Apple’s COVID-19 Exposure Notification System Was a Good Idea Hampered by Bad Bureaucracy

As the Omicron variant of SARS-CoV-2 drives case counts to record highs, you may be wondering why you haven’t been hearing much about the groundbreaking COVID-19 Exposure Notification System that was jointly developed by Apple and Google early last year.

On the one side, there’s the adage that “no news is good news.” After all, if everything is working as designed, you probably won’t be hearing much about it. However, we’re also not seeing it being nearly as widely promoted by public health agencies as it was last year, nor are we hearing a lot of success stories about it, either.

By contrast, we hear stories of how the Apple Watch is saving people’s lives several times a month, but we rarely hear of iPhone users seeking medical attention of COVID-19 testing after receiving an alert from Apple’s Exposure Notification System.

I’ve personally been running Canada’s COVID Alert app since it began rolling out in July 2020, and while both iOS 14 and iOS 15 have diligently popped up a system-level notification every month to remind me that my iPhone is still scanning for exposure notifications on my behalf, I have yet to see an actual exposure notification. Nor has anybody in my circle of personal or professional contacts — some of whom found out through other means that they actually had been exposed to COVID-19.

To be clear, the Exposure Notification System is still baked into iOS 15, the apps that support it are still out there, and it’s still running on many other devices. However, the consensus seems to be that it’s not running on enough devices to have made a difference, and it seems much of the blame for that lies at the feet of the public health agencies who were supposed to be figuring these things out.

At the end of the day, Apple (and Google) merely provided the tools. It was up to national and regional governments to sort out exactly how these tools would be implemented. In fact, Exposure Notifications couldn’t even be enabled without direct authorization through an official public health agency. Originally, this required a standalone app, but Apple made this even easier in iOS 13.7 and IOS 14 by allowing it to be turned on directly in the iPhone’s Health settings — assuming your local public health authority supported it.

Multiple Obstacles

Looking back over the 18 months since its release, however, the Exposure Notification System appeared to be hampered by multiple layers of bureaucracy. This wasn’t quite the “if you build it, they will come” scenario that Apple and Google had clearly been hoping for.

First, uptake was quite slow, especially in North America. Apple rolled out the technology in late April 2020, as part of the iOS 13.5 beta, but it wasn’t until July that the first North American implementation showed up — and that was in Canada. In the U.S., the contact tracing and exposure notifications were left in the hands of individual state governments, and although only four states initially signed on, by early August twenty U.S. states had announced they were on board. Sadly, the actual implementations took somewhat longer.

Meanwhile, in Europe, most countries enthusiastically adopted the Apple-Google system early on, although some like the U.K. and France wanted to go their own way. France even went so far as to accuse Apple of being unhelpful, mostly due to Apple’s stance on privacy; while several countries wanted to get detailed GPS location information and other personal data, Apple would have no part of it, and wasn’t about to open up the iPhone to allow these more invasive contact tracing apps do to their thing.

The U.K. originally tried the same thing, but when it fell afoul of the country’s own government privacy regulations, it was forced to walk back those plans, and the Apple-Google system seemed like the ideal solution that quelling those criticisms.

In the United States, however, the state-level implementation also proved to be a problem. Not only did this mean that things were being rolled out inconsistently, but it also created complications when folks travelled across state lines. The Apple-Google teams attempted to address this with a national server, but it still required states to opt in to that, and of course, this only worked for those states that were using the Apple-Google Exposure Notification System in the first place.

Myoung Cha, who headed up Apple’s health strategic initiatives when the Exposure Notification System was being developed, recently took to Twitter to share his thoughts on why the system has fared so poorly in the U.S. In a follow-up interview with The Washington Post (Apple News+), Cha said that on a purely technological level, Apple and Google moved quickly to build the best system they possibly could — Cha described it as “a land speed record for software development” — in the end it wasn’t enough to overcome bureaucratic forces that had different priorities.

The Biden administration, when they came into power, put almost all their chips into the vaccines as their silver bullet to beat the virus. I think that was strategically the biggest mistake.

Myoung Cha

As Cha points, out, the federal government repeatedly missed opportunities to get more people to adopt the app, and of course various states each had their own way of approaching it. The result was a “patchwork system” that was probably doomed from the very start — especially without a united front of public health officials making a strong push for it.

