The federal and provincial governments are working behind the scenes on a digital approach to the laborious task of tracking patients who have tested positive for the virus that causes COVID-19 — but a patchwork of apps across the country could lead to low uptake numbers and poor data.
Federal, provincial and territorial public health officers held their regular conference call earlier this week. This one was dominated by a discussion about contact tracing, according to a provincial official who was briefed on the call but is not authorized to speak publicly about it.
While Innovation Minister Navdeep Bains has said the federal government is working with tech companies on a potential solution, the job of tracking cases falls within provincial jurisdiction.
At least two provinces — Ontario and British Columbia — are pursuing vendors for their own apps, said the source, while other provinces are evaluating their own solutions.
And at least one Canadian city is looking to move ahead on its own. Earlier this week, the Ottawa Board of Health passed a motion to allow Ottawa Public Health to start looking into technology to support contact tracing.
Vera Etches, Ottawa’s medical officer of health, said she wants to work with a third-party developer to customize an existing application to perform digital contact tracing — to speed up the process and take some of the burden off those who do the work.
Developers say one app the best solution
Alán Aspuru-Guzik, a professor of chemistry and computer science at the University of Toronto, is talking to some provinces about MyTrace, an app being developed out of the Vector Institute for Artificial Intelligence.
“When you download the app, what you’re going to start doing is voluntarily recalling your own trajectory in GPS … Whenever you’re running into a person, you will exchange anonymized Bluetooth keys and then you will know you were close to a person,” he said.
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“Let’s say this person gets sick and then now the contact tracing authorities ask the person, ‘Would you be willing to provide an anonymous version of your trajectory to the health authorities?’ That’s a voluntary thing. And the person will then provide this trajectory.”
Vector has been in discussions with several provinces. Aspuru-Guzik said he’d like to see one app used across the country.
“Ideally, we should have one Canadian app. This is just the problem that we are a federation and there’s a lot of moving pieces,” he said.
“It’s less than ideal that there is more than one app potentially being rolled out.”‘
Yoshua Bengio is the scientific director of Montreal’s Mila Institute, which researches artificial intelligence. He’s in talks with the federal and Quebec governments about deploying an app which calculates a user’s risk factor based on their profile.
“The phones can exchange messages with each other in a way that’s anonymous,” he said. “It’s going to happen with a delay — you won’t know whose phone it was, when exactly it happened, but it will still allow your phone to calculate your risk.”
Bengio said he’s waiting for a green light from Ottawa and Quebec to move ahead.
“It’s understandable that governments want to understand something that could have, potentially, an impact on privacy and dignity of people and I think it’s wise to take the time right now to study what is on the table,” he said.
“At the same time, of course, every day that goes by that we don’t collect [this] information on the phones is potentially lives that we’re not saving.”
Bengio said the success of digital contact tracing will depend on how many people use it. But promoting widespread digital contact tracing could be difficult if different apps are at work in different jurisdictions across the country.
“Unfortunately, the best solution for Canada is that we have one app. It’s like vaccinations. So if more people have the app then we’re all collectively protected,” he said.
“If there are two apps, then, and half of the people go with one and half to the other, then it’s like if we only had 25 per cent of protection rather than 50 per cent of protection. So it’s much better collectively that we choose one way of doing it and we stick to it for the whole country.”
An ‘inexact tool’
Teresa Scassa, the Canada research chair in information law and policy at the University of Ottawa, said using different apps in different provinces likely would cause confusion and diminish uptake. So far, she said, the literature has suggested a contact tracing system needs a participation rate of about 60 percent to be effective.
“If you’re not going to get that, why are you doing it?” she said.
Some people won’t want to use the app because they have concerns about privacy, where their data is going and how it’s being stored, while others won’t want to turn their GPS tracking on, Scassa said.
“Some people are just not that tech-savvy and downloading an app, setting it up, adopting whatever, it’s not going to appeal to them. Many people don’t have cell phones, including some of the people who are at most high risk for COVID-19 … the elderly demographic,” she added.
“It’s a pretty inexact tool.”
She also said testing levels in Canada also need to greatly improve before contact tracing apps can work.
“This is totally untested experimental technology that the governments are planning to endorse for rollout on the population as a whole, related to their health, in the middle of a crisis where people have genuine anxiety,” she said.
“It seems to me that that is problematic in and of itself and in terms of ethics.”
Bains said those concerns are part of the ongoing conversations between the provinces and companies.
“From our perspective, really, the focus is how to avoid a patchwork. How can we have scalability and adoption? And in order to do that, we need to address the core issue of privacy,” he said during a media briefing on Thursday.
“We need to make sure that Canadians feel confident that this tool or this solution protects their personal privacy and those are the issues we’re engaged with, with different organizations looking at these solutions.”
The federal privacy commissioner’s office said it has spoken with the Department of Innovation, Science and Economic Development and Health Canada about contact tracing apps. Last week, the commissioner’s office released a guide for government institutions to follow while responding to the COVID-19 crisis.
“The current health crisis calls for a flexible and contextual application of privacy laws. Privacy is not an impediment to saving lives,” said Privacy Commissioner Daniel Therrien in a statement to CBC News.
“During a crisis, laws can be applied flexibly and contextually, but they must still apply. Public health objectives and privacy protection can be achieved at the same time”
While talks continue behind the scenes on contact tracing technology, provinces are also doing tracking the old fashioned way: with humans.
That route can be labour intensive, however, since it involves volunteers interviewing patients for pertinent information, such as how many people they came into contact with before learning they’d been infected.
Most provinces already have a few hundred people working on the file, but none of the provinces contacted by CBC would say how many they think they’ll need.
Chief Public Health Officer Dr. Theresa Tam said the federal government is willing to help the provinces find volunteers.
So far, Health Canada has recruited more than 44,000 volunteers and is willing to deploy their skills to the regions that need them.
Infectious disease epidemiologist Dr. Brenda Coleman said health authorities have enough tracers for now, but that could change over time.
“Once we start to loosen restrictions and we see the numbers increase, we’re going to have to give public health a lot of help to do that. We’re going to have to double our capacity,” she said.