Contact tracing apps and values dilemmas: A privacy paradox in a neo-liberal world

Short- and Long-Term Predicted and Witnessed Consequences of Digital Surveillance During the COVID-19 Pandemic: Scoping Review

BACKGROUND

The COVID-19 pandemic has prompted the deployment of digital technologies for public health surveillance globally. The rapid development and use of these technologies have curtailed opportunities to fully consider their potential impacts (eg, for human rights, civil liberties, privacy, and marginalization of vulnerable groups).

OBJECTIVE

We conducted a scoping review of peer-reviewed and gray literature to identify the types and applications of digital technologies used for surveillance during the COVID-19 pandemic and the predicted and witnessed consequences of digital surveillance.

METHODS

Our methodology was informed by the 5-stage methodological framework to guide scoping reviews: identifying the research question; identifying relevant studies; study selection; charting the data; and collating, summarizing, and reporting the findings. We conducted a search of peer-reviewed and gray literature published between December 1, 2019, and December 31, 2020. We focused on the first year of the pandemic to provide a snapshot of the questions, concerns, findings, and discussions emerging from peer-reviewed and gray literature during this pivotal first year of the pandemic. Our review followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) reporting guidelines.

RESULTS

We reviewed a total of 147 peer-reviewed and 79 gray literature publications. Based on our analysis of these publications, we identified a total of 90 countries and regions where digital technologies were used for public health surveillance during the COVID-19 pandemic. Some of the most frequently used technologies included mobile phone apps, location-tracking technologies, drones, temperature-scanning technologies, and wearable devices. We also found that the literature raised concerns regarding the implications of digital surveillance in relation to data security and privacy, function creep and mission creep, private sector involvement in surveillance, human rights, civil liberties, and impacts on marginalized groups. Finally, we identified recommendations for ethical digital technology design and use, including proportionality, transparency, purpose limitation, protecting privacy and security, and accountability.

CONCLUSIONS

A wide range of digital technologies was used worldwide to support public health surveillance during the COVID-19 pandemic. The findings of our analysis highlight the importance of considering short- and long-term consequences of digital surveillance not only during the COVID-19 pandemic but also for future public health crises. These findings also demonstrate the ways in which digital surveillance has rendered visible the shifting and blurred boundaries between public health surveillance and other forms of surveillance, particularly given the ubiquitous nature of digital surveillance.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-https://doi.org/10.1136/bmjopen-2021-053962.

Between Technological Utopia and Dystopia: Online Expression of Compulsory Use of Surveillance Technology

This study investigated people's ethical concerns of surveillance technology. By adopting the spectrum of technological utopian and dystopian narratives, how people perceive a society constructed through the compulsory use of surveillance technology was explored. This study empirically examined the anonymous online expression of attitudes toward the society-wide, compulsory adoption of a contact tracing app that affected almost every aspect of all people's everyday lives at a societal level. By applying the structural topic modeling approach to analyze comments on four Hong Kong anonymous discussion forums, topics concerning the technological utopian, dystopian, and pragmatic views on the surveillance app were discovered. The findings showed that people with a technological utopian view on this app believed that the implementation of compulsory app use can facilitate social good and maintain social order. In contrast, individuals who had a technological dystopian view expressed privacy concerns and distrust of this surveillance technology. Techno-pragmatists took a balanced approach and evaluated its implementation practically.

Mobile Apps for COVID-19: A Systematic Review of Reviews

BACKGROUND

One measure national governments took to react to the acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) pandemic was mobile applications (apps). This study aims to provide a high-level overview of published reviews of mobile apps used in association with coronavirus disease 19 (COVID-19), examine factors that contributed to the success of these apps, and provide data for further research into this topic.

METHODS

We conducted a systematic review of reviews (also referred to as an umbrella review) and searched two databases, Medline and Embase, for peer-reviewed reviews of COVID-19 mobile apps that were written in English and published between January 1st 2020 and April 25th 2022.

RESULTS

Out of the initial 17,611 studies, 24 studies were eligible for the analysis. Publication dates ranged from May 2020 to January 2022. In total, 54% (n = 13) of the studies were published in 2021, and 33% (n = 8) were published in 2020. Most reviews included in our review of reviews analyzed apps from the USA, the UK, and India. Apps from most of the African and Middle and South American countries were not analyzed in the reviews included in our study. Categorization resulted in four clusters (app overview, privacy and security, MARS rating, and miscellaneous).

CONCLUSIONS

Our study provides a high-level overview of 24 reviews of apps for COVID-19, identifies factors that contributed to the success of these apps, and identifies a gap in the current literature. The study provides data for further analyses and further research.

An open-source digital contact tracing system tailored to haulage

Digital contact tracing presents numerous advantages compared to manual contact tracing methods, especially in terms of enhanced speed and automation. Nevertheless, a lack of comprehensive evaluation regarding functionality, efficiency, benefits, and acceptance within communities remains. Here we primarily focus on the functionality of THEA-GS, an open-source digital contact tracing tool developed through consultation with stakeholders. Additionally, we provide insights from its implementation on a limited sample of haulage drivers in Uganda, serving as a representative case for a low- and middle-income country. THEA-GS comprises two primary components: (a) a smartphone application, and (b) a suite of server-programs responsible for data processing and analysis, including databases and a web-based interface featuring dashboards. In essence, the mobile application records the timestamped location of haulage drivers within the road network and identifies possible transmission hotspots by analyzing factors such as the duration of stops and the communities associated with them. The tool can be integrated with national infrastructure to compare drivers' diagnostic results and contact structure, thereby generating individual and community risk assessments relative to the road network. During the Omicron-variant wave of the COVID-19 pandemic, a total of 3,270 haulage drivers were enrolled between October 2021 and October 2022. Around 75% of these drivers utilized THEA-GS for approximately two months. Based on an analysis of 3,800 test results, which included 48 positive cases, 125 contacts, and 40 million time-stamped GPS points, THEA-GS shows a significant speed improvement, being approximately 90 times faster than MCT. For instance, the average time from sample collection to notifying a case and their contacts was approximately 70 and 80 min, respectively. The adoption of this tool encountered challenges, mainly due to drivers' awareness of its purpose and benefits for public health. THEA-GS is a place-based digital contact tracing tool specifically designed to assist National Public Health Institutions in managing infectious disease outbreaks involving the haulage industry as a high-risk group. While its utility, acceptance, and accuracy have not been fully evaluated, our preliminary tests conducted in Uganda indicate the tool's functionality is robust, but social acceptance and adoption are heavily reliant on establishing trust among users.