Still, as The Washington Post notes, there are still more than 20 states that don’t use it at all. This includes some of the largest and hardest-hit states, like Florida and Texas, which have reported millions of cases and tens of thousands of deaths. However, even in places like California, where the system has had some of the best uptake, with more than 15 million people using it — only about three percent of the nearly 3.9 million cases came to light via the Apple-Google system.

Meanwhile in Canada

By contrast, Canada’s COVID Alert app was highly publicized by both the Federal and many provincial governments when it first came out, right down to billboard campaigns and TV ad spots. It accumulated 6.7 million downloads in the weeks following its launch, which isn’t too bad for a county with only 38 million people.

However, in Canada, there was the problem of actually triggering the notifications. The system had to have some way of knowing when a person tested positive, and it had to be authenticated by a health authority to prevent both pranksters and well-intentioned hypochondriacs from triggering false notifications.

In almost every implementation, this was done by entering a code into the companion health app, except that getting these codes often proved to be burdensome. As Canada’s National Post reports, the codes typically weren’t provided automatically after a positive diagnoses; instead, folks had to ask for the code, or sometimes even make a separate telephone call to get it.

In some cases, people reported having to wait on hold for two hours with their local public health organization to receive a key instead of it being sent to them automatically after their positive COVID-19 test.

Christopher Nardi, National Post

In other words, a positive COVID-19 diagnosis wouldn’t likely result in an exposure notification unless the person had such a big heart that they were willing to go to the trouble of getting a code in the hopes of letting random people know that they had also been potentially exposed. It’s likely this happened in only a fraction of cases — even when people were otherwise using the COVID Alert app.

If you have to call a hotline and wait for two hours on the line, or wait 20 minutes or even 15 minutes, you’re probably unlikely to do that.

Carole Piovesan, former co-chair of the advisory committee for COVID Alert

Since health matters are a provincial responsibility in Canada, this varied between different provinces, and there were also at least two major ones — Alberta and British Columbia — who never signed on to the Apple-Google Exposure Notification System in the first place.

According to the Post, the Canadian government appears to have silently “gave up” on COVID alerts several months ago. The app remains available, and the Federal government still insists that it’s supporting it, but the Health Minister for the province of Newfoundland and Labrador disagrees.

The federal government gave up on COVID alerts app some time ago, several months before Christmas. In actual fact, they’ve stopped supporting it and they stopped updating their dashboard. The uptake was so low that the effort to maintain those sites was unreasonable given the fact it was yielding so little.

Dr. John Haggie, Health Minister, Newfoundland and Labrador

As the Post notes, however, updates to the app have become less frequent, and more importantly it appears that only half the folks who originally downloaded the COVID Alert app in 2020 are still actively running it — around 3.1 million in November.

Even taking away the 9.3 million people in Alberta and B.C. — the two provinces that don’t support the app at all — that’s still a relatively small number compared to the 29 million folks in the provinces where the app is available.

Further, The Toronto Star (Apple News+) reports that the province of Nova Scotia has stopped handing out the keys entirely, having basically “given up” due to a lack of interest.

When the federal government first announced the app, Nova Scotia Health did provide the one-time use codes, however, uptake was very low. Given the surge of cases in Nova Scotia, focus is on notifying the case and relying on them to notify their close contacts, who they may have exposed to the virus.

Marla MacInnis, spokesperson for Nova Scotia’s health department.

The Star also notes that only “37,000 or so” one-time keys have been handed out since the app was first released, which is a pretty unimpressive number compared to the 1.9 million cases of COVID-19 that have been reported in Canada during that same time.

Nonetheless, while the Canadian government’s PR efforts have understandably shifted to promoting vaccinations, it continues to recommend the COVID Alert app, even for those who have been vaccinated.

Comment

While the government of Canada is currently focusing promotion efforts on vaccination and the use of rapid tests, it still recommends the use of COVID Alert, including for individuals who have been vaccinated.

Alexander Beattie, spokesperson for Health Canada

Although experts say the poor uptake means that the promised effects of the app have been “muted,” considering how little effort it takes to install it, use it, and keep it running on your iPhone, there’s little reason not to use it. It just seems that you’re far more likely to find out you’ve been exposed to the coronavirus through other means than actually receiving a COVID-19 Exposure Notification.