Alberta’s use of a smartphone app to help slow the spread of the coronavirus may provide other provinces with insight on what to do — and what to avoid — as Canada begins easing restrictions, heightening the need for effective contact tracing.
ABTraceTogether, launched late last week, is the first such app released by a provincial public health authority. An accompanying instructional video explains: “The more people who use the app, the safer everyone will be.”
Early uptake figures and a key design quirk, however, illustrate how challenging it will be to ensure widespread adoption and efficacy in Alberta and elsewhere.
Contact tracing is the practice of identifying and notifying people at risk of contracting the virus from someone known to have been infected. Anyone who came in close contact with that person is instructed to self-isolate to avoid spreading the virus further.
So far, tracing in Canada has been done manually, with public health staff or volunteers getting in touch with each patient’s recent contacts one by one. An app can speed up that process, and doesn’t require users to remember where they’ve been or, just as importantly, with whom.
[embedded content]
“If there’s some way technology can help… we all want to get out of our houses,” said Richard Lachman, a digital technology and culture researcher at Ryerson University in Toronto. But he warned against treating the software as a “panacea.”
Alberta’s app employs Bluetooth technology to determine with whom a user has spent time (at least 15 minutes in a 24-hour period). But it only works if everyone involved has the app running on their phone and Bluetooth enabled.
Early hurdles
As of Tuesday, ABTraceTogether had been downloaded just over 120,000 times, Alberta Health spokesperson Tom McMillan told CBC News. If each download accounts for a new user, that makes up less than three per cent of the province’s population of around 4.4 million.
A group of British researchers suggested a similar app would only be effective if it were adopted by 56 per cent of the U.K.’s population.
McMillan declined to provide a target figure for Alberta, but said in an email, “Our goal is for as many Albertans to use it as possible.”
Even users who’ve installed the app may have trouble using it effectively. Those running Apple’s mobile operating system, iOS, are advised upon installation to “place your phone upside down or screen side down in your pocket” to keep their screen unlocked while out running essential errands.
An FAQ explains ABTraceTogether doesn’t work properly when running in the background. In other words, it can’t guarantee contact tracing continues while a user opens an email or replies to a text message. “If you need to use other apps, just remember to switch back” afterward, the FAQ states.
Apple teamed up with rival Google to develop contact tracing technology. (Mike Segar/Reuters)
Alberta’s health minister, Tyler Shandro, said Apple has been made aware of the issue.
“We’re looking forward to the fix being able to make its way to the App Store as soon as possible,” he said.
App developers are hopeful a rare joint project by Apple and Google will eventually allow them to streamline apps across iOS and Android devices, letting contact tracing run in the background and making the services more widely available.
How it works
While some previous contact tracing apps relied on GPS data, tracking a user’s every movement, the Bluetooth method is emerging as a more accessible and less intrusive alternative.
James Petrie, a member of an international team developing a similar app called Covid Watch, said earlier iterations of the software focused on GPS tracking, but, “We hit a number of challenges — like how do you share this data between people without identifying them?”
A PhD candidate in applied mathematics at the University of Waterloo in Ontario, Petrie said Bluetooth provides more promise because of its ubiquity among smartphones and its ability for direct communication from one device to another.
That’s how ABTraceTogether works. It was developed using the same code that formed the basis of Singapore’s groundbreaking TraceTogether app. Deloitte and IBM were hired to tweak and rebrand the app for Alberta.
The software exchanges anonymous data with another user’s device when it’s located less than two metres away for several minutes. If someone with the app is diagnosed with COVID-19, they will be asked to consent for other users to be alerted and the information given to manual contact tracers, but the patient would remain anonymous.
(CBC)
“Users will merely be informed that they have come into close contact with someone who has tested positive,” said Dr. Deena Hinshaw, Alberta’s chief medical officer of health.
Unveiling the app last Friday, she took great pains to underscore its privacy features, such as how data remains encrypted on a user’s phone and is only saved for 21 days.
“The use of technology for this purpose may seem intrusive, but downloading the app is completely voluntary and data will not be accessed unless a user provides consent to share their data with [Alberta Health Services],” she said.
Other provinces
Some other provinces have acknowledged they’re considering how to implement digital contact tracing.
A New Brunswick government spokesperson said on Tuesday the province plans to implement an “anonymous privacy-by-design solution” using Bluetooth. Last week, New Brunswick’s privacy commissioner said he expected Premier Blaine Higgs and others to be shown a demonstration of the app within 10 days.
Dr. Deena Hinshaw, Alberta’s top public health doctor, said ABTraceTogether would log interactions between users when they were located less than two metres apart for a period of at least 15 minutes within 24 hours. (Art Raham/CBC)
Newfoundland and Labrador Health Minister John Haggie said earlier this week his province would ensure privacy is respected by seeking advice from experts on the topic.
British Columbia, however, is “not focusing on tracing apps such as these at this time,” according to the Health Ministry.
The patchwork of plans leaves open the possibility that contact tracing apps will be incompatible from one jurisdiction to another, as interprovincial travel slowly resumes.
“It works really well if a lot of people can communicate with the same system,” said Petrie, “so I’m hoping for Canada to see a national app, or at least to have provincial apps that can communicate, but I think that’s still a few weeks or months out.”
Contact tracing app TraceTogether was released by the Singapore government to curb the spread of the coronavirus. (Edgar Su/Reuters)
Ontario Premier Doug Ford has called for a national contact tracing strategy. Prime Minister Justin Trudeau, however, said on Radio-Canada talk show Tout le monde en parle he hasn’t seen the right technology “so far.”
Richard Lachman, an associate professor at Ryerson’s RTA School of Media, pointed out, smartphone apps should only be seen as part of the solution to the ongoing crisis, along with other measures such adequate testing, physical distancing and widespread hand-washing.
“There are much bigger questions that will be required,” he said, “and I don’t want us to get distracted.”
The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
