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Chambers T, Anglemyer A, Chen ATY, Baker MG. An evaluation of the COVID-19 self-service digital contact tracing system in New Zealand. Health Policy 2024; 144:105073. [PMID: 38657315 DOI: 10.1016/j.healthpol.2024.105073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 04/07/2024] [Accepted: 04/13/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Digital contact tracing (DCT) aims to improve time-to-isolation (timeliness) and find more potentially exposed individuals (sensitivity) to enhance the utility of contact tracing. The aim of this study was to evaluate the public uptake of a DCT self-service survey and its integration with the Bluetooth exposure notification system within the New Zealand Covid Tracer App (NZCTA). METHODS We adopted a retrospective cohort study design using community COVID-19 cases from February 2022 to August 2022 in New Zealand (1.2 million cases). We examined the proportion of cases completing a self-service survey and the time to complete the survey by age, sex and ethnicity. RESULTS Overall, 66 % of cases completed their self-service survey. Completion was influenced by age, sex and ethnicity. The median completion time was 1.8 h (IQR 0.2, 17.2), with 95 % of those completing this survey doing so within 48 h of case identification. Around 13 % of all survey completers also uploaded their Bluetooth data, which resulted in an average of 663 cases per day notifying 4.5 contacts per case. CONCLUSION The combination of high public uptake and rapid response times suggest self-service DCT could be a useful tool for future outbreaks, particularly if implemented in conjunction with manual processes and other DCT tools (e.g. Bluetooth) to address issues related to performance (sensitivity, timeliness), effectiveness, and health equity.
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Affiliation(s)
- Tim Chambers
- Department of Public Health, University of Otago, Wellington, New Zealand.
| | - Andrew Anglemyer
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Andrew Tzer-Yeu Chen
- Koi Tū: The Centre for Informed Futures, The University of Auckland, New Zealand
| | - Michael G Baker
- Department of Public Health, University of Otago, Wellington, New Zealand
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Chambers T, Anglemyer A, Chen A, Atkinson J, Baker MG. Population and contact tracer uptake of New Zealand's QR-code-based digital contact tracing app for COVID-19. Epidemiol Infect 2024; 152:e66. [PMID: 38629265 PMCID: PMC11062780 DOI: 10.1017/s0950268824000608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 02/27/2024] [Accepted: 04/10/2024] [Indexed: 04/30/2024] Open
Abstract
This study aimed to understand the population and contact tracer uptake of the quick response (QR)-code-based function of the New Zealand COVID Tracer App (NZCTA) used for digital contact tracing (DCT). We used a retrospective cohort of all COVID-19 cases between August 2020 and February 2022. Cases of Asian and other ethnicities were 2.6 times (adjusted relative risk (aRR) 2.58, 99 per cent confidence interval (95% CI) 2.18, 3.05) and 1.8 times (aRR 1.81, 95% CI 1.58, 2.06) more likely than Māori cases to generate a token during the Delta period, and this persisted during the Omicron period. Contact tracing organization also influenced location token generation with cases handled by National Case Investigation Service (NCIS) staff being 2.03 (95% CI 1.79, 2.30) times more likely to generate a token than cases managed by clinical staff at local Public Health Units (PHUs). Public uptake and participation in the location-based system independent of contact tracer uptake were estimated at 45%. The positive predictive value (PPV) of the QR code system was estimated to be close to nil for detecting close contacts but close to 100% for detecting casual contacts. Our paper shows that the QR-code-based function of the NZCTA likely made a negligible impact on the COVID-19 response in New Zealand (NZ) in relation to isolating potential close contacts of cases but likely was effective at identifying and notifying casual contacts.
