The Hawaii Department of Health is launching a phone app that can notify volunteer users about possible COVID-19 exposures and assist the state’s contact tracing efforts.
The AlohaSafe Alert app will be pilot-tested starting Wednesday on Lanai in partnership with Pulama Lanai, according to Janice Okubo, DOH spokeswoman. Pulama Lanai is the management company that oversees tech billionaire Larry Ellison’s 98% ownership stake in the island.
The app uses new technology jointly developed by Google and Apple. It holds “great potential as another tool” for contact tracers, said Dr. Sarah Kemble, acting state epidemiologist.
Coronavirus-tracking apps have been discussed for months and implemented in other countries, but state governments in the U.S. have been slow to pick them up because of privacy concerns. Eight months into the pandemic, some experts wonder what that might mean for the public’s willingness to use it.
Contact tracing, a manual method used by public health authorities to slow the spread of infectious disease by contacting and isolating those who were exposed or infected, is time-consuming and not fool-proof.
“In theory, this app will automate some of the contact tracing work, removing the human element,” Kemble said. “We are listening to feedback from the public and want to find the right balance between acting quickly and cautiously when it comes to the implementation of new technologies.”
Kemble said she recognized the public will have concerns about privacy and information.
“We are weighing the potential benefits against the risks in the context of an emergency that demands that we make every effort to protect the health and safety of the people of Hawaii,” she said.
Hawaii is among about a dozen states where local health authorities are adopting the Google-Apple joint technology, which triggers phone alerts using Bluetooth digital signals to tell phone owners if their paths have crossed with someone who reported a positive COVID-19 test.
Ryan Ozawa, the founder of community chat group Hawaii Slack, closely tracks COVID-19 data and has mapped the disease’s spread. He said it could be a game-changer for the state’s contact tracing team, which was too short-staffed to keep up with past infection surges. Even after an expansion and revamp of its processes, the state’s team is still struggling to reach everyone who tests positive for the virus.
“Contact tracing apps are the only practical solution when case counts explode or public health staffing is strained,” Ozawa said.
National Tools Made Local
Google and Apple developers say their Exposure Notification System was designed specifically for local public health authorities and gives them sole oversight and access to the data.
It’s up to local health officials to customize an app for their jurisdiction. Such digital contact tracing apps are picking up steam across the country. New York, Virginia and New Jersey were among the first states to launch the tool in October. Colleges, such as Michigan State University, are conducting pilot programs.
- Once you download the AlohaSafe Alert app from the Apple or Google Play store, your device is able to sense any close contacts or other users with the app installed that are in close proximity to them for a certain amount of time.
- When the app senses a close contact, the two devices exchange a secure, random and anonymous code via Bluetooth. There is no identifiable information (i.e. location, name, etc.) exchanged.
- If someone tests positive for COVID-19, a DOH representative will contact them for their normal contact tracing interview. The contact tracer will then provide the patient with an eight-digit verification code that the patient will enter into their AlohaSafe Alert app.
- App users can then opt to upload all of the random, anonymous codes their device broadcasted to other devices to the national key server, which is hosted by the Association of Public Health Laboratories.
- Each day the AlohaSafe Alert app will check its own list of codes against the list of codes uploaded by confirmed positive cases. If there’s a match, the app displays a notification. Anonymous codes keep the notification source private.
- If there is a match, the AlohaSafe Alert app generates an alert that you may have been exposed to COVID-19, so you can self-quarantine, follow up with testing or take other measures to reduce the risk of exposure to friends or family.
- Source: aio Digital, AlohaSafe Alert developer
Brandon Kurisu, president of aio Digital, led the team that created the forthcoming AlohaSafe Alert app for the Hawaii health department. AlohaSafe Alert automatically sends people a message if they are believed to have been exposed to an infected person. Bluetooth digital information exchange is anonymous and uses distance, signal strength, duration of an interaction to determine the level of an exposure risk, he said.
“All three of those things have to hit certain criteria in order to trigger the notification,” Kurisu said. “The worse things these apps can do is give you false notifications.”
Google and Apple provide one access key per public health authority at the state or country level, he said.
Kemble said DOH recognizes that the Bluetooth technology is still “somewhat unproven” but shows promise to assist the department’s existing processes.
A national Association of Public Health Laboratories server enables public health authorities to connect with people visiting from out of state, even if they use different exposure notification apps from different states.
“It’ll be like cross-border contact tracing,” Kurisu said. Colorado, Delaware, New York, New Jersey, Nevada, North Carolina, North Dakota, Pennsylvania, Wyoming and Washington, D.C. are already on the national association’s server, and soon California Connecticut, Michigan and Washington will join them, enabling interstate tracing.
Kurisu would not specify how much it will cost to roll out the app, but noted that the Central Pacific Bank Foundation and the nonprofit Hawaii Executive Collaborative have provided financial support.
DOH has not paid for the app except for staff hours spent working with the developer, according to DOH spokeswoman Janice Okubo.
“At this time, we do not anticipate using funds to launch or market the app, but will invest staff time and effort into these activities,” she said.
For comparison, New York used public and private grant funding to cover about $700,000 in app development costs.
Other Local Efforts
There are other COVID-19 tracking app initiatives that have sprouted locally.
Oceanit founder and CEO Patrick Sullivan said the company is developing its own app specifically for the ASSURE-19 saliva-based diagnostic test that Oceanit is developing.
Another app called Perseus was developed by local nonprofit Sustain Hawaii and has a test-centric approach.
Perseus app developer Kevin Vaccarello said the Perseus app — which includes features like symptom tracking and a telehealth component — was designed as a tool to harness voluntary public action to stop the crisis.
“The good news is most apps don’t overlap and tackle a specific aspect of the pandemic, from helping businesses notify customers of potential exposure to making it easy to get a test and get test results,” Ozawa said.
Adoption And Trust
The app’s ability to assist local contact tracing efforts greatly depends on whether the majority of residents download and use it. Not everyone has a phone, and not everyone is familiar with this kind of technology.
Guam launched a similar exposure notification app in September but the number of people who downloaded it is still far from the number estimated necessary. A 60% participation rate is needed for the tool to be effective, Pacific Daily News reported.
“People also need to trust the government and the major tech companies that their data will be secure,” Kemble said. “Both government and tech companies are well aware of these challenges and are working to build in the necessary security features to ensure the information is protected.”
University of Hawaii professor Jenifer Sunrise Winter, who specializes in data governance of health information, said a successful app must provide a clear privacy statement and officials must clearly indicate to users how they secure the data.
The general fear with apps is that personal information could be hacked or repurposed for other uses, she said. For example, some companies are already selling location data and phone owners may not even be aware.
After eight months of living with the pandemic, public trust in the state government’s ability to prevent the spread of disease is waning.
“It seems like it’s coming late in the game,” she said. “People are already frustrated with the process. That might help with adoption, but it also might mean people are so frustrated with the process they aren’t going to trust anything or anyone at this point.”