. Google required approval of the app by the Minnesota Department of Health, which had concerns that it would create false security for people who weren’t in high-risk zones, said Dr. Bjorn Westgard, an ER physician and population health researcher at HealthPartners Institute.
Everything from privacy concerns to competition to technological issues have slowed the adoption of mobile COVID-19 tracking technology in the U.S., despite studies showing that it helped identify more cases of the infectious disease in China and other Asian countries, and its more recent adoption by Democratic nations in Europe. Minnesota officials are just starting to consider this method of tracking.
Technology as a result has done little to support the person-intensive process of contact tracing, by which health officials identify the immediate contacts of people with COVID-19 who might have been exposed to the virus.
The Minnesota Department of Health has a network of hundreds of contact tracers, including county workers and volunteers from health insurance companies, to conduct these investigations and try to identify people who need to be quarantined due to their exposures to the virus.
Nationally, the U.S. Centers for Disease Control and Prevention has called for 100,000 contact tracers, more than triple the current supply.
Minnesota on Thursday reported nine deaths and 365 lab-confirmed cases of COVID-19, bringing the statewide totals so far in the pandemic to 1,406 deaths and 34,123 cases. About 30% of investigations are unable to identify the sources of infections that occur in communities, which is troubling for health officials because it means the virus is spreading beyond their ability to track and contain it.
App can help
A mobile tracker app “is not a replacement for manual contact tracing, but it will help,” said Shashi Shekhar, a computer science professor at the University of Minnesota. “In China, they were showing that with the smartphones, they were discovering many more cases than they could with the manual contact tracing alone.”
Germany unveiled a tracker app in mid-June, using platforms that Apple and Google collectively created and enabled on their mobile devices. (Check your Apple phone’s health privacy settings to see if the COVID-19 exposure feature has been added. It is benign unless you download an app to enable it.)
The Apple and Google platforms are based on Bluetooth technology that can identify when two app users spend 15 minutes close together. If one ends up suffering COVID-19, the mobility data can be used to identify and alert others with exposure risks.
A survey this month in Germany showed one of the problems, though. More than half of respondents either didn’t have a phone or didn’t want to use the tracking app.
The CDC has offered broad guidance to states on the use of tracking apps, but a top official with the federal agency said Thursday that a lack of public interest is slowing adoption.
“One of the challenges has been the willingness of members of the public to use these devices,” said Dr. Jay Butler, CDC deputy director for infectious diseases. “It has a lot of promise. It also has a lot of challenges.”
North Dakota is among the first states to try to develop an app using the Google and Apple platforms to identify people who have been in close, sustained contact with others who have COVID-19.
Before that, the state this spring repurposed mobile technology that linked fans of North Dakota State Bison football into an app for finding people at risk for COVID-19 exposure. The app, called Care 19, uses GPS technology to record people’s movements. If people test positive for COVID-19, state contact tracers call and ask them to share the location information from the app.
“I can access my app and use that as a reminder that, ‘Oh yeah, this was the day I went to visit my grandmother and that was during my potentially infectious period,’ ” said Michelle Dethloff, an infectious disease program manager for the North Dakota Department of Health.
The next generation of the Care 19 app would upload de-identified movement data into a public portal, so that people could be warned if they had been in proximity to others diagnosed with COVID-19.
So far, more than 35,000 people have used Care 19, representing less than 5% of North Dakota’s population.
Privacy has been a major concern, even for apps such as Care 19 that only keep GPS location data for 14 days and track people by user codes rather than names.
“The COVID-19 crisis has accelerated the recent advance of ‘Big Tech’ initiatives to grab the private health data of American patients,” said Twila Brase of the Citizens’ Council for Health Freedom, a St. Paul-based privacy advocacy group.
In a statement Thursday, Minnesota IT Services announced that it is exploring ways to use mobile devices to protect people from COVID-19, but “is not exploring use of any GPS-based technology or any technology that would capture location history or personally-identifiable information.”
While Republicans tend to favor privacy restrictions, some of the first apps have emerged in states with conservative governors — weighing the privacy trade-offs against the potential for apps to limit the spread of COVID-19 without economically damaging or shutting down businesses.
The U’s Shekhar said the use of these apps by states seems warranted amid a pandemic, and not that different from the emergency and Amber Alert notices that government agencies already send to people via their mobile devices without their direct consent.
Aggregate mobile phone data also is being used to rank states in their COVID-19 responses. Companies can measure, amid stay-at-home orders, how far from home people are traveling and how many trips they are making.
Minnesota’s online COVID-19 dashboard includes some of this mobile phone data, currently showing that travel levels are returning to normal following the end of a statewide stay-at-home order on May 18 and the reopening of businesses and restaurants in June.
Users of HealthPartners’ SafeDistance app continue to submit data indicating local level disease risks. The app is available for Apple phones.
The app’s developers also are in discussions with colleges and large institutions that could use the tracking to identify risk levels on campus.