Here's how U.S. states are using digital contact tracing to stop COVID-19
Digital contact tracing could be a way to help stop COVID-19 in the U.S., but the structure of the country means that there will be 50 individual platforms carrying out their own tracking. We're here to help you keep track of them.
As governments across the globe prepare to relax social distancing and stay-at-home orders, many of them are considering contract tracing — and specifically, digital contact tracing — as a way to help continue controlling the spread of COVID-19.
In the U.S., there will be about 50 different contact tracing apps and platforms. One for each state, and possibly another two for Washington, D.C. and Puerto Rico. To help you keep track of what individual states and governments are doing, here's a current rundown of contact tracing platforms in the U.S., as well as additional information about Apple's and Google's Exposure Notification system and other contact tracing solutions.
What is digital contact tracing?
Contact tracing, as a public health strategy, isn't new. Health and medical experts have used manual contact tracing to track and curb the spread of disease for centuries.
Generally, it involves human public health officials or volunteers who interview people who have been diagnosed with a disease. During these interviews, contact tracers track who that person may have come into contact with so that public health officials can test them, trace all of their contacts, and so on. It is, as you might expect, arduous.
Digital contact tracing seeks to largely automate this process. By using smartphone technology like Bluetooth or location data, public health organizations can track and alert all of the smartphone users that an infected person has come into contact with.
Many independent entities have devised their own digital contact tracing technology, from MIT to the government of Singapore. But none of them have generated as much buzz as the system announced by Apple and Google in April.
Apple and Google's effort
The Apple and Google contact tracing system is actually not an app. Instead, it's a developer framework that public health entities can use to create their own individual contact tracing apps.
The underlying framework is a cross-platform system that works on both Android and iOS. It works by collecting Bluetooth signals from devices that you come into close proximity with. If you, or the owners of one of those devices, is diagnosed with COVID-19, those proximity contacts are alerted with a notification.
Unlike other attempts at digital contact tracing, the system does away with some of the inherent restrictions on background Bluetooth usage in iOS. In stark contrast to some contact tracing efforts, the Apple-Google API also places a strong emphasis on privacy, encryption and decentralization.
Because of that, Apple and Google are seemingly distancing themselves from the contact tracing moniker. In more recent announcements, the two tech giants have taken to calling the system "Exposure Notification."
Which states are using the Apple-Google contact tracing API?
As of May 22, no U.S. state government or public health agency has created a finished app using the Apple-Google API. But since the framework was officially released to the public in iOS 13.5, several U.S. states have announced plans to build platforms using it.
Alabama Governor Kay Ivey said in a press briefing on May 21 that the state would become one of the first to "partner" with Apple and Google to create an app "to track those who may have been exposed to COVID-19 using Bluetooth signals."
"And hopefully this will become an important tool in the toolkit to slow the spread of coronavirus by using what almost every Alabamian has in their pocket: a cell phone," Ivey said.
There's currently no information regarding the name of the app, or when it might be released.
Earlier in 2020, North Dakota became one of the first states to issue a contact tracing app, alongside neighboring South Dakota. Released far before the Apple-Google API was debuted, it relied on location data and other information instead of anonymized Bluetooth signals.
On Wednesday, May 20, the North Dakota Governor's Office announced that state health officials will begin building a second digital contact tracing app using the Apple and Google technology.
"North Dakota is excited to be among the first states in the nation to utilize the exposure notification technology built by Apple and Google to help keep our citizens safe," said Gov. Doug Burgum.
The app will actually be a second version of the state's current Care19 app, dubbed "Care19 Exposure," which is also in use in South Dakota. It's unclear if South Dakota will also be using the updated app. The first version of the Care19 app ran into concerns about location data privacy.
In a joint Apple-Google statement to AppleInsider, the two companies said that South Carolina would be one of the first U.S. states to build out a contact tracing app, tentatively called "SC-Safer-Together," using their Exposure Notification framework.
However, a spokesperson for South Carolina's Department of Health and Environmental Control has since clarified that the state has "no plans to pursue this application." The DHEC had only received a memorandum of understanding from the Medical University of South Carolina authorizing it to "explore the potential development" of an app using the Apple-Google framework
A spokesperson for MUSC added that they are still in the "development, evaluation and state-level discussion and review stage of things," adding that the project has not been approved or deployed by any state-level agency.
Other digital contact tracing methods across the U.S.
Like some countries in Europe, however, there are several states that have released contact tracing apps without the Exposure Notification framework. Similarly, some states have claimed that they won't use phone-based contact tracing at all. Here's a current list of them.
If a state isn't listed here, it's because they currently have no plans in the area of digital contact tracing. If and when they do, we will update this list.
Utah's "Healthy Together"
Utah released its first contact tracing app, Healthy Together, in late April — after Apple and Google announced their framework. The app, developed by social media startup Twenty, is currently in beta testing as of May 14.
Healthy Together uses a mix of personally identifiable GPS data, cell tower triangulation and Bluetooth signal data to keep tabs on the people that a user comes into contact with. The data it collects may be shared with Utah state officials, as well as some members of Twenty's development staff.
On Utah's website, the state says that it uses location data because systems that rely only on Bluetooth, like the Apple-Google API, aren't accurate enough. In addition to contact tracing, the app also contains features for finding nearby COVID-19 testing facilities and receiving test results.
Care19 in South Dakota
On April 7, three days before the Apple-Google API announcement, the state of North Dakota launched a free mobile contact tracing app called Care19. Eventually, neighboring South Dakota also began urging residents to install the app.
The app, developed by football fan tracking startup ProudCrowd, uses randomly assigned ID numbers and location data to track the spread of coronavirus. While it uses Wi-Fi, cell tower and GPS location data, it anonymizes that data and only stores a user's location for "10 minutes or more."
If a Care19 user tests positive for COVID-19, health department staffers will ask that user permission to share their location data with the state.
States that are undecided about digital contact tracing
Nearly a month after the Apple-Google API's official release, a majority of U.S. states are still undecided about whether they will use any type of smartphone-based system for contact tracing.
A New York Department of Health spokesperson said that the state is "evaluating various technology applications that could assist in" contact tracing. That spokesperson added that "the key to effective contact tracing is direct outreach by individuals to work with a positive case to successfully identify their contacts," suggesting that in-person contact tracers will remain the primary tactic in the state.
And according to Business Insider, other states were also on the fence. That includes California, Illinois, Kansas, Kentucky, Maine, Massachusetts, Michigan, Minnesota, Montana, Nevada, West Virginia, Wisconsin, Pennsylvania, Rhode Island, South Dakota, Virginia and Washington.
States that don't plan to use smartphone contact tracing
Some states also said that they'll forego digital contact tracing in favor of human-based solutions. The Texas Department of Health Services, for example, said in a statement to AppleInsiderthat it "is not and will not be using a phone app for contact tracing."
Per Business Insider's inquiry, the following states also plan to rely on human contact tracers: Colorado, Delaware, Florida, Georgia, Hawaii, Indiana, Louisiana, Maryland, Missouri, New Mexico, North Carolina, Ohio, Oregon, Tennessee and Vermont.
Even though Apple and Google announced their application programming interface (API) in April, it wasn't ready to deploy. The first beta version of the Exposure Notification system was released in late April.
Despite the fact that it hasn't been released, Apple and Google have already taken some fire from public health agencies on their strong privacy-focused approach.
Countries like the U.K., France and Germany were said to be in a "standoff" with the two American tech giants over the decentralized nature of how contact data is stored. Some of those countries have conceded, while the U.K. has pushed on with its own proprietary solution.
But contact tracing apps without the Apple-Google API have their own setbacks. Early COVID-19 contact tracing apps deployed in places such as Singapore suffered from user inconvenience due to the fact that they required a phone to remain unlocked and a user to keep the app open to work properly.