Few provinces still resisting COVID Alert app as new features under consideration

Quebec becomes sixth province to launch exposure notification app, with N.S. and P.E.I. not far behind

CBC.ca
October 6, 2020

Quebec has joined the COVID Alert app, leaving B.C. and Alberta as the only remaining provinces with no immediate plans to activate the digital tool. Both Nova Scotia and P.E.I. have committed to joining in the coming days.

The federal government-administered smartphone app allows users to report a positive coronavirus test and alert others of a potential exposure.

Health Canada says more features could be on the way, but the federal agency says its priority remains to have all provinces and territories join the app "as is."

"The app will only really help us if many people choose to activate it," Quebec Premier François Legault told reporters in Montreal on Monday evening shortly after downloading it himself.

Quebec had initially balked at the app. But as the province confronts a steep increase in COVID-19 infections -- reporting more than 1,000 new cases daily since last Friday -- Legault's government had a change of heart.

"If you want to make a difference and return to a more normal life, please reduce your contacts and activate the COVID app," he said.

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According to data provided by Health Canada, COVID Alert has been downloaded more than 3.3 million times since it was launched July 31. At least 800 users across the country have reported a positive test through the tool. Most of the reporting has so far come from Ontario, which was the first province to activate the app. Federal officials have said the more users install it, the more effective it will be.

The app is designed to bolster contact tracing -- the practice of reaching individuals who've potentially been exposed to someone diagnosed with COVID-19 -- at a time when case counts in several provinces are rising. Toronto Public Health even called off most of its contact tracing efforts, apparently unable to handle the demand due to a steady increase in the city's infection rate.

Based on the exposure notification framework developed jointly by tech giants Apple and Google, the app allows mobile devices to communicate with each other using Bluetooth technology, with smartphones carrying out a digital handshake when they're less than two metres apart for at least 15 minutes.

The information isn't shared with the government. Nor are the users' identities, locations or health data.

When someone tests positive, public health provides them with a one-time code to enter into the app, which then relays an exposure notification to others with whom they've been in close contact for an extended period.

More features needed?

More than two months after COVID Alert's launch, however, there are calls for the federal government to authorize more features and increase the app's potential effectiveness.

Dr. Andrew Morris, an infectious disease physician and professor at the University of Toronto's faculty of medicine, urged the app's developers to consider adding anonymized functions that would allow users -- or even public health officials -- to be told how frequently people are spending extended periods in close contact with others. The prolonged exposure is considered a driver of coronavirus transmission.

Fitness apps and automatic screen time logging provide examples of the way a COVID app could share data with users about their behaviour and help shape their actions, Morris said. For example, the app could inform users of the total number of people they've been in close contact with for extended periods.

"People do modify their behaviour based on that information," he said.

B.C.'s provincial health officer, Dr. Bonnie Henry, recently said the province is working with federal officials "to make some adjustments that will meet our needs" before adopting the app.

Health Canada hinted last week at two potential additions to come, while stressing its priority remains for all provinces and territories to join and allow residents to report a positive test through COVID Alert.

"It would be premature to provide a list of what's being considered, but there's definitely lots of discussions currently on wearable devices or QR codes or push notifications," Marika Nadeau, the director of Health Canada's COVID Alert task force, said on a call with reporters.

In Singapore -- one of the first countries to widely adopt a contact tracing app -- officials distributed Bluetooth-enabled wearable "tokens" to users without smartphones.

Canada's app is only available on Apple and Android devices made in the past five years. Health Canada estimates that accounts for 92 percent of smartphone users across the country. But it still leaves the technology out of reach for marginalized groups who are more vulnerable to the virus.

In England and Wales, the U.K.'s National Health Service provides businesses with scannable QR codes that can be read using a COVID app. Users who've frequented the premises can later be notified in the event of an outbreak.

Adding features to Canada's app, however, would likely come with a tradeoff: the obligation for users to provide it with more information. Already, some Canadians have been skittish about installing a government-administered app, harbouring the unfounded fear that it will allow them to be tracked.

"You have to be careful," said Brian Jackson, who's been analyzing similar apps for the Toronto-based Info-Tech Research Group, an information technology research and advisory firm.

"The more features you add, the more there is to understand and the more ins and outs there are to the technology layers involved … and to what data is sent back and forth."

Jackson said the move will work as long as the federal government is able to roll out new features while maintaining a "privacy first" approach.

App is working, evidence suggests

COVID Alert's built-in privacy features make it impossible to know how many users have received an exposure notification through the app, but anecdotes continue to illustrate its potential.

On Sunday, a curling tournament in Waterloo, Ont., was halted after a participant received news through the app that they had been near a person with COVID-19.

Rocco Rossi, president and CEO of the Ontario Chamber of Commerce and a former federal Liberal Party official, tweeted last week he'd received an exposure notification and then tested negative. He later said in an interview he suspects the potential exposure may have occurred during a recent trip on Toronto's subway.

"I didn't have to have physical contact tracers using up resources to try to find me," he said, referring to the speed at which the app alerted him.

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There is also evidence that other users have been testing positive after first being notified through the app, though it's impossible to tell how many infections have been prevented by its use.

Ottawa Public Health said last month it had recorded its first COVID-19 diagnosis prompted by an exposure notification.

Lucie Vignola, a member of Health Canada's COVID Task Force, told CBC Radio on Monday they've been told of users who've received an alert, tested positive for the virus, "then modified their behaviour to make sure that they weren't transmitting it within the community, including a teacher."