In the spring of 2020, Graham Grieve was teaching English in Italy on a Fulbright Scholarship. The country was one of the first to face significant outbreaks of COVID-19, and Grieve was one of the first in the world to attempt to teach through a screen. Struggling to connect with students, he quickly started to think about how to get students back into the classroom.
“I realized that schools were going to try and reopen if they could, because online education was untenable for so many,” he said. “But looking at the different public safety protocols that schools would be using, it was clear that contact tracing was going to have a lot of holes.”
Contact tracing is a public health practice used to identify people who have been exposed to infectious disease, in order to slow its spread. During the COVID-19 pandemic, contact tracers have been calling people who test positive for COVID-19 and asking them who they have spent at least 15 minutes with, at less than six feet of range, in the prior two weeks. The process is notoriously flawed because patients are often unable to remember the names of everyone they’ve come into contact with.
When Grieve got back to the U.S. in March, he immediately started building the contact tracing app Trace Innovations to help address that problem. The company, headquartered in San Francisco, provides a centralized, technological contact tracing tool for schools to lower the burden on human contact tracers. Once the app is downloaded onto students’ devices, it counts how many students spend fifteen minutes or more within six feet of each other. When a student tests positive, Trace Innovations provides school administrators with a list of potential close contacts.
It’s not the only company to develop coronavirus-fighting tech headquartered in the San Francisco Bay Area. Nodle has created a wearable device that buzzes employees when they’re too close to each other to encourage social distancing, for example. The most well-known contact tracing tech comes from Google and Apple, which teamed up with public health officials to create an exposure notification system. Their technology, called CA Notify in California, tells users individually when they’ve been exposed to someone who self-identifies as testing positive for COVID.
Yet the promotion of these types of technological contact tracing solutions fizzled out around May of this year. Public health officials in San Francisco shifted their energy to focusing on measures like vaccines and masks, and decreased resources for contact tracing overall. Whereas the Department of Public Health once had 300 contact tracers, manually calling patients one by one, they now only have a few more than 80. Because of this, some people believe contact tracing tech deserves another shot.
“San Francisco had probably the best contact tracing program in the country, and yet, we still weren’t able to reach all the contacts as quickly as was necessary to prevent the spread of disease,” said Michael Reid, the Chief Medical Officer for UCSF’s Pandemic Initiative for Equity and Action, who led the city’s contact tracing program up until this past June.
But there’s a plethora of privacy concerns with tech-based contact tracing, mainly stemming from worries about the government control of location data and whether that data is properly anonymized. (These apps do not track a user’s location; they only keep track of which users are within six feet of others.)
Still, Trace Innovations has made a controversial choice in relation to privacy: the tool collects data and hands it over to a singular, centralized body. In the case of schools they work with, a principal or school nurse typically receives it.
Parents are notified when the school decides to start using the app, and students and parents sign opt-in language. Additionally, Trace Innovations clears tracing data from their personal servers every 15 days, which Google and Apple’s technology does not do. Whereas some may fear CA Notify for it’s affiliation with the government, Trace Innovations requires users to trust a private company with their data, as well as a human contact tracer at school.
Grieve says this is important for schools, where lots of unvaccinated students mingle. “A lot of people aren’t actually taking the recommended next steps after getting a notification from Apple or Google,” like quarantining and getting a coronavirus test, he said. “Without hierarchical authority, there isn’t the follow-through to protect people. Private organizations need to be able to actually understand who was exposed to prevent a future outbreak.”
Reid, however, issues some caution. “I think as long as that information is used judiciously, it’s probably fine, but I worry about how the information is released,” he said. “Who’s guaranteeing the welfare of the Latinx kitchen worker who gets exposed, and then the school says ‘hey, you can’t come to work?’ That’s where I get anxious about how these things are used in the private sector, because it doesn’t always align with core equity values.”
Moreover, the tech itself isn’t always accurate. Most contact tracing tools rely on Bluetooth technology, which the very inventors of Bluetooth said was a flawed approach in May of 2020. Anyone who’s ever struggled to connect their cell phone to a Bluetooth speaker just a few inches away is familiar with their concerns: the technology just isn’t very consistent. It uses radio waves, which physical barriers and other electromagnetic signals easily interfere with. It’s also possible for Bluetooth-dependent devices to declare someone a close contact who was less than six feet away, but behind a sealed door.
Even at low adoption rates, however, the tech makes an impact. An Oxford study conducted in Washington state showed that in regions with contact tracing app usage as low as 15%, infections and deaths decreased 8% and 6%. Further, Reid argues that public health measures like vaccination and masking are more likely to have the adverse impact of encouraging risky behavior than contact tracing tech — despite all three strategies creating more benefit than harm.
Since August 16, 367 cases of the coronavirus have been reported at SFUSD schools. However, because of the district’s heavy bureaucracy, Grieve says Trace Innovations is only working with private schools at the moment. Six California private schools are using the tech, including Woodside Priory in the Peninsula.
Google, Apple, and Trace Innovations all assert that their tech should by no means be considered stand-alone solutions. Grieve adds that the most successful implementation of contact tracing apps involves the people themselves.
“For contact tracing apps to be successful, they really need to be partnered with a human contact tracer,” he said. “By combining manual methods with Bluetooth, we’re able to fill in the gaps.”