Exploring the role and mechanism of COVID-19 apps in fighting the current pandemic

Application in the current pandemic

Table 1 shows basic applications of COVID-19 app in the current pandemic.

1. Early detection and diagnosis of infection: The COVID-19 app allows exchange of a key code in between smartphone users after the app has been downloaded. Following reporting of an infected status on the individual smartphones, this information is collected by a centralized or decentralized database. NHSX and Aarogya Setu have opted for a centralized database so the contact matching happens on a central computer server rather than individual smartphones. Notification to the database triggers an alarm and alerts are cascaded to contacts that have interacted with suspected patient’s smartphones. These contacts are then traced and risk assessment done. Following risk assessment decision regarding COVID-19 testing or self-isolation advice or monitoring of symptoms with support is given. Depending on the COVID-19 test results, further steps are undertaken [Figure 1] to support the person.

2. Identify “Clusters” or “Hotspots” of infection: By contact tracing in a community, clusters or hotspots can be found. This will help epidemiologist to learn how the coronavirus has spread and precise dynamics of transmission. It will help in understanding the demographics involved in this infection and shed light on intrahousehold and/or community spread. Cluster assessment will also help to analyze socioeconomic areas predominantly affected and the influence of high-density population in the spread of COVID-19.^[9]

3. “Location App:” Some of these contact tracing apps are combined with a “location tracking” smartphone application which will let trace location and movements an infected person and others they may have been in contact with using GPS, for example, travelers on public transport or visitors in a supermarket, for example, Aarogya Setu app.^[11] This mechanism also allows monitoring of the pandemic as well.

Overview of current COVID-19 apps

There have been a number of COVID-19 apps developed by several institutions and government agencies around the world. Table 2 gives an overview of the characteristics of various COVID-19 apps currently available. Many of them function similarly differences are highlighted in the table. These are at separate stages of application in the current pandemic and use platforms such as Apple iOS and Google Android systems. There has been a surge in the number of mobile phone apps that attempt to monitor and prevent the spread of the virus. The first such app was the TraceTogether App, developed by the Singaporean government and first released on March 20, 2020.^[13] This app makes use of the phone’s Bluetooth contact tracing to communicate with other phones in the vicinity. When a person tests positive for COVID-19, the phone then catalogs all the people whom that phone had been in close proximity and allows the government to contact trace these phones for potential viral transmission. Experiences of countries such as South Korea and Germany where mobile-based contact tracing has helped in reducing the spectrum of the pandemic have encouraged various national governments to develop and utilize them in their own countries to stem the spread of COVID-19.^{[10,11,14-19]} Following the initial control of the spread of infection, the process should provide geographical evidence to support removal of “lockdown” measures with an extended belief that mobile contact tracing with other contact tracing strategies and infection prevention measures will eventually help to prevent a “Second wave” of the virus outbreak.

The success of various COVID-19 apps will, however, depend on the uptake of the application system. Academics estimate 80% of the smartphone users which is about 60% of the population will have to actively use it. Second, it is a technology-dependent process hence people should be able to navigate the system.

Security concerns

Researchers have warned use of the application system can pose a risk to users. The use of centralized database has triggered security concerns about data privacy; however, the Government of India and National Cyber Security Centre have tried to allay these concerns.^[11,20] NHSX believe centralized database will give better insight into how the disease spreads and helps it to make the app more efficient. However, this has highlighted privacy concerns. A decentralized database on individual smartphones has been put forward by Apple and Google who suggest their system makes it harder for data breaches. The debate continues with privacy protection remediation steps underway.

Aarogya Setu and India’s effort to fight the pandemic

On April 2, 2020, the Government of India introduced an ambitious project to curb the spread of the COVID-19 pandemic with its own Aarogya Setu COVID-19 contact tracing app.^[11] Aarogya Setu is an open-source cross-platform for tracking mobile applications developed by the National Informatics Centre and comes under the Ministry of Electronics and Information Technology. This app is designed to help control the spread of coronavirus and make its information accessible to the common people. Currently available in 12 different languages and as of May 2, 2020, the app has more than 115 million users, which is more than any contact tracing app in the world. The Aarogya Setu app uses data provided by users, Bluetooth and location generated social graph to track if one has come close to anyone who could have tested COVID-19 positive. With the Bluetooth feature, it tries to determine the risk if one has been near (within six feet) of a COVID-19-infected person by scanning through the database of known cases across India. Using location information, it determines whether the location of an infected person is amongst an infected area. Thus, it provides a mobile tracking and tracing service which is monitored by the Government of India with the aim of controlling the spread of disease and eventually permits lifting the lockdown and other restrictive measures.

The Aarogya Setu app in mandatory to be download by all public health officials including people residing in the isolation and containment zones. The biggest difference between the Aarogya Setu app and Google and Apple technology is that the former uses both Bluetooth and GPS location data while the latter is only dependent on Bluetooth to function. Almost 98% Aarogya Setu users are Android platform.

As with other COVID-19 apps, there have been concerns about security and data privacy. There is an apprehension that since the location app linked with it may be used by law enforcement officials to monitor movement, quarantine, and self-isolation restrictions and if found in breach of them leading to punitive actions. However, people have been reassured about the need of monitoring to control the spread of the virus outbreak and also that the users’ data in the app are secure. To make it transparent and with the philosophy of providing transparency, privacy, and security in line with India’s policy of Open Source Property, the source code of Aarogya Setu has been made open source on May 24, 2020. The terms and privacy policy have been changed. This suggests only data relevant to COVID-19 infection will be collected.

The Aarogya Setu app has several advantages compared to other COVID-19 contact tracing apps with possibly the most reach and impact nationally, while pioneering new data driven epidemiology logical flattening of the curve through “syndromic mapping.” This approach of “syndromic mapping,” combined with principals of path tracing and movement patterns COVID-19-positive people, thus permits epidemiology modeling. The platform has been able to reach many users and helps advise them for quarantine, caution, or testing providing much needed education and information about COVID-19 to the general population. Analytics of Bluetooth contacts and location data has also helped identify potential hotspots with higher probability of COVID-19 cases allowing state governments and district administrations and health authorities to take necessary steps to contain the COVID-19 pandemic. The precision achieved by a combination of Bluetooth-based contact tracing and identification of hotspots will hold the key to effectively break the chain of infection, flattening the curve, and thus save lives in India.