containment strategy
Contact tracing apps are potentially useful tools for supporting national COVID-19 containment strategies. Various national apps with different technical design features have been commissioned and issued by governments worldwide.
Objective: Our goal was to develop and propose an item set that was suitable for describing and monitoring nationally issued COVID-19 contact tracing apps.
This item set could provide a framework for describing the key technical features of such apps and monitoring their use based on widely available information.
Methods: We used an open-source intelligence approach (OSINT) to access a multitude of publicly available sources and collect data and information regarding the development and use of contact tracing apps in different countries over several months (from June 2020 to January 2021). The collected documents were then iteratively analyzed via content analysis methods. During this process, an initial set of subject areas were refined into categories for evaluation (ie, coherent topics), which were then examined for individual features.
These features were paraphrased as items in the form of questions and applied to information materials from a sample of countries (ie, Brazil, China, Finland, France, Germany, Italy, Singapore, South Korea, Spain, and the United Kingdom [England and Wales]). This sample was purposefully selected; our intention was to include the apps of different countries from around the world and to propose a valid item set that can be relatively easily applied by using an OSINT approach.
Results: Our OSINT approach and subsequent analysis of the collected documents resulted in the definition of the following five main categories and associated subcategories:
(1) background information (open-source code, public information, and collaborators);
(2) purpose and workflow (secondary data use and warning process design);
(3) technical information (protocol, tracing technology, exposure notification system, and interoperability);
(4) privacy protection (the entity of trust and anonymity); and
(5) availability and use (release date and the number of downloads).
Based on this structure, a set of items that constituted the evaluation framework were specified. The application of these items to the 10 selected countries revealed differences, especially with regard to the centralization of the entity of trust and the overall transparency of the apps’ technical makeup.
Conclusions: We provide a set of criteria for monitoring and evaluating COVID-19 tracing apps that can be easily applied to publicly issued information. The application of these criteria might help governments to identify design features that promote the successful, widespread adoption of COVID-19 tracing apps among target populations and across national boundaries.
read the study at https://mhealth.jmir.org/2021/3/e27232
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As vaccination programmes are gradually launched by various jurisdictions, post-trial surveillance with real-world evidence is of utter importance for close monitoring of their safety and effectiveness. This paper introduces a vaccine passport concept implemented with blockchain technology. In the following, the methods of contact tracing and vaccine efficacy monitoring with intact personal privacy protection will be discussed.
Vaccine passports with health records
Data are an indispensable and valuable commodity in dealing with global health crises. The COVID-19 pandemic, a global public health emergency as declared by the WHO on 30 January 2020, has highlighted the importance of health data sharing. Data sharing at the early phase of an outbreak enabled healthcare professionals, researchers and policy makers in mastering information required for formulating strategies. Trusted dissemination channels are primarily government official records, peer-reviewed journals and authorised open online databases. Capitalising on these dissemination channels, governments and global scholars share important information for public health measures, from release of full viral genome sequences, pathological features and clinical phases of COVID-19 presentations, to development of diagnostic tests and potential medications, and potential therapeutic and prophylactic agents,to name but a few. Contact tracing is a vital strategy in finding out potential and hidden cases. A convincing showcase was made by Taiwan, where the authorities have used PCR alongside contact tracing in assessing the COVID-19’s transmission dynamics from the initial 100 confirmed cases This approach has much contributed to Taiwan’s success in keeping its health system intact with less than 900 cases even after a year into the pandemic.
Aside from contact tracing for infected patients, daily monitoring among community dwellers could be useful in infection control and resumption of normal social activities. Vaccine passports and digital contact tracing applications (apps) could be widely adopted in recording personal health profiles, contacts, and more importantly vaccination status in later stages. Inevitably, the concept of a vaccine passport led to a heated debate among people from all walks of life over its scientific evidence and ethical concerns.
Application of blockchain
Data sharing as an infection control measure only works on wide acceptance and adoption among citizens. Invariably, data security and integrity would come to the spotlight regarding data access and sharing issues; apart from data storage infrastructure, non-functional requirements such as availability, confidentiality and integrity are also fundamental to data storage, communication and mobilisation. Availability refers to the organised input of required data. Confidentiality is tantamount to authentic data access and usage authorisation, while data integrity ensures data safety against breaches.
Electronic health records and personal health records account for an immense portion of data in this digital era, with a 46% growth in 5 years. Nevertheless, solutions for data protection remain limited, primarily stored via content management system with encryption, in designated host servers. According to the Department of Health and Human Services of the USA, at least 3054 healthcare data infringements were observed from 2009 to 2019, involving leakage of 230 954 151 electronic medical records.A solution for data sharing with robust privacy protection is of paramount importance as well as urgently needed, and blockchain technology seems to be a qualified candidate.
Vaccine passport, as a form of portable health data, with adoption of blockchain technology, can be a promising tool for health monitoring and alerts while protecting personal privacy.
more at https://innovations.bmj.com/content/7/2/337
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Contact tracing aims to avoid transmission by isolating, at an early stage, only those individuals who are infectious or potentially infectious, to minimize the societal costs associated with isolation. Considerable resources are therefore directed at improving surveillance capacities to allow efficient and rapid investigation and isolation of cases and their contacts. To enhance tracing capacities, the use of digital technologies has been proposed, leveraging the widespread use of smartphones. Therefore, proximity-sensing applications have been designed and made available to automatically trace contacts, notify users about potential exposure to COVID-19, and invite them to isolate.
The efficacy of digital contact tracing against coronavirus disease 2019 (COVID-19) epidemic is debated: Smartphone penetration is limited in many countries, with low coverage among the elderly, the most vulnerable to COVID-19.
Quantifying the impact of digital contact tracing is essential to envision this strategy within a wider response plan against the COVID-19 epidemic.
We modeled this intervention together with household isolation assuming a 50% detection of clinical cases. In a scenario of high transmissibility (R = 2.6), we found that household isolation by itself would produce a reduction in peak incidence of 27%, while the inclusion of digital contact tracing could increase this effect by 30% for a reasonably achievable app adoption (~20% of the population) and by 144% for a large-scale app adoption (~60%). At a moderate transmissibility level (R = 1.7), the app would substantially damp transmission (36 to 89% peak incidence reduction for increasing app adoption), bringing the epidemic to manageable levels if adopted by 32% of the population or more.
The app-based tracing and household isolation have different effects across settings, the first intervention efficiently preventing transmissions at work that are not well targeted by the second.
Moreover, app-based contact tracing also yields a protection for the elderly despite the lower penetration of smartphones in this age category.
These results may inform the inclusion of digital contact tracing within a COVID-19 response plan.
read the study at https://advances.sciencemag.org/content/7/15/eabd8750
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