Breaking the chain with individual gain? Investigating the moral intensity of COVID-19 digital contact tracing

During the COVID-19 pandemic, contact tracing apps such as the German Corona-Warning-App (CWA) were introduced to facilitate contact tracing of infected individuals with the aim of breaking chains of infection. Therefore, using a contact tracing app is beneficial to society as a whole. Even though this is a good cause, the rather reluctant use of the CWA in the beginning indicated that the pains (e.g., privacy concerns) obviously outweighed the gains (helping others) at the level of the individual user. Thus, in order to identify what lies behind the gain of this app and how it can be promoted, we were interested in the individual's moral perspective (helping others) on the app. We expected a positive relation between CWA download and moral intensity derived from (i) the magnitude or seriousness of consequences, (ii) social norms about app use, (iii) the individual proximity to COVID-19 cases, and (iv) the probability of the app's positive effect. Using a heterogeneous German sample of N = 1,454, we found a strong influence of moral intensity on app download. Furthermore, a manipulation of moral intensity among non-users led to a higher number of downloads in a follow-up study (N = 662) as compared to the population. Our results show possibilities to enhance the adoption of contact tracing apps and potentially other apps for the common good in the population.

Reconceptualizing Women's Wellbeing During the Pandemic: Sport, Fitness and More-Than-Human Connection

This paper explores the gendered, disruptive effects and affective intensities of COVID-19 and the ways that women working in the sport and fitness sector were prompted to establish more-than-human connection through technologies, the environment, and objects. Bringing together theoretical and embodied insights from object interviews with 17 women sport and fitness professionals (i.e., athletes, coaches, instructors) in Aotearoa New Zealand, this paper advances a relational understanding of the multiple human and nonhuman forces that shape and transform women's wellbeing during pandemic. Drawing upon particular feminist materialisms (i.e., Barad, Braidotti, Bennett), we reconceptualize wellbeing to move beyond biomedical formulations of health or illness. Through our analysis and discussion, we trace embodied ways of knowing that produce wellbeing as a more-than-human entanglement, a gendered phenomenon that can be understood as an ongoing negotiation of affective, material, cultural, technological and environmental forces during a period of disruption and uncertainty.

Feasibility of digital contact tracing in low-income settings - pilot trial for a location-based DCT app

BACKGROUND

Data about the effectiveness of digital contact tracing are based on studies conducted in countries with predominantly high- or middle-income settings. Up to now, little research is done to identify specific problems for the implementation of such technique in low-income countries.

METHODS

A Bluetooth-assisted GPS location-based digital contact tracing (DCT) app was tested by 141 participants during 14 days in a hospital in Monrovia, Liberia in February 2020. The DCT app was compared to a paper-based reference system. Hits between participants and 10 designated infected participants were recorded simultaneously by both methods. Additional data about GPS and Bluetooth adherence were gathered and surveys to estimate battery consumption and app adherence were conducted. DCT apps accuracy was evaluated in different settings.

RESULTS

GPS coordinates from 101/141 (71.6%) participants were received. The number of hours recorded by the participants during the study period, true Hours Recorded (tHR), was 496.3 h (1.1% of maximum Hours recordable) during the study period. With the paper-based method 1075 hits and with the DCT app five hits of designated infected participants with other participants have been listed. Differences between true and maximum recording times were due to failed permission settings (45%), data transmission issues (11.3%), of the participants 10.1% switched off GPS and 32.5% experienced other technical or compliance problems. In buildings, use of Bluetooth increased the accuracy of the DCT app (GPS + BT 22.9 m ± 21.6 SD vs. GPS 60.9 m ± 34.7 SD; p = 0.004). GPS accuracy in public transportation was 10.3 m ± 10.05 SD with a significant (p = 0.007) correlation between precision and phone brand. GPS resolution outdoors was 10.4 m ± 4.2 SD.

CONCLUSION

In our study several limitations of the DCT together with the impairment of GPS accuracy in urban settings impede the solely use of a DCT app. It could be feasible as a supplement to traditional manual contact tracing. DKRS, DRKS00029327 . Registered 20 June 2020 - Retrospectively registered.

Using passive Wi-Fi for community crowd sensing during the COVID-19 pandemic

Sensing passersby and detecting crowded locations is a growing area of research and development in the last decades. The COVID-19 pandemic compelled authorities and public and private institutions to monitor access and occupancy of crowded spaces. This work addresses the detection of crowds in points of interest (POI) by using a territory grid analysis categorizing POIs by the services available in each location and comparing data gathered from a community passive Wi-Fi infrastructure against mobile cellular tower association data from telecom companies. In Madeira islands (Portugal), we used data from the telecom provider NOS for the timespan of 4 months as ground truth and found a strong correlation with sparse passive Wi-Fi. An official regional mobile application shows the occupancy data to end-users based on the territory categorization and the passive Wi-Fi infrastructure in POIs. Occupancy data shows historical hourly trends of each location, and the real-time occupation, helping visitors and locals plan their commutes better to avoid crowded spaces.

Addressing Complexity in the Pandemic Context: How Systems Thinking Can Facilitate Understanding of Design Aspects for Preventive Technologies

The COVID-19 pandemic constitutes a wicked problem that is defined by rapidly evolving and dynamic conditions, where the physical world changes (e.g., pathogens mutate) and, in parallel, our understanding and knowledge rapidly progress. Various preventive measures have been developed or proposed to manage the situation, including digital preventive technologies to support contact tracing or physical distancing. The complexity of the pandemic and the rapidly evolving nature of the situation pose challenges for the design of effective preventive technologies. The aim of this conceptual paper is to apply a systems thinking model, DSRP (distinctions, systems, relations, perspectives) to explain the underlying assumptions, patterns, and connections of the pandemic domain, as well as to identify potential leverage points for design of preventive technologies. Two different design approaches, contact tracing and nudging for distance, are compared, focusing on how their design and preventive logic are related to system complexity. The analysis explains why a contact tracing technology involves more complexity, which can challenge both implementation and user understanding. A system utilizing nudges can operate using a more distinct system boundary, which can benefit understanding and implementation. However, frequent nudges might pose challenges for user experience. This further implies that these technologies have different contextual requirements and are useful at different levels in society. The main contribution of this work is to show how systems thinking can organize our understanding and guide the design of preventive technologies in the context of epidemics and pandemics.

