Tag Archives: Bernard J. Wolfson

Can COVID Tracing Apps Help Fight The Pandemic?

My 18-year-old daughter, Caroline, responded quickly when I told her that she’d soon be able to download an app to alert her when she had been in risky proximity to someone with COVID-19, and that public health officials hoped to fight the pandemic with such apps.

“Yeah, but nobody will use them,” she replied.

My young smartphone addict’s dismissal sums up a burning question facing technologists around the country as they seek to develop and roll out apps to track the newly resurgent pandemic.

The app developers, and the public health experts who are watching closely, worry that if they do not engage enough people, the apps will fail to catch a significant number of infections and people at risk of infection. Their success relies on levels of compliance and public health competence that have been sorely lacking in the U.S. during the COVID crisis.

“We can’t even get people to wear masks in this country,” said Dr. Eric Topol, director of the Scripps Research Translational Institute in San Diego. “How are we going to get them to be diligent about using their phones to help with contact tracing?”

The tracking apps, a handful of which have already been launched in the U.S., enable cellphones to send signals to one another when they are nearby — and if they are equipped with the same app, or a compatible one. The devices keep a record of all their digital encounters, and later on, they alert users when someone with whom they were in physical proximity tests positive for the virus.

For an app to stop an outbreak in a given community, 60% of the population would have to use it, although a lower rate of participation could still reduce the number of cases and deaths, according to one recent study. Some say an adoption rate as low as 10% could provide benefits.

In many places where apps have been implemented so far, adoption has failed to reach even that lower threshold. In France, less than 3% of the population had activated the government-endorsed app, StopCovid, as of late June. Italy’s app had attracted about 6% of the population. The percentage of residents who have downloaded the app endorsed by North and South Dakota, Care19, is in the low single digits.

One exception is Germany, where more than 14% of the population downloaded the new Corona Warn App in the first week after its launch.

COVID-19 apps are generally intended to supplement the work of human contact tracers, who follow up with people who’ve tested positive for the virus, asking them where they’ve been and with whom they’ve been in contact. The tracers then contact those potentially exposed individuals and advise them on the next steps, such as testing or self-quarantine.

Human contact tracing, slow and laborious in the best of times, has been a notable failure in the United States so far: An insufficient number of sometimes inadequately trained people have been deployed, and the infected people they’ve contacted often won’t cooperate.

The prospects for digital tracing appear no better. “Ideally, we’d have a digital way to supplement the human contact tracing,” said Topol. But “there hasn’t been any place yet globally where there’s proof that it goes from a clever idea to really helping people.”

Close to 20 tracing apps are in use or under development in the U.S.

A growing number of U.S. app developers are targeting state health agencies because Google, the maker of Android cellphone software, and iPhone maker Apple won’t enable an app to use their joint platform without a state’s endorsement. The Google-Apple technology, despite very limited use so far, is considered by many the most promising platform.

However, many states are lukewarm to the Google-Apple technology — and to digital contact tracing more broadly. In a Business Insider survey published in June, only three states said they had committed to the Google-Apple model, while 19 — including California — were noncommittal. Seventeen states had no plans for a smartphone-based tracking system. The remaining 11 didn’t respond or gave unclear plans.

In April, California Gov. Gavin Newsom said his office was working with Apple and Google to make their technology a part of the state’s plan for easing out of the stay-at-home order. Two months later, the Golden State seems to have backed off the idea.

Instead, it is training 20,000 human contact tracers with the hope they will hit the ground running this month. The state’s Department of Public Health told California Healthline in an email that most contact tracing “can be done by phone, text, email and chat.”

Trust Is Important

The multiple obstacles to successful use of digital tracing apps include indifference or outright hostility to anti-COVID measures. Some people won’t even wear masks or are leery of other public health efforts.

Moreover, to the extent that people do adopt phone-based tracing, it might miss potential outbreaks among the hardest-hit populations — seniors and low-income people, who are less likely than others to engage with smartphones.

“If adoption is high among 20-year-olds and low among seniors and in nursing homes, we probably don’t want the result to be that seniors and nursing homes don’t get the attention they should get through contact-tracing efforts,” said Greg Nojeim, director of the Freedom, Security and Technology Project at the Center for Technology and Democracy in Washington, D.C.

