Ahead of a second wave of the coronavirus in Canada, experts say its time to talk more seriously about the country’s exposure notification app, COVID Alert.
Since it launched in July, the app has been downloaded more than 2.7 million times. But July was a different time in the pandemic.
When it first launched in Ontario, roughly 80 to 100 people were testing positive each day. Fast-forward eight weeks and those tallies have jumped to upwards of 400, renewing pressure to control the spread.
If anyone still needs an incentive to download the app, this is it, said Emily Seto, an engineer and health technology specialist at the Centre for Global eHealth Innovation at the University of Toronto.
“This could be the time when this app really shows its benefits,” she said. “That is, if people choose to use it.”
Get the message out
COVID Alert has been touted by federal ministers and public health officials as a powerful tool to curtail the pandemic in Canada.
Despite the relatively low number of downloads, Canada’s top doctor, Theresa Tam, said earlier this month that the app needed time to prove its effectiveness.
“As societies open, as schools and colleges and other places restart, now is the time to give it a go,” she said on Sept 3.
The encouragement was echoed by Prime Minister Justin Trudeau, who took to national television Wednesday evening to warn Canadians of a second wave of the COVID-19 pandemic.
He said the app is “one more way to keep ourselves and others safe.”
Seto agrees, but worries the word hasn’t been spread properly. She said now is the time to ensure the messaging is “loud and clear.”
The push for mask-wearing and hygienic practices was broadcast widely and successfully, she said, and “the same tactics can be done regarding COVID Alert.”
“There was a lot of communication around wearing masks for students going back to school, as well as physical distancing. That would have been a good opportunity to get a strong message out about the benefits of the app for parents and also high school students.”
From the day the app rolled out (July 31) to Sept. 22, just 375 people who tested positive for COVID-19 have logged their diagnosis. That’s a far cry from the more than 1,000 new daily cases nationally.
The app does not collect information on how many people have subsequently been notified of exposure, so it’s unclear how far those positive cases have stretched.
However, there has been an apparent increase in activity over the last four weeks. Since Sept 1., 263 people who tested positive for the virus logged their diagnosis to notify others of possible exposure. The app has also been downloaded 490,000 times during the same period, according to the Public Health Agency of Canada.
Given that the recent rise in cases is being driven by young people — often gathering in large groups — the message about the benefit and safety of the app needs to get laser-focused, said Dr. Isaac Bogoch, an infectious disease expert based out of Toronto General Hospital.
“It needs consistent messaging, consistent reminders, and it needs to be done with age, language and culturally appropriate messaging in mind to get the most uptake,” he said.
“Like anything else, if you take your foot off the gas pedal, people will lose interest and might not do it.”
Limitations not binding
Some countries have fared better than others in adopting digital methods.
Germany’s tracing app has been downloaded more than 18 million times since its launch in June and has been touted by the government as a key tool in the country’s effort to contain the virus. Unlike Canada’s, the app can provide users with their COVID-19 test result, sent directly to their smartphone. In its first 100 days, it was used to transmit 1.2 million test results from labs to users.
Seto said this feature is extremely useful and, if possible in Canada, would likely drive up adoption. But the app already has its limits, which Seto said might be a factor in whether people choose to download it in the first place.
The app is only available for download on iPhones with at least iOS 13.5 and Androids with at least version 6. While this limitation has come under criticism, “we’re still very far from having a large percentage of people who have compatible phones actually use it,” said Seto.
Canada’s COVID Alert is strictly voluntary. It uses Bluetooth data to ping any devices that may have had close contact with someone who has tested positive for COVID-19.
The person infected would first have to be tested, then would have to enter that positive diagnosis into their smartphone. The app considers close contact as being an interaction that lasts at least 15 minutes and occurs less than two metres apart, which is determined by the strength of the signal from each device in that interaction.
It retains no identifying personal data. So long as the Bluetooth function is on, users can be notified.
But because the app is voluntary, the onus is on the person who tested positive to log that anonymous information into the app to alert others of potential exposures.
It has also yet to be rolled out or adopted countrywide. It is currently available in Ontario, New Brunswick, Newfoundland and Labrador, and, as of last week, Saskatchewan. It is still in the works in Alberta and Manitoba, though Alberta has used its own provincial app for some time now.
Both Quebec and B.C. have no plans to use the federal app. Quebec has shunned it over supposed privacy concerns, despite the app receiving the blessings of federal and provincial privacy commissioners and endorsements from technology experts.
“We need to remember that 2.2 million isn’t really dispersed across Canada, it’s primarily focused in Ontario and a couple of other provinces. The denominator isn’t Canada’s 38 million people,” Bogoch said.
“But we’ve already seen the successes of digital tools in this pandemic. We’ve also seen the failures of digital tools. But this is something that is simple, free and provides incremental benefit and safety. It’s as simple as that.”
Chance to relaunch
Since the app initially launched while the COVID-19 situation was improving in Ontario and much of Canada, there’s no reason why the government shouldn’t consider a re-launch, said Seto.
“It would be of benefit to keep it at the top of people’s minds,” she said. “Now is the time to do another push in terms of a campaign to get people to download.”
But the app is not a panacea to the crisis we’re facing, Dr. Susan Bondy, an associate professor at the Dalla Lana School of Public Health at the University of Toronto, said in a previous interview.
She said it’s just one piece of a larger puzzle, and that the other classic methods of preventing the virus’s spread are just as important. Done in tandem, it can have a significant impact, she added.
“It’s just to help curb the incredible workload burden of trying to identify all the contacts of somebody who tested positive,” Bondy said.
“People who are risk-averse will take their contacts from two down to zero, and people who are not risk-averse will bring it down from a thousand to merely 10, recognizing that sometimes they will be in a large, untraceable environment like a store or park… That’s how this app helps.”
You can download the app for iPhone on Apple here and for Android on Google Play here.
— with files from Global News’ Amanda Connelly and Beatrice Britneff