Sovereignty in the Digital and Contact Tracing Apps

Recently, the concept of sovereignty in the digital has attracted much attention. Several publications dealing with this concept assume that it can best be described as a network of different, overlapping exercises of power. Nevertheless, there is a need for further research on how exactly sovereignty in the digital can be understood. In order to contribute to a better understanding of this concept, I illustrate its complex structure using contact tracing apps as a paradigmatic example. I conduct a narrative review to show what sovereignty looks like in the context of these apps. In the context of digital contact tracing apps, sovereignty is best understood as a complex network of three actors-nations, (big tech) companies, and individuals-that exercise various forms of power against or on behalf of each other to claim sovereignty for themselves and to either weaken or strengthen the sovereignty claims of other actors. Since large parts of the results can be generalized from the particular context of contact tracing apps, they contribute to a better overall understanding of the concept of sovereignty in digital. This might, in turn, be helpful for discussions about this technology as well as about the regulation and governance of the digital in general.

Use of digital technologies for public health surveillance during the COVID-19 pandemic: A scoping review

Throughout the COVID-19 pandemic, a variety of digital technologies have been leveraged for public health surveillance worldwide. However, concerns remain around the rapid development and deployment of digital technologies, how these technologies have been used, and their efficacy in supporting public health goals. Following the five-stage scoping review framework, we conducted a scoping review of the peer-reviewed and grey literature to identify the types and nature of digital technologies used for surveillance during the COVID-19 pandemic and the success of these measures. We conducted a search of the peer-reviewed and grey literature published between 1 December 2019 and 31 December 2020 to provide a snapshot of questions, concerns, discussions, and findings emerging at this pivotal time. A total of 147 peer-reviewed and 79 grey literature publications reporting on digital technology use for surveillance across 90 countries and regions were retained for analysis. The most frequently used technologies included mobile phone devices and applications, location tracking technologies, drones, temperature scanning technologies, and wearable devices. The utility of digital technologies for public health surveillance was impacted by factors including uptake of digital technologies across targeted populations, technological capacity and errors, scope, validity and accuracy of data, guiding legal frameworks, and infrastructure to support technology use. Our findings raise important questions around the value of digital surveillance for public health and how to ensure successful use of technologies while mitigating potential harms not only in the context of the COVID-19 pandemic, but also during other infectious disease outbreaks, epidemics, and pandemics.

The insufficiency of the Malaysian contact tracing app from the perspective of Chinese tourists: preparing for international tourism in the post-COVID-19 world

Understanding tourists' feedback on using Mysejahtera is critical for tourism recovery in these destinations, and even more so for countries like Malaysia and China, where national Contact Tracing Applications (CTA) are mandatory. However, Previous surveys on CTA use have mainly focused on voluntary CTA users, using qualitative research methods. In this research, Chinese overseas students in Malaysia are included as the reference group, and Chinese tourists with experiences traveling overseas are put into the experimental group. A total of 890 questionnaires were collected and taken as the original data to carry out the Chi-squared and Mann-Whitney U tests. Meanwhile, the experiment implemented a multiple linear regression mechanism to explore the variables that may improve the app Mysejahtera, with further analysis being conducted. According to the results, language issues are the most significant barrier to Chinese visitors using MySejahtera; the inability to register with a Chinese mobile phone number and the need to register a permanent address in Malaysia have a significant negative impact on the use of MySejahtera; and visitors' trust in science positively related to MySejahtera use.

Governing digital crisis responses: platform standards and the dilemma of COVID-19 contact tracing

In response to the impact of the SARS-CoV-2 (COVID-19) pandemic, various developers turned to smartphone-based contact tracing to address the challenges of manual tracing. Due to the presence of network effects, i.e., the effectiveness of contact tracing applications increases with the number of users, information technology standards were critical to the technology's success. The standardization efforts in Europe led to a variety of trade-offs concerning the choice of an appropriate technological architecture due to the contradictory tensions resulting from the dualism between the need for contact tracing data to contain the pandemic and the need for data minimization to preserve user privacy. Drawing predominantly on the software platform and standards literature, we conduct an interpretive case study to examine the emergence and consequences of this multi-layered decision situation. Our findings reveal how Google and Apple were able to limit the individual leeway of external developers, thereby effectively resolving the European standards war. Furthermore, we identify and discuss the various short-term and long-term trade-offs associated with the standardization of contact tracing applications and translate our findings into recommendations for policy makers with respect to future crisis situations. Specifically, we propose a strategy grounded in our data that enables responsible actors to make goal-oriented and rapid decisions under time constraints.

The privacy and control paradoxes in the context of smartphone apps

This research examines how various factors, such as the degree of e-privacy concerns and control over data access permissions, can influence a user's intention to install a smartphone app. We conducted two survey-based experiments with 441 participants. In each experiment, we manipulated the degree of control over the number and type of data access permissions granted to different fictional apps. In Study 1, participants were informed about the set of permissions the apps required. In Study 2, participants indicated which individual permissions they were willing to grant to the apps. In both experiments, we assessed the level of e-privacy concerns, perceived app importance, and the intention to install the apps. The results suggest that the type of app plays a central role in determining both the perceived benefit of installing the app and the level of e-privacy concerns. The intention to install an app is more strongly associated with perceived app importance than with e-privacy concerns (especially when app importance is high, and users have explicit control over which specific data access permissions they want to grant). The implications of these results are discussed regarding psychological factors involved in app installation decision-making process and the importance of promoting data protection by design.

Developing digital contact tracing tailored to haulage in East Africa to support COVID-19 surveillance: a protocol

INTRODUCTION

At the peak of Uganda's first wave of SARS-CoV-2 in May 2020, one in three COVID-19 cases was linked to the haulage sector. This triggered a mandatory requirement for a negative PCR test result at all ports of entry and exit, resulting in significant delays as haulage drivers had to wait for 24-48 hours for results, which severely crippled the regional supply chain.To support public health and economic recovery, we aim to develop and test a mobile phone-based digital contact tracing (DCT) tool that both augments conventional contact tracing and also increases its speed and efficiency.

METHODS AND ANALYSIS

To test the DCT tool, we will use a stratified sample of haulage driver journeys, stratified by route type (regional and local journeys).We will include at least 65% of the haulage driver journeys ~83 200 on the network through Uganda. This allows us to capture variations in user demographics and socioeconomic characteristics that could influence the use and adoption of the DCT tool. The developed DCT tool will include a mobile application and web interface to collate and intelligently process data, whose output will support decision-making, resource allocation and feed mathematical models that predict epidemic waves.The main expected result will be an open source-tested DCT tool tailored to haulage use in developing countries.This study will inform the safe deployment of DCT technologies needed for combatting pandemics in low-income countries.

