Prime Minister Justin Trudeau made a midsummer prediction as he unveiled a new smartphone app, designed to help slow down the spread of the novel coronavirus by alerting users about whether they’ve been exposed to COVID-19.
“As of this morning, the COVID Alert app is ready to download through the App Store or on the Google Play Store on your phone,” Trudeau said, during the July 31 announcement.
“Right now, it’s connected to the Ontario health system, but we know other provinces will be joining soon.”
Two months later, with new coronavirus cases continuing to soar across the country, federal officials are still trying to negotiate with the provinces and territories so they can make Trudeau’s prediction come true.
As for the delay, both sides appear to be pointing their fingers at each other.
“The federal government has not enabled their COVID-19 app in Alberta,” said a provincial health spokesperson. “You’d have to ask Ottawa as to why.”
Alberta Health Minister Tyler Shandro added on Monday that there were “still a couple of issues, still a couple of questions that were remaining to be answered” before the province could start using the app.
In Ottawa, federal officials have declined to comment on specifics, but insist they are working with the provinces and territories and believe they are moving forward.
The federal health department also believes it is making progress.
“We are confident that several additional provinces will be coming on board very shortly,” said Health Canada spokesperson Tammy Jarbeau.
But as of the start of October, just four out of 13 provinces and territories, representing about 45 per cent of the nation’s population, have successfully integrated the app into their public health networks.
The federal government says that’s because it’s up to the provinces and territories to decide when and how to use the app.
“It hasn’t been a lack of our government trying to work with the provinces to necessarily allay any of the concerns,” a senior federal government source told Global News.
“We can’t force a province to take it, nor should that be the appropriate approach.”
The app was jointly created by Google and Apple, while the code it uses was written by Shopify and Linux Foundation Public Health, a nonprofit organization that works with public health agencies to create digital applications. Security features for the app were developed in collaboration with Blackberry.
COVID Alert uses Bluetooth “proximity” technology to notify smartphone users if they come into close contact with another smartphone user who’s tested positive for the novel coronavirus and has uploaded their test results to the app.
The system is also completely voluntary. After downloading the software, smartphone users who test positive for the coronavirus must decide on their own whether to upload any positive test results using a unique code provided by local health authorities. This feature is only available to residents once the app is rolled out in their province or territory.
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The government retains almost no data about people who use the app, including how many people have been notified of possible exposures and where these exposures occurred.
According to Health Canada, all of the companies who helped develop the app volunteered their time and resources. The government said it has spent roughly $500,000 on staffing and other costs associated with the app.
Provinces and territories without the app
Quebec, the country’s second most populous province and hardest hit by the pandemic, said on Sept. 4 that there was no need for a smartphone app because the pandemic was “stable.” At the time, Quebec was reporting about 130 new coronavirus infections a day.
Then, on Sept. 28, with the average number of daily infections five times higher than what it was three weeks earlier, the province’s health minister Christian Dubé conceded that the app would likely be available to Quebecers within a week.
“The simple answer is that yes, we will have the application,” Dubé said.
Alberta, meanwhile, told Global News it wants to use COVID Alert, but prefers its residents are able to “seamlessly transition” over to the federal app from an existing provincial app that cost roughly $650,000 to create.
B.C., which has seen a recent spike in new cases, also said it wants to use the federal app, adding that it is working with developers to see how it can be “tailored to be supportive of the contact tracing” that public health officials in the province are already doing.
“It is an ongoing discussion. The team with the federal government is working with individual provinces sequentially, so we are on that list, but we are also working with them to make some adjustments that will meet our needs,” said Dr. Bonnie Henry, the provincial health officer, on Sept. 24.
But the federal government says it prefers that the app doesn’t have any contact-tracing functions, such as collecting the name, phone number and address of users.
It’s unclear from either B.C.’s or the federal government’s responses when the app might be rolled out in the province.
The three territories, meanwhile, all expressed concern that the app may not be effective outside urban areas, particularly if access to the internet and smartphones is limited.
The federal government, however, says constant access to the internet isn’t needed to use the app properly. It recommends people use Wi-Fi or cellular data to connect to the internet once a day to make sure the app can update itself with the most recent information, including data that allows users to be notified of possible exposures.
Global News asked the government if it initially planned to roll out the app nationwide all at once, or if it intended to negotiate with the provinces and territories individually.
Health Canada did not answer this question directly, but said there has been “unprecedented collaboration” between governments and private corporations to design and implement the app.
How effective is the app?
When the government first announced COVID Alert in June, Trudeau said It’s up to individual Canadians to decide whether they’ll download it. He added that the app will be “most effective” when as many people as possible are using it.
To date, roughly 2.9 million Canadians have downloaded the app, according to government data. That’s roughly eight per cent of the total population and about 10 per cent of all smartphone users.
Due to the security features of the app, Health Canada said it cannot break down the number of downloads by individual province or territory.
Of the roughly 12,000 confirmed cases of COVID-19 in Ontario between July 31, when the app was launched, and the end of September, only 514 people have chosen to update the app with their positive test results, according to Health Canada.
This means only four per cent of all people who could have used the app to warn others of possible exposure did.
And while researchers have found that even limited use of the app can significantly reduce infections and deaths, public health experts told Global News low uptake is still concerning. Smartphone users must also use the app properly — uploading their positive test results — in order for it to be effective.
“If the app is picked up by a substantial portion of the population it becomes more and more useful,” said Dr. Gerald Evans, chair of infectious disease studies at Queen’s University.
While Evans supports the app in general, and thinks as many people as possible should download it, he says there are drawbacks to choosing an app that’s completely voluntary — primarily that people aren’t very good at admitting when they’ve been exposed to a virus.
“There’s a lot of requirements for the user to do things, and that’s really where the challenge is,” he said.
App could be far more useful
Some of the concerns expressed by Evans were raised in a study published by researchers at Oxford University’s Big Data Institute in May.
The researchers concluded that, absent other types of intervention, such as manual contact tracing, about 60 per cent of the population would need to use a notification app to effectively control the spread of the novel coronavirus.
The study also said decentralized systems like the one Canada chose — where the government knows almost nothing about how and where the app is being used — deprive public health agencies of valuable information that could be used to better track and understand transmission of the virus.
“Aggregated data (not linked to individuals) is essential for evaluating and improving the performance of the app,” the researchers said.
The government, meanwhile, says the app is just one tool used by health officials to slow the spread of COVID-19 and that traditional methods of contact tracing provide valuable insight that helps inform public policy decisions.
Health Canada also cites a recent study published by Google and Oxford researchers that found if 15 per cent of smartphone owners used an exposure notification app then infections could drop by as much as eight per cent, while deaths could decline by six per cent.
The study said notification apps are also sixteen times more likely to identify possible exposures among “random daily contacts” than traditional contract tracing. This is because people are unlikely to know the names and details of people they come into contact with in public spaces, such as transit, whereas an app doesn’t need to know who the person is in order to notify them.
But Lucie Abeler-Dörner, scientific manager at Oxford and one of the authors of the study cited by the government, told Global News the computer modelling that predicted the app would be effective even with low usership is based on the assumption that everyone who tests positive uploads their status to the app.
The fact that very few Canadians have used the app to upload their positive diagnosis means the combined effect of the app and manual contact tracing is “only slightly increased” over the effect of manual contact tracing alone, she said.
“If only four per cent of infected people send out notifications, the added benefit of the app over manual tracing will be reduced approximately to the same extent,” she said.
with files from Heather Yourex-West