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Affiliation(s)
- Tim Chambers
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Andrew Anglemyer
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Andrew Chen
- Koi Tū: The Centre for Informed Futures, The University of Auckland, Auckland, New Zealand
| | - June Atkinson
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Michael G. Baker
- Department of Public Health, University of Otago, Wellington, New Zealand
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Leal Neto O, Von Wyl V. Digital Transformation of Public Health for Noncommunicable Diseases: Narrative Viewpoint of Challenges and Opportunities. JMIR Public Health Surveill 2024; 10:e49575. [PMID: 38271097 PMCID: PMC10853859 DOI: 10.2196/49575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 09/13/2023] [Accepted: 12/12/2023] [Indexed: 01/27/2024] Open
Abstract
The recent SARS-CoV-2 pandemic underscored the effectiveness and rapid deployment of digital public health interventions, notably the digital proximity tracing apps, leveraging Bluetooth capabilities to trace and notify users about potential infection exposures. Backed by renowned organizations such as the World Health Organization and the European Union, digital proximity tracings showcased the promise of digital public health. As the world pivots from pandemic responses, it becomes imperative to address noncommunicable diseases (NCDs) that account for a vast majority of health care expenses and premature disability-adjusted life years lost. The narrative of digital transformation in the realm of NCD public health is distinct from infectious diseases. Public health, with its multifaceted approach from disciplines such as medicine, epidemiology, and psychology, focuses on promoting healthy living and choices through functions categorized as "Assessment," "Policy Development," "Resource Allocation," "Assurance," and "Access." The power of artificial intelligence (AI) in this digital transformation is noteworthy. AI can automate repetitive tasks, facilitating health care providers to prioritize personal interactions, especially those that cannot be digitalized like emotional support. Moreover, AI presents tools for individuals to be proactive in their health management. However, the human touch remains irreplaceable; AI serves as a companion guiding through the health care landscape. Digital evolution, while revolutionary, poses its own set of challenges. Issues of equity and access are at the forefront. Vulnerable populations, whether due to economic constraints, geographical barriers, or digital illiteracy, face the threat of being marginalized further. This transformation mandates an inclusive strategy, focusing on not amplifying existing health disparities but eliminating them. Population-level digital interventions in NCD prevention demand societal agreement. Policies, like smoking bans or sugar taxes, though effective, might affect those not directly benefiting. Hence, all involved parties, from policy makers to the public, should have a balanced perspective on the advantages, risks, and expenses of these digital shifts. For a successful digital shift in public health, especially concerning NCDs, AI's potential to enhance efficiency, effectiveness, user experience, and equity-the "quadruple aim"-is undeniable. However, it is vital that AI-driven initiatives in public health domains remain purposeful, offering improvements without compromising other objectives. The broader success of digital public health hinges on transparent benchmarks and criteria, ensuring maximum benefits without sidelining minorities or vulnerable groups. Especially in population-centric decisions, like resource allocation, AI's ability to avoid bias is paramount. Therefore, the continuous involvement of stakeholders, including patients and minority groups, remains pivotal in the progression of AI-integrated digital public health.
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Affiliation(s)
- Onicio Leal Neto
- Department of Computer Science, ETH Zurich, Zurich, Switzerland
- Global Health Institute, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
- Department of Epidemiology and Biostatistics, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Viktor Von Wyl
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
- Epidemiology, Biostatistics & Prevention Institute, University of Zurich, Zurich, Switzerland
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Geenen C, Raymenants J, Gorissen S, Thibaut J, McVernon J, Lorent N, André E. Individual level analysis of digital proximity tracing for COVID-19 in Belgium highlights major bottlenecks. Nat Commun 2023; 14:6717. [PMID: 37872213 PMCID: PMC10593825 DOI: 10.1038/s41467-023-42518-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/12/2023] [Indexed: 10/25/2023] Open
Abstract
To complement labour-intensive conventional contact tracing, digital proximity tracing was implemented widely during the COVID-19 pandemic. However, the privacy-centred design of the dominant Google-Apple exposure notification framework has hindered assessment of its effectiveness. Between October 2021 and January 2022, we systematically collected app use and notification receipt data within a test and trace programme targeting around 50,000 university students in Leuven, Belgium. Due to low success rates in each studied step of the digital notification cascade, only 4.3% of exposed contacts (CI: 2.8-6.1%) received such notifications, resulting in 10 times more cases detected through conventional contact tracing. Moreover, the infection risk of digitally traced contacts (5.0%; CI: 3.0-7.7%) was lower than that of conventionally traced non-app users (9.8%; CI: 8.8-10.7%; p = 0.002). Contrary to common perception as near instantaneous, there was a 1.2-day delay (CI: 0.6-2.2) between case PCR result and digital contact notification. These results highlight major limitations of a digital proximity tracing system based on the dominant framework.