ETHICS AND DISSEMINATION

This work has received ethics approval from the School of Public Health Higher Degrees, Research and Ethics Committee at Makerere University and The Uganda National Council for Science and Technology. This work will be disseminated through peer-reviewed publications, our websites https://project-thea.org/ and Github for the open source code https://github.com/project-thea/.

Where horizontal and vertical surveillances meet: Sense-making of US COVID-19 contact-tracing apps during a health crisis

Analyzing user reviews of seven US digital contact-tracing apps for COVID-19, this article unpacks how the new form of surveillance technology is understood and experienced by individuals during a global health crisis. The findings suggest that the app users felt empowered via self-tracking capacity and expressed community-level care and concerns, including those regarding the marginalized. At the same time, the users were raising doubts over technical effectiveness, navigating varying levels of voluntary choice available, and negotiating privacy concerns depending on the (dis)trust they held of institutional entities behind the governance of the apps. We argue that it is critical to investigate how surveillance technologies are situated across horizontal and vertical relationships in people's everyday lives to fully understand the individual and societal acceptance and/or refusal of the very systems during crises.

Adoption of Covid-19 contact tracing app by extending UTAUT theory: Perceived disease threat as moderator

Objectives

Contact tracing applications are technological solutions that can quickly trace and notify users of their potential exposure to the Covid-19 virus and help contain the spread of the disease. However, extant research delineating the various factors predicting the adoption of contact tracing apps is scant. The study's primary objective is to develop and validate a research model based on the unified theory of acceptance and use of technology (UTAUT), health belief model (HBM), perceived privacy risk and perceived security risk to understand the adoption of contact tracing application.

Methods

An online survey was carried out among users of the ‘Aarogya Setu’ contact tracing app in India. The partial least squares structural equation modelling (PLS-SEM) tool was employed to analyze data from 307 respondents.

Results

The results showed that performance expectancy, social influence, and facilitating conditions positively influenced users’ intention to adopt the app. In contrast, perceived privacy and security risks were significant barriers to app adoption. Perceived disease threat as a moderator mitigated the adverse impact of perceived privacy risk on users' intention to adopt contact tracing apps.

Conclusions

The current study gives insights on both drivers and barriers to the adoption of contract tracing applications. Various theoretical and practical implications of significance are provided for academicians and practitioners to effectively promote app adoption to tackle the Covid-19 pandemic.

Acceptability of the COVID-19 contact-tracing app - Does culture matter?

During the pandemic, several countries deployed contact-tracing apps in order to contain or reduce the community spread of COVID-19. However, the success rate in terms of acceptance and use of these apps was reportedly low. Using information gathered from citizens across four European countries and the United States of America, this study explores the role of national culture in relation to the acceptance of these apps. Using partial least squares structural equation modelling (PLS-SEM), an analysis was undertaken of 3595 records from a cross-country survey dataset that is in the public domain and can be obtained from the Centre for Open Science (Study 1). This analysis was followed by another survey comprising 910 respondents (Study 2). The research model was then validated by using a qualitative approach and undertaking interviews with 51 participants from four countries (Study 3). The results confirmed the moderating role of national culture on the acceptability of the contact-tracing apps in relation to power-distance, masculinity, individualism, long-term orientation and indulgence in the pre-deployment phase (Study 1). There were, however, no significant differences in acceptability of the apps between countries in relation to uncertainty avoidance; and none of the hypotheses in Study 2 was supported. The study concludes that national culture is significant in terms of the acceptance of COVID-19 apps only during the pre-deployment phase; therefore attention is required with pertinence to pre-deployment strategies. Recommendations regarding how governments and public health institutions can increase the acceptability of contact-tracing apps have been highlighted.

Tracing app technology: an ethical review in the COVID-19 era and directions for post-COVID-19

We conducted a systematic literature review on the ethical considerations of the use of contact tracing app technology, which was extensively implemented during the COVID-19 pandemic. The rapid and extensive use of this technology during the COVID-19 pandemic, while benefiting the public well-being by providing information about people's mobility and movements to control the spread of the virus, raised several ethical concerns for the post-COVID-19 era. To investigate these concerns for the post-pandemic situation and provide direction for future events, we analyzed the current ethical frameworks, research, and case studies about the ethical usage of tracing app technology. The results suggest there are seven essential ethical considerations-privacy, security, acceptability, government surveillance, transparency, justice, and voluntariness-in the ethical use of contact tracing technology. In this paper, we explain and discuss these considerations and how they are needed for the ethical usage of this technology. The findings also highlight the importance of developing integrated guidelines and frameworks for implementation of such technology in the post- COVID-19 world.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10676-022-09659-6.

How is “solidarity” understood in discussions about contact tracing apps? An overview

Background

In the context of the COVID-19 pandemic, there is much discussion about contact tracing apps, their use to contain the spread of the virus as well as the ethical, legal, and social aspects of their development, implementation, acceptance, and use. In these discussions, authors frequently mention “solidarity” when making key points in arguments. At the same time, authors rarely specify how they understand “solidarity”. This lack of specification about how they understand “solidarity” can lead to misunderstandings in discussions.

Objective

To prevent such misunderstandings, it is important to specify how one understands “solidarity” when mentioning it in the discussions on contact tracing apps. Therefore, the aim of this paper is to elaborate how “solidarity” is understood in the context of contact tracing apps, i.e., how different authors understand “solidarity” when using it in discussions about these apps.

Methods

In order to find out how different authors understand “solidarity” when discussing contact tracing apps, I conduct a literature review. I collect papers from several databases, inductively work out central differences and similarities between the different uses of “solidarity”, and use them to code and analyze relevant passages.

Results

In the final sample, five different understandings of “solidarity” in the context of contact tracing apps can be identified. These understandings differ in how different authors (1) imagine the basic concept of solidarity, i.e., what “solidarity” refers to, (2) how they temporally relate solidarity to contact tracing apps, and (3) how they perceive the causal interactions between solidarity and contact tracing apps, i.e., the different ways in which solidarity and contact tracing apps influence each other.

Conclusions

The five understandings of “solidarity” in the context of contact tracing apps presented here can serve as guidance for how “solidarity” can be understood in discussions—thus contributing to a better mutual understanding and preventing communicative misunderstandings.