Unresolved technical challenges could also hamper the effectiveness of the apps.

To capture risky close encounters between users, some apps employ GPS to track their location. Others use Bluetooth, which gauges the proximity of two cellphones to each other without revealing their whereabouts.

Neither approach is perfect at measuring distance, and either might incorrectly assess a COVID threat to users. GPS can tell if two people are at the same address, but not if they are on different floors of a building. Bluetooth determines distance based on the strength of a phone’s signal. But signal strength can be distorted if a phone is in somebody’s purse or pocket, and metal objects can also interfere with it.

The biggest barrier to public buy-in is the privacy question. Advocates of the Google-Apple system, which uses Bluetooth, say the two companies enhanced the prospects for wide adoption by addressing fundamental privacy concerns

Google-Apple won’t allow apps to track the locations of smartphone users, and it ensures that all contacts traced are stored on the phones of individuals, not on a centralized database that would give public health authorities greater access to the information.

That means every decision based on the tracking data is up to the smartphone users. They decide whether to notify other app users if they contract the virus or whether to follow the advice — to self-quarantine and contact public health authorities — that would accompany an alert of possible exposure.

The Google-Apple system makes it easy for apps that use it to communicate with one another, which could be particularly important in multistate regions — the Washington metropolitan area, for example — where each state might have a different app and people frequently travel back and forth across state lines.

But developers of apps that don’t use the Google-Apple platform will struggle to sync with it, especially if their apps track locations or use a centralized server. Those include the Care19 app in the Dakotas and Healthy Together, Utah’s app, which both use GPS and Wi-Fi to track locations. Healthy Together also allows public health officials to see people’s names, phone numbers and location history.

These models are anathema to privacy-first app proponents, which might limit their uptake. In fact, North Dakota has announced it is planning a second app based on the Google-Apple technology.

Some public health experts, however, warn that the strong privacy focus of Google-Apple, to the exclusion of other important factors, may limit the value of the apps in tackling the pandemic.

“Apple-Google in their partnership have pretty narrowly defined what is acceptable,” said Jeffrey Kahn, director of Johns Hopkins University’s Berman Institute of Bioethics. “If these things are going to work as everyone hopes, we have to have a fuller and more soup-to-nuts discussion about all the parts that matter.”

This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

Can I Get Tested for COVID19?

Last week, after Mayor Eric Garcetti announced that Los Angeles was offering COVID-19 tests to all city and county residents, I decided to get one myself — and test Garcetti’s bold new promise in the bargain.

I was surprised how easily I was able to log on to L.A.’s testing website. I answered a few questions about myself, including whether I had any symptoms of the disease — the answer was no — and within three minutes, I had a same-day appointment at one of eight city-run testing sites.

In fact, it was a same-hour appointment. I rushed out of the house unshowered to drive across a large swath of the county to the site — a Los Angeles Fire Department training center next to Dodger Stadium.

The trip would easily take 90 minutes in non-pandemic times, but I got to the designated freeway off-ramp in under half an hour. That’s when the traffic jam began: It took 75 minutes to snake my way the additional half-mile to a red tent, where a masked fire department employee handed me a zip-close bag containing the testing materials.

She directed me to one of three lanes up ahead, where I sat in my car and performed the test on myself.

I rolled a cotton swab in my mouth for 30 seconds, dropped it into a clear liquid inside a test tube, twisted the cap onto the tube and placed it back in the plastic bag. A protectively swathed attendant plucked the bag from my hand with metal tongs as I held it out of my car window, and deposited it in a large blue bin.

It was all very simple. I was now among 10,000 L.A. County residents who visited a city testing site that day — triple the number of previous days, when tests were limited to those with coronavirus symptoms or those considered high-risk even if asymptomatic.

The mayor is clearly proud of his new strategy. At a news conference last week, he spoke of the praise he had received from doctors, public health officials and other mayors who, he said, told him, “Thank you for leading the way.”