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Affiliation(s)
- Caspar Geenen
- KU Leuven, Dept of Microbiology, Immunology and Transplantation, Laboratory of Clinical Microbiology, Leuven, Belgium.
| | - Joren Raymenants
- KU Leuven, Dept of Microbiology, Immunology and Transplantation, Laboratory of Clinical Microbiology, Leuven, Belgium
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Sarah Gorissen
- KU Leuven, Dept of Microbiology, Immunology and Transplantation, Laboratory of Clinical Microbiology, Leuven, Belgium
| | - Jonathan Thibaut
- KU Leuven, Dept of Microbiology, Immunology and Transplantation, Laboratory of Clinical Microbiology, Leuven, Belgium
| | - Jodie McVernon
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Victorian Infectious Diseases Laboratory Epidemiology Unit, Royal Melbourne Hospital at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Natalie Lorent
- University Hospitals Leuven, Respiratory Diseases, Leuven, Belgium
- KU Leuven, Dept of CHROMETA, Laboratory of Thoracic Surgery and Respiratory Diseases (BREATHE), Leuven, Belgium
| | - Emmanuel André
- KU Leuven, Dept of Microbiology, Immunology and Transplantation, Laboratory of Clinical Microbiology, Leuven, Belgium
- University Hospitals Leuven, Laboratory Medicine, Leuven, Belgium
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Daniore P, Nittas V, Ballouz T, Menges D, Moser A, Höglinger M, Villiger P, Schmitz-Grosz K, Von Wyl V. Performance of the Swiss Digital Contact-Tracing App Over Various SARS-CoV-2 Pandemic Waves: Repeated Cross-sectional Analyses. JMIR Public Health Surveill 2022; 8:e41004. [PMID: 36219833 PMCID: PMC9700234 DOI: 10.2196/41004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/28/2022] [Accepted: 10/09/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Digital proximity-tracing apps have been deployed in multiple countries to assist with SARS-CoV-2 pandemic mitigation efforts. However, it is unclear how their performance and effectiveness were affected by changing pandemic contexts and new viral variants of concern. OBJECTIVE The aim of this study is to bridge these knowledge gaps through a countrywide digital proximity-tracing app effectiveness assessment, as guided by the World Health Organization/European Center for Prevention and Disease Control (WHO/ECDC) indicator framework to evaluate the public health effectiveness of digital proximity-tracing solutions. METHODS We performed a descriptive analysis of the digital proximity-tracing app SwissCovid in Switzerland for 3 different periods where different SARS-CoV-2 variants of concern (ie, Alpha, Delta, and Omicron, respectively) were most prevalent. In our study, we refer to the indicator framework for the evaluation of public health effectiveness of digital proximity-tracing apps of the WHO/ECDC. We applied this framework to compare the performance and effectiveness indicators of the SwissCovid app. RESULTS Average daily registered SARS-CoV-2 case rates during our assessment period from January 25, 2021, to March 19, 2022, were 20 (Alpha), 54 (Delta), and 350 (Omicron) per 100,000 inhabitants. The percentages of overall entered authentication codes from positive tests into the SwissCovid app were 9.9% (20,273/204,741), 3.9% (14,372/365,846), and 4.6% (72,324/1,581,506) during the Alpha, Delta, and Omicron variant phases, respectively. Following receipt of an exposure notification from the SwissCovid app, 58% (37/64, Alpha), 44% (7/16, Delta), and 73% (27/37, Omicron) of app users sought testing or performed self-tests. Test positivity among these exposure-notified individuals was 19% (7/37) in the Alpha variant phase, 29% (2/7) in the Delta variant phase, and 41% (11/27) in the Omicron variant phase compared to 6.1% (228,103/3,755,205), 12% (413,685/3,443,364), and 41.7% (1,784,951/4,285,549) in the general population, respectively. In addition, 31% (20/64, Alpha), 19% (3/16, Delta), and 30% (11/37, Omicron) of exposure-notified app users reported receiving mandatory quarantine orders by manual contact tracing or through a recommendation by a health care professional. CONCLUSIONS In constantly evolving pandemic contexts, the effectiveness of digital proximity-tracing apps in contributing to mitigating pandemic spread should be reviewed regularly and adapted based on changing requirements. The WHO/ECDC framework allowed us to assess relevant domains of digital proximity tracing in a holistic and systematic approach. Although the Swisscovid app mostly worked, as reasonably expected, our analysis revealed room for optimizations and further performance improvements. Future implementation of digital proximity-tracing apps should place more emphasis on social, psychological, and organizational aspects to reduce bottlenecks and facilitate their use in pandemic contexts.
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Affiliation(s)
- Paola Daniore
- Institute for Implementation Science in Healthcare, University of Zurich, Zurich, Switzerland
- Digital Society Initiative, University of Zurich, Zurich, Switzerland
| | - Vasileios Nittas
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Tala Ballouz
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Dominik Menges
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - André Moser
- Clinical Trials Unit, University of Bern, Bern, Switzerland
| | - Marc Höglinger
- Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Winterthur, Switzerland
| | | | | | - Viktor Von Wyl
- Institute for Implementation Science in Healthcare, University of Zurich, Zurich, Switzerland
- Digital Society Initiative, University of Zurich, Zurich, Switzerland
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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Wu M, Li C, Shen Z, He S, Tang L, Zheng J, Fang Y, Li K, Cheng Y, Shi Z, Sheng G, Liu Y, Zhu J, Ye X, Chen J, Chen W, Li L, Sun Y, Chen J. Use of temporal contact graphs to understand the evolution of COVID-19 through contact tracing data. COMMUNICATIONS PHYSICS 2022; 5:270. [PMID: 36373056 PMCID: PMC9638278 DOI: 10.1038/s42005-022-01045-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 10/17/2022] [Indexed: 06/16/2023]
Abstract
Digital contact tracing has been recently advocated by China and many countries as part of digital prevention measures on COVID-19. Controversies have been raised about their effectiveness in practice as it remains open how they can be fully utilized to control COVID-19. In this article, we show that an abundance of information can be extracted from digital contact tracing for COVID-19 prevention and control. Specifically, we construct a temporal contact graph that quantifies the daily contacts between infectious and susceptible individuals by exploiting a large volume of location-related data contributed by 10,527,737 smartphone users in Wuhan, China. The temporal contact graph reveals five time-varying indicators can accurately capture actual contact trends at population level, demonstrating that travel restrictions (e.g., city lockdown) in Wuhan played an important role in containing COVID-19. We reveal a strong correlation between the contacts level and the epidemic size, and estimate several significant epidemiological parameters (e.g., serial interval). We also show that user participation rate exerts higher influence on situation evaluation than user upload rate does, indicating a sub-sampled dataset would be as good at prediction. At individual level, however, the temporal contact graph plays a limited role, since the behavior distinction between the infected and uninfected individuals are not substantial. The revealed results can tell the effectiveness of digital contact tracing against COVID-19, providing guidelines for governments to implement interventions using information technology.
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Affiliation(s)
- Mincheng Wu
- State Key Laboratory of Industrial Control Technology, Zhejiang University, Hangzhou, 310027 China
- College of Control Science and Engineering, Zhejiang University, Hangzhou, 310027 China
| | - Chao Li
- State Key Laboratory of Industrial Control Technology, Zhejiang University, Hangzhou, 310027 China
- College of Control Science and Engineering, Zhejiang University, Hangzhou, 310027 China
| | - Zhangchong Shen
- College of Control Science and Engineering, Zhejiang University, Hangzhou, 310027 China
| | - Shibo He
- State Key Laboratory of Industrial Control Technology, Zhejiang University, Hangzhou, 310027 China
- College of Control Science and Engineering, Zhejiang University, Hangzhou, 310027 China
| | - Lingling Tang
- Shulan (Hangzhou) Hospital Affiliated to Shulan International Medical College, Zhejiang Shuren University, Hangzhou, 310015 China
| | - Jie Zheng
- Zhejiang Institute of Medical-care Information Technology, Hangzhou, 311100 China
| | - Yi Fang
- Westlake Institute for Data Intelligence, Hangzhou, 310012 China
| | - Kehan Li
- College of Control Science and Engineering, Zhejiang University, Hangzhou, 310027 China
| | - Yanggang Cheng
- College of Control Science and Engineering, Zhejiang University, Hangzhou, 310027 China
| | - Zhiguo Shi
- College of Information Science and Electronic Engineering, Zhejiang University, Hangzhou, 310027 China
| | - Guoping Sheng
- Shulan (Hangzhou) Hospital Affiliated to Shulan International Medical College, Zhejiang Shuren University, Hangzhou, 310015 China
| | - Yu Liu
- Westlake Institute for Data Intelligence, Hangzhou, 310012 China
| | - Jinxing Zhu
- Westlake Institute for Data Intelligence, Hangzhou, 310012 China
| | - Xinjiang Ye
- Westlake Institute for Data Intelligence, Hangzhou, 310012 China
| | - Jinlai Chen
- Westlake Institute for Data Intelligence, Hangzhou, 310012 China
| | - Wenrong Chen
- Westlake Institute for Data Intelligence, Hangzhou, 310012 China
| | - Lanjuan Li
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Zhejiang University, Hangzhou, 310027 China
| | - Youxian Sun
- State Key Laboratory of Industrial Control Technology, Zhejiang University, Hangzhou, 310027 China
- College of Control Science and Engineering, Zhejiang University, Hangzhou, 310027 China
| | - Jiming Chen
- State Key Laboratory of Industrial Control Technology, Zhejiang University, Hangzhou, 310027 China
- College of Control Science and Engineering, Zhejiang University, Hangzhou, 310027 China
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