Increased airborne transmission of COVID-19 with new variants, implications for health policies

New COVID-19 variants, either of higher viral load such as delta or higher contagiousness like omicron, can lead to higher airborne transmission than historical strains. This paper highlights their implications for health policies, based on a clear analytical understanding and modeling of the airborne contamination paths, of the dose following exposure, and the importance of the counting unit for pathogens, itself linked to the dose-response law. Using the counting unit of Wells, i.e. the quantum of contagium, we develop the conservation equation of quanta which allows deriving the value of the quantum concentration at steady state for a well-mixed room. The link with the monitoring concentration of carbon dioxide is made and used for a risk analysis of a variety of situations for which we collected CO₂ time-series observations. The main conclusions of these observations are that 1) the present norms of ventilation, are both insufficient and not respected, especially in a variety of public premises, leading to high risk of contamination and that 2) air can often be considered well-mixed. Finally, we insist that public health policy in the field of airborne transmission should be based on a multi parameter analysis such as the time of exposure, the quantum production rate, mask wearing and the infector proportion in the population in order to evaluate the risk, considering the whole complexity of dose evaluation. Recognizing airborne transmission requires thinking in terms of time of exposure rather than in terms of proximal distance.

Factors impacting the use of the NZ COVID Tracer application in New Zealand"

The COVID-19 pandemic has clearly created devastating damage on world economics and public health. This project identifies key concerns of end-users toward the NZ COVID-19 contact tracing app in New Zealand. The key research objective in this study is to understand the usage behaviour towards the mobile application NZ COVID-19 Tracer used for contact tracing purposes. Secondly, the study explores the reasons for using the contact tracing app. Thirdly, it examines the relationship between usage behaviour of the NZ-COVID Tracer app with age, the user's perceived health, attitude towards COVID-19, whether family or friends are infected by COVID-19, trust in maintaining social distancing, trust in data privacy, smartphone usage and the media's role in motivating people to use this app. Consequently, understanding these issues and challenges could help improve the usage of this contact tracing app, which in turn would contribute to better public health outcomes in disease management and containment. Findings of the study reveals that age, smartphone usage behaviour, and trust in privacy data protection from the app provider has a statistically significant relationship on usage behaviour of the NZ COVID Tracer app. Self-perceived health status and attitudes towards the COVID-19 pandemic did not have a significant relationship on NZ COVID Tracer app usage behaviour. While social media, such as Facebook, has been shown to be the most popular source of news for COVID-19 among New Zealanders, it is television that acted as a motivational tool to encourage people to use the contact tracing mobile application and to practice other measures to help protect against the COVID-19 pandemic.

Examining the Prediction of COVID-19 Contact-Tracing App Adoption Using an Integrated Model and Hybrid Approach Analysis

COVID-19 contact-tracing applications (CTAs) offer enormous potential to mitigate the surge of positive coronavirus cases, thus helping stakeholders to monitor high-risk areas. The Kingdom of Saudi Arabia (KSA) is among the countries that have developed a CTA known as the Tawakkalna application, to manage the spread of COVID-19. Thus, this study aimed to examine and predict the factors affecting the adoption of Tawakkalna CTA. An integrated model which comprises the technology acceptance model (TAM), privacy calculus theory (PCT), and task-technology fit (TTF) model was hypothesized. The model is used to understand better behavioral intention toward using the Tawakkalna mobile CTA. This study performed structural equation modeling (SEM) analysis as well as artificial neural network (ANN) analysis to validate the model, using survey data from 309 users of CTAs in the Kingdom of Saudi Arabia. The findings revealed that perceived ease of use and usefulness has positively and significantly impacted the behavioral intention of Tawakkalna mobile CTA. Similarly, task features and mobility positively and significantly influence task-technology fit, and significantly affect the behavioral intention of the CTA. However, the privacy risk, social concerns, and perceived benefits of social interaction are not significant factors. The findings provide adequate knowledge of the relative impact of key predictors of the behavioral intention of the Tawakkalna contact-tracing app.

Delineating privacy aspects of COVID tracing applications embedded with proximity measurement technologies & digital technologies

As the COVID-19 pandemic expanded over the globe, governments implemented a series of technological measures to prevent the disease's spread. The development of the COVID Tracing Application (CTA) was one of these measures. In this study, we employed bibliometric and topic-based content analysis to determine the most significant entities and research topics. Additionally, we identified significant privacy concerns posed by CTAs, which gather, store, and analyze data in partnership with large technology corporations using proximity measurement technologies, artificial intelligence, and blockchain. We examined a series of key privacy threats identified in our study. These privacy risks include anti-democratic and discriminatory behaviors, politicization of care, derogation of human rights, techno governance, citizen distrust and refusal to adopt, citizen surveillance, and mandatory legislation of the apps' installation. Finally, sixteen research gaps were identified. Then, based on the identified theoretical gaps, we recommended fourteen prospective study strands. Theoretically, this study contributes to the growing body of knowledge about the privacy of mobile health applications that are embedded with cutting-edge technologies and are employed during global pandemics.

Digital government transformation in turbulent times: Responses, challenges, and future direction

We are living in turbulent times, with the threats of COVID-19 and related social conflicts. Digital transformation is not an option but a necessity for governments to respond to these crises. It has become imperative for governments worldwide to enhance their capacity to strategically use emerging digital technologies and develop innovative digital public services to confront and overcome the pandemic. With the rapid development of digital technologies, digital government transformation (DGT) has been legitimated in response to the pandemic, contributing to innovative efficacy, but it also has created a set of challenges, dilemmas, paradoxes, and ambiguities. This special issue’s primary motive is to comprehensively discuss the promises and challenges DGT presents. It focuses on the nature of the problems and the dilemmatic situation in which to use the technologies. Furthermore, it covers government capacity and policy implications for managerial and institutional reforms to respond to the threats and the uncertainty caused by disruptive digitalization in many countries. To stimulate discussion of the theme of this special issue, this editorial note provides an overview of previous literature on DGT as a controlling measure of the pandemic and the future direction of research and practice on DGT.

Learning From the Past to Improve the Future

Contact tracing apps were considered among the first tools to control the spread of COVID-19 and ease lockdown measures. While these apps can be very effective at stopping transmission and saving lives, the level of adoption remains significantly below the expected critical mass. The public debate as well as academic research about contact tracing apps emphasizes general concerns about privacy (and the associated risks) but often disregards the value-added services, as well as benefits, that can result from a larger user base. To address this gap, the study analyzes goal-congruent features as drivers for user adoption. It uses market research techniques – specifically, conjoint analysis – to study individual and group preferences and gain insights into the prescriptive design. While the results confirm the privacy-preserving design of most European contact tracing apps, they emphasize the role of value-added services in addressing heterogeneous user segments to drive user adoption. The findings thereby are of relevance for designing effective contact tracing apps, but also inform the user-oriented design of apps for health and crisis management that rely on sharing sensitive information.