At a time when a shortage of tests still impedes efforts to grapple with the virus in many parts of California and the rest of the U.S., it is noteworthy that Garcetti is now offering testing to all 10 million-plus residents of the nation’s largest county.

“That’s a story in and of itself: that they have the availability and they can make this effort,” Ronald Brookmeyer, dean of the Fielding School of Public Health at UCLA, told me.

But Garcetti’s plan is not a silver bullet. Though public health experts say it is vital to know how many people without symptoms are virus carriers, millions of people may choose not to get tested. And even if you don’t have the virus when you take the test, that’s no protection against future infection.

What officials do with the results is crucial, said Brookmeyer. They need to follow up on the positive cases to reach friends, family members, colleagues and other contacts who may have been exposed — a process known as “contact tracing.” They must also find ways to safely isolate those who test positive and protect vulnerable people in their lives. “We have to get the most bang for the buck of every single test that we do,” Brookmeyer said.

Garcetti said he would hand over COVID-positive cases for contact tracing and other follow-up to public health officials from L.A. County, which includes the city of L.A. and nearly 230 smaller communities.

Testing sites run by the county are sticking to the more restrictive policy of accommodating only those who are symptomatic or at high risk, which now includes people in essential jobs, such as health care employees, first responders and food supply workers.

That decision was made in part because testing capacity is still constrained, Dr. Christina Ghaly, director of L.A. County’s Department of Health Services, said at a news conference.

Garcetti promised the city’s test sites will continue to give priority to those groups, even as testing is opened up to the general population, but he said the city has stockpiled 300,000 tests, with more on the way. Kyle Arteaga, a spokesperson for the supplier, San Dimas, California-based Curative Inc., said the company can meet L.A.’s expanded demand.

The city is paying an average of about $120 for each test, but the price could drop as much as 10% if there were a significant increase in volume. If L.A. ended up doing a million tests, it would likely cost the city between about $110 million and $120 million.

Wider testing of the population will ultimately be critical to subdue the virus, largely because a significant number of infected people have no symptoms and need to know so they can avoid infecting others.

But the testing program has limitations. First, any results will provide a biased sample, since the Angelenos who make and keep appointments will be skewed toward those with the time, inclination and transportation required.

And while Garcetti suggested that negative test results could ease worried minds, any such relief is only temporary. “A negative test one day doesn’t mean that you won’t get infected the next day, or the one after that,” said L.A. County’s Ghaly.

Finally, the accuracy of the self-administered mouth-swabbing tests used in L.A. has not been fully proved. Having a health care worker in full protective regalia plunge a swab all the way to the back of your nose is still the officially preferred method.

The reliability of the L.A. test suffers if you don’t cough forcefully a few times to bring up potentially virus-laden sputum before rolling that cotton tip around in your mouth. A four-minute video I watched before driving to the test site instructed me to do so, but there was no reminder when I got there and no staffers watched me to make I sure I did.

I think I did it correctly, though, so I am confident in the result: negative. But that only means I was “probably not infected” at the time of the test, the notice told me. And it cautioned that I can still be exposed to the virus at any time.

I still see lots of hand-washing and social distancing in my future.

Kaiser Health News correspondent Anna Almendrala contributed to this report.

Keeping Young Adults Safe During The Pandemic

Last month, after California Gov. Gavin Newsom ordered most of the state’s residents to stay home, I found myself under virtual house arrest with an uncomfortably large number of Gen Zers.

Somehow I had accumulated four of my children’s friends over the preceding months. I suppose some parents more hard-nosed than I would have sent them packing, but I didn’t have the heart — especially in the case of my daughter’s college roommate, who couldn’t get back to her family in Vietnam.

So, I had to convince six bored and frustrated 18- to 21-year-olds that, yes, they too could catch the coronavirus ― that they needed to stop meeting their friends, wipe down everything they brought into the house and wash their hands more frequently than they had ever imagined.

The first two weeks were nerve-wracking. I cringed every time I heard the front door open or close, and when any of the kids returned home, I grilled them remorselessly.

The day after a house meeting in which I laid down the law, I found my son, Oliver, 21, inside his cramped music studio in the back of the house with a kid I’d never seen before. And that night, I saw one of our extra-familial housemates in a car parked out front, sharing a mind-altering substance with a young man who used to visit in the pre-pandemic era.

If I’ve been neurotically vigilant, it’s because the stakes are high: I’ve got asthma and Oliver has rheumatoid arthritis, making us potentially more vulnerable to the ravages of the virus.

But even as I play the role of enforcer, I recognize that these kids are as anxious and worried as I am.

My daughter, Caroline, 18, is filled with sadness and despair, feelings she had largely overcome after going away to college last fall. She recently started doing telephone sessions with her old therapist. Oliver has begun therapy — remotely, for now ― after dismissing it as pointless for the past several years.

A study released this month by Mental Health America, an advocacy and direct service organization in Alexandria, Virginia, shows that people under age 25 are the most severely affected by a rise in anxiety and depression linked to social isolation and the fear of contracting COVID-19.

That is not surprising, even though the virus has proved far deadlier for seniors. Mental health problems were already rising sharply among teens and young adults before the pandemic. Now their futures are on hold, they can’t be with their friends, their college campuses are shuttered, their jobs are evaporating — and a scary virus makes some wonder if they even want those jobs.

Paul Gionfriddo, Mental Health America’s CEO, says parents should be attentive even to subtle changes in their kids’ behavior or routine. “Understand that the first symptoms are not usually external ones,” Gionfriddo says. “Maybe their sleep patterns change, or they’re eating less, or maybe they are distracted.”

If your teens or young adults are in distress, they can screen themselves for anxiety or depression by visiting www.mhascreening.org. They will get a customized result along with resources that include reading material, videos and referrals to treatment or online communities.

The Child Mind Institute (www.childmind.org or 212-308-3118) offers a range of resources, including counseling sessions by phone. If your young person needs emotional support, or just to vent to an empathetic peer, they can call a “warmline.” For a list of numbers by state, check www.warmline.org.

Caroline’s case is probably typical of college kids. She moved back home from San Francisco last month after her university urged students to leave the dorms. Her stuff is stranded up there, and we have no idea when we’ll be able to reclaim it. Meanwhile, she has been planning to share an off-campus apartment starting in August with four of her friends from the dorm. We can get attractive terms if we sign the lease by April 30 ― but what if school doesn’t reopen in the fall?

For Oliver, who’s been living with me all along, the big challenges are a lack of autonomy, a need for money and cabin fever. Those stressors got the best of him recently, and he started doing sorties for a food delivery service. Of course, it makes me crazy with worry every time he goes out, and when he returns home I’m in his face: “Did you wear a mask and gloves? Did you keep your distance? Wash your hands!”

But what can I do, short of chaining him to the water heater? And if going out — and getting some cash in his pocket ― makes him feel better, that can’t be all bad (unless he catches the virus).

If your kid dares to work outside the house, and you dare let him, several industries are hiring — particularly grocery stores, pharmacies and home delivery and food services. Child care for parents who have to work is also in demand, so your fearless teen might want to ask around the neighborhood.

Volunteering ― again, if they dare — is another good way for young people to feel independent and useful. In every community, there are vulnerable seniors who need somebody to shop for them or deliver meals to their homes. You can use www.nextdoor.com, a local networking app, to find out if any neighbors need help.

Food banks are in great need of volunteers right now. To find a food bank near you, go to www.feedingamerica.org. Blood donations are also needed. Older teens and young adults can arrange to donate by contacting the American Red Cross (www.redcross.org). For a list of creative ways to help, check out Youth Service America (www.ysa.org).

While the kids are inside the house, which in my case is still most of the time, put them to work. “Anxiety loves idle time, and when we don’t have a lot to do, our brain starts thinking the worst thoughts,” says Yesenia Marroquin, a psychologist at Children’s Hospital of Philadelphia.

I’ve harnessed the able bodies of my young charges for household chores. A few weekends ago, I decreed a spring cleaning. They organized themselves with surprising alacrity to weed the backyard, sweep and mop the floors, clean the stove and haul out volumes of trash.

Considering the circumstances, the house is looking pretty darn good these days.

This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.