Data privacy during pandemics: a systematic literature review of COVID-19 smartphone applications

BACKGROUND

On January 8, 2020, the Centers for Disease Control and Prevention officially announced a new virus in Wuhan, China. The first novel coronavirus (COVID-19) case was discovered on December 1, 2019, implying that the disease was spreading quietly and quickly in the community before reaching the rest of the world. To deal with the virus' wide spread, countries have deployed contact tracing mobile applications to control viral transmission. Such applications collect users' information and inform them if they were in contact with an individual diagnosed with COVID-19. However, these applications might have affected human rights by breaching users' privacy.

METHODOLOGY

This systematic literature review followed a comprehensive methodology to highlight current research discussing such privacy issues. First, it used a search strategy to obtain 808 relevant papers published in 2020 from well-established digital libraries. Second, inclusion/exclusion criteria and the snowballing technique were applied to produce more comprehensive results. Finally, by the application of a quality assessment procedure, 40 studies were chosen.

RESULTS

This review highlights privacy issues, discusses centralized and decentralized models and the different technologies affecting users' privacy, and identifies solutions to improve data privacy from three perspectives: public, law, and health considerations.

CONCLUSIONS

Governments need to address the privacy issues related to contact tracing apps. This can be done through enforcing special policies to guarantee users privacy. Additionally, it is important to be transparent and let users know what data is being collected and how it is being used.

Contact tracing apps for the COVID-19 pandemic: a systematic literature review of challenges and future directions for neo-liberal societies

PURPOSE

The COVID-19 pandemic has spread with increased fatalities around the world and has become an international public health crisis. Public health authorities in many countries have introduced contact tracing apps to track and trace infected persons as part of measures to contain the spread of the Severe Acute Respiratory Syndrome-Coronavirus 2. However, there are major concerns about its efficacy and privacy which affects mass acceptance amongst a population. This systematic literature review encompasses the current challenges facing this technology and recommendations to address such challenges in the fight against the COVID-19 pandemic in neo-liberal societies.

METHODS

The systematic literature review was conducted by searching databases of Google Scholar, Web of Science, PubMed, IEEE Xplore Digital Library, PsycInfo and ScienceDirect using the search terms ("Contact Tracing" OR "Contact Tracing apps") AND ("COVID-19" OR "Coronavirus") to identify relevant literature. The searches were run against the title, keywords, or abstract, depending on the search platforms. The searches were conducted between January 1, 2020, through 31st January 2021. Further inputs were also taken from preprints, published government and technical reports. We explore and discuss from the selected literature, the key challenges and issues that influence unwillingness to use these contact tracing apps in neo-liberal societies which include the plausibility of abuse of user privacy rights and lack of trust in the government and public health authorities by their citizens. Other challenges identified and discussed include ethical issues, security vulnerabilities, user behaviour and participation, and technical constraints.

RESULTS AND CONCLUSION

Finally, in the analysis of this systematic literature review, recommendations to address these challenges, future directions, and considerations in the use of digital contact tracing apps and related technologies to contain the spread of future pandemic outbreaks are presented. For policy makers in neo-liberal societies, this study provides an in-depth review of issues that must be addressed. We highlight recommendations to improve the willingness to use such digital technologies and could facilitate mass acceptance amongst users.

Effect of the COVID-19 pandemic on public managers' attitudes toward digital transformation

The COVID-19 pandemic has induced a process of digital acceleration and has likely changed the attitudes of local public managers toward information and communication technology (ICT). While this attitude change has been reasonably argued, it has not been systematically measured. This study narrows this gap by measuring the attitudes of public managers before and after the outbreak of the COVID-19 pandemic. Overall, this study finds that the pandemic has led public managers to be more confident in the capacity of ICT to help cities achieve their economic, social, and environmental goals and respond to challenges. Both explicit and implicit measures confirmed attitude changes. The explicit measures also indicated that the change in public managers' attitude toward ICT was similar to their change in attitude toward scientific progress and greater than their change in attitude toward other issues that have played a major role during the pandemic, namely, climate change, citizen participation, and privacy.

Digital technology and disease surveillance in the COVID-19 pandemic: a scoping review protocol

INTRODUCTION

Infectious diseases pose a risk to public health, requiring efficient strategies for disease prevention. Digital health surveillance technologies provide new opportunities to enhance disease prevention, detection, tracking, reporting and analysis. However, in addition to concerns regarding the effectiveness of these technologies in meeting public health goals, there are also concerns regarding the ethics, legality, safety and sustainability of digital surveillance technologies. This scoping review examines the literature on digital surveillance for public health purposes during the COVID-19 pandemic to identify health-related applications of digital surveillance technologies, and to highlight discussions of the implications of these technologies.

METHODS AND ANALYSIS

The scoping review will be guided by the framework proposed by Arksey and O'Malley and the guidelines outlined by Colquhoun et al and Levac et al. We will search Medline (Ovid), PsycInfo, PubMed, Scopus, CINAHL (EBSCOhost), ACM Digital Library, Google Scholar and IEEE Explore for relevant studies published between December 2019 and December 2020. The review will also include grey literature. Data will be managed and analysed through an extraction table and thematic analysis.

ETHICS AND DISSEMINATION

Findings will be disseminated through traditional academic channels, as well as social media channels and research briefs and infographics. We will target our dissemination to provincial and federal public health organisations, as well as technology companies and community-based organisations managing the public response to the COVID-19 pandemic.

Should Digital Contact Tracing Technologies be used to Control COVID-19? Perspectives from an Australian Public Deliberation

Mobile phone-based applications (apps) can promote faster targeted actions to control COVID-19. However, digital contact tracing systems raise concerns about data security, system effectiveness, and their potential to normalise privacy-invasive surveillance technologies. In the absence of mandates, public uptake depends on the acceptability and perceived legitimacy of using technologies that log interactions between individuals to build public health capacity. We report on six online deliberative workshops convened in New South Wales to consider the appropriateness of using the COVIDSafe app to enhance Australian contact tracing systems. All groups took the position (by majority) that the protections enacted in the app design and supporting legislation were appropriate. This support is contingent on several system attributes including: the voluntariness of the COVIDSafe app; that the system relies on proximity rather than location tracking; and, that data access is restricted to local public health practitioners undertaking contact tracing. Despite sustained scepticism in media coverage, there was an underlying willingness to trust Australian governing institutions such that in principle acceptance of the new contact tracing technology was easy to obtain. However, tensions between the need to prove system effectiveness through operational transparency and requirements for privacy protections could be limiting public uptake. Our study shows that informed citizens are willing to trade their privacy for common goods such as COVID-19 suppression. But low case numbers and cautionary public discourses can make trustworthiness difficult to establish because some will only do so when it can be demonstrated that the benefits justify the costs to individuals.

Review of Transit Data Sources: Potentials, Challenges and Complementarity

Public transport has become one of the major transport options, especially when it comes to reducing motorized individual transport and achieving sustainability while reducing emissions, noise and so on. The use of public transport data has evolved and rapidly improved over the past decades. Indeed, the availability of data from different sources, coupled with advances in analytical and predictive approaches, has contributed to increased attention being paid to the exploitation of available data to improve public transport service. In this paper, we review the current state of the art of public transport data sources. More precisely, we summarize and analyze the potential and challenges of the main data sources. In addition, we show the complementary aspects of these data sources and how to merge them to broaden their contributions and face their challenges. This is complemented by an information management framework to enhance the use of data sources. Specifically, we seek to bridge the gap between traditional data sources and recent ones, present a unified overview of them and show how they can all leverage recent advances in data-driven methods and how they can help achieve a balance between transit service and passenger behavior.

Nationwide rollout reveals efficacy of epidemic control through digital contact tracing

Fuelled by epidemiological studies of SARS-CoV-2, contact tracing by mobile phones has been put to use in many countries. Over a year into the pandemic, we lack conclusive evidence on its effectiveness. To address this gap, we used a unique real world contact data set, collected during the rollout of the first Norwegian contact tracing app in the Spring of 2020. Our dataset involves millions of contacts between 12.5% of the adult population, which enabled us to measure the real-world app performance. The technological tracing efficacy was measured at 80%, and we estimated that at least 11.0% of the discovered close contacts could not have been identified by manual contact tracing. Our results also indicated that digital contact tracing can flag individuals with excessive contacts, which can help contain superspreading related outbreaks. The overall effectiveness of digital tracing depends strongly on app uptake, but significant impact can be achieved for moderate uptake numbers. Used as a supplement to manual tracing and other measures, digital tracing can be instrumental in controlling the pandemic. Our findings can thus help informing public health policies in the coming months.

COVID ‐19 Apps and Privacy Protections from Users' Perspective

As the spread of the novel coronavirus (COVID‐19) continues to be a global challenge, there have been numerous efforts and actions from both government and private organizations towards keeping their community members healthy and safe. One of the approaches is to use mobile apps to trace contacts and update the status of the infected individuals efficiently and conveniently so that the spread of COVID‐19 can be minimized and contained. While these apps could offer many advantages, it also raises serious privacy concerns for many users and hence possibly refusing to adopt it. In this study, we aim to understand the users' expectations on the privacy protections and the provisions under which they are willing to use COVID‐19 apps. We believe our study results can guide policymakers and app developers on the design, deployment, and acceptability of the COVID‐19 apps that can be widely adopted.

The effect of toxicity on COVID-19 news network formation in political subcommunities on Reddit: An affiliation network approach

Political polarization remains perhaps the “greatest barrier” to effective COVID-19 pandemic mitigation measures in the United States. Social media has been implicated in fueling this polarization. In this paper, we uncover the network of COVID-19 related news sources shared to 30 politically biased and 2 neutral subcommunities on Reddit. We find, using exponential random graph modeling, that news sources associated with highly toxic – “rude, disrespectful” – content are more likely to be shared across political subreddits. We also find homophily according to toxicity levels in the network of online news sources. Our findings suggest that news sources associated with high toxicity are rewarded with prominent positions in the resultant network. The toxicity in COVID-19 discussions may fuel political polarization by denigrating ideological opponents and politicizing responses to the COVID-19 pandemic, all to the detriment of mitigation measures. Public health practitioners should monitor toxicity in public online discussions to familiarize themselves with emerging political arguments that threaten adherence to public health crises management. We also recommend, based on our findings, that social media platforms algorithmically promote neutral and scientific news sources to reduce toxic discussion in subcommunities and encourage compliance with public health recommendations in the fight against COVID-19.

Pandemic information support lifecycle: Evidence from the evolution of mobile apps during COVID-19

Information sharing and consumption play an important role during a pandemic in managing constrained resources and devising effective plans to minimize a pandemic's impact. The type of support extended by information also changes as a pandemic evolves. In this paper, we present a novel framework to understand the different types of information support needed during a pandemic crisis. Adapting phases from the pandemic crisis management lifecycle, we propose five different overlapping phases of our proposed Pandemic Information Support Lifecycle (PISL): awareness information support, preventive care information support, active information support, confidence-building information support and evaluation information support. To validate the proposed PISL, we examine the evolution of new mobile apps during the current COVID-19 pandemic by developing a taxonomy for mobile app-based information support. The proposed lifecycle presents future phases of information support for the ongoing COVID-19 pandemic, while identifying specific areas that need additional research and mobile-based information support development.

Contact Tracing Apps: Lessons Learned on Privacy, Autonomy, and the Need for Detailed and Thoughtful Implementation

The global and national response to the COVID-19 pandemic has been inadequate due to a collective lack of preparation and a shortage of available tools for responding to a large-scale pandemic. By applying lessons learned to create better preventative methods and speedier interventions, the harm of a future pandemic may be dramatically reduced. One potential measure is the widespread use of contact tracing apps. While such apps were designed to combat the COVID-19 pandemic, the time scale in which these apps were deployed proved a significant barrier to efficacy. Many companies and governments sprinted to deploy contact tracing apps that were not properly vetted for performance, privacy, or security issues. The hasty development of incomplete contact tracing apps undermined public trust and negatively influenced perceptions of app efficacy. As a result, many of these apps had poor voluntary public uptake, which greatly decreased the apps' efficacy. Now, with lessons learned from this pandemic, groups can better design and test apps in preparation for the future. In this viewpoint, we outline common strategies employed for contact tracing apps, detail the successes and shortcomings of several prominent apps, and describe lessons learned that may be used to shape effective contact tracing apps for the present and future. Future app designers can keep these lessons in mind to create a version that is suitable for their local culture, especially with regard to local attitudes toward privacy-utility tradeoffs during public health crises.

COVID-19 Apps as a Digital Intervention Policy: A Longitudinal Panel Data Analysis in South Korea

Many countries have developed COVID-19 tracking apps that help individuals trace and detect “people” who are likely to have come in contact with confirmed patients. However, their adoption rates remain low. This study, therefore, investigated South Koreans’ adoption and usage behaviors of COVID-19 apps that detect the “place” where infectious people are found and alert people within 100m in dangerous zones. Our focus was on such apps’ impact on various facets of human life . Specifically, we analyzed mobile app usage data from 5,940 panelists at the start of the pandemic in South Korea and after the first major wave (January 6 to August 2, 2020). Findings showed that higher-income and more educated individuals were more likely to adopt COVID-19 apps early, and male and low-income people tended to use the COVID-19 tracking apps more frequently. In addition, this study offered empirical evidence of health protective behaviors, such as driving, shopping online, ordering food online, and avoiding travel and public transportation, and supported social- and religious-coping for people using COVID-19 apps. The implications are valuable for policy makers to implement a digital policy to motivate people to voluntarily engage in self-protective and coping behaviors through COVID-19 apps.

State of the Art in Adoption of Contact Tracing Apps and Recommendations Regarding Privacy Protection and Public Health: Systematic Review

BACKGROUND

During the COVID-19 pandemic, contact tracing apps have received a lot of public attention. The ongoing debate highlights the challenges of the adoption of data-driven innovation. We reflect on how to ensure an appropriate level of protection of individual data and how to maximize public health benefits that can be derived from the collected data.

OBJECTIVE

The aim of the study was to analyze available COVID-19 contact tracing apps and verify to what extent public health interests and data privacy standards can be fulfilled simultaneously in the process of the adoption of digital health technologies.

METHODS

A systematic review of PubMed and MEDLINE databases, as well as grey literature, was performed to identify available contact tracing apps. Two checklists were developed to evaluate (1) the apps' compliance with data privacy standards and (2) their fulfillment of public health interests. Based on both checklists, a scorecard with a selected set of minimum requirements was created with the goal of estimating whether the balance between the objective of data privacy and public health interests can be achieved in order to ensure the broad adoption of digital technologies.

RESULTS

Overall, 21 contact tracing apps were reviewed. In total, 11 criteria were defined to assess the usefulness of each digital technology for public health interests. The most frequently installed features related to contact alerting and governmental accountability. The least frequently installed feature was the availability of a system of medical or organizational support. Only 1 app out of 21 (5%) provided a threshold for the population coverage needed for the digital solution to be effective. In total, 12 criteria were used to assess the compliance of contact tracing apps with data privacy regulations. Explicit user consent, voluntary use, and anonymization techniques were among the most frequently fulfilled criteria. The least often implemented criteria were provisions of information about personal data breaches and data gathered from children. The balance between standards of data protection and public health benefits was achieved best by the COVIDSafe app and worst by the Alipay Health Code app.

CONCLUSIONS

Contact tracing apps with high levels of compliance with standards of data privacy tend to fulfill public health interests to a limited extent. Simultaneously, digital technologies with a lower level of data privacy protection allow for the collection of more data. Overall, this review shows that a consistent number of apps appear to comply with standards of data privacy, while their usefulness from a public health perspective can still be maximized.

Best Practice Guidance for Digital Contact Tracing Apps: A Cross-disciplinary Review of the Literature

BACKGROUND

Digital contact tracing apps have the potential to augment contact tracing systems and disrupt COVID-19 transmission by rapidly identifying secondary cases prior to the onset of infectiousness and linking them into a system of quarantine, testing, and health care worker case management. The international experience of digital contact tracing apps during the COVID-19 pandemic demonstrates how challenging their design and deployment are.

OBJECTIVE

This study aims to derive and summarize best practice guidance for the design of the ideal digital contact tracing app.

METHODS

A collaborative cross-disciplinary approach was used to derive best practice guidance for designing the ideal digital contact tracing app. A search of the indexed and gray literature was conducted to identify articles describing or evaluating digital contact tracing apps. MEDLINE was searched using a combination of free-text terms and Medical Subject Headings search terms. Gray literature sources searched were the World Health Organization Institutional Repository for Information Sharing, the European Centre for Disease Prevention and Control publications library, and Google, including the websites of many health protection authorities. Articles that were acceptable for inclusion in this evidence synthesis were peer-reviewed publications, cohort studies, randomized trials, modeling studies, technical reports, white papers, and media reports related to digital contact tracing.

RESULTS

Ethical, user experience, privacy and data protection, technical, clinical and societal, and evaluation considerations were identified from the literature. The ideal digital contact tracing app should be voluntary and should be equitably available and accessible. User engagement could be enhanced by small financial incentives, enabling users to tailor aspects of the app to their particular needs and integrating digital contact tracing apps into the wider public health information campaign. Adherence to the principles of good data protection and privacy by design is important to convince target populations to download and use digital contact tracing apps. Bluetooth Low Energy is recommended for a digital contact tracing app's contact event detection, but combining it with ultrasound technology may improve a digital contact tracing app's accuracy. A decentralized privacy-preserving protocol should be followed to enable digital contact tracing app users to exchange and record temporary contact numbers during contact events. The ideal digital contact tracing app should define and risk-stratify contact events according to proximity, duration of contact, and the infectiousness of the case at the time of contact. Evaluating digital contact tracing apps requires data to quantify app downloads, use among COVID-19 cases, successful contact alert generation, contact alert receivers, contact alert receivers that adhere to quarantine and testing recommendations, and the number of contact alert receivers who subsequently are tested positive for COVID-19. The outcomes of digital contact tracing apps' evaluations should be openly reported to allow for the wider public to review the evaluation of the app.

CONCLUSIONS

In conclusion, key considerations and best practice guidance for the design of the ideal digital contact tracing app were derived from the literature.

Seeing Like a State, Enacting Like an Algorithm: (Re)assembling Contact Tracing and Risk Assessment during the COVID-19 Pandemic

As states increasingly use algorithms to improve the legibility of society, particularly during the COVID-19 pandemic, it is common for concerns about the expanding power of the algorithm or the state to be raised in a deterministic manner. However, how are the algorithms for states’ legibility projects enacted, contested, and reconfigured? Drawing on interviews and media data, this study fills this gap by examining Health Code (jiankangma), the Chinese contact tracing and risk assessment algorithmic system that serves as the COVID-19 health passport. I first explore the intensive and invisible work and infrastructures that enact and stabilize Health Code’s sociotechnical assemblage. I then show how this assemblage is frequently challenged and destabilized by errors, breakdowns, and exclusions. Facing unintended engagements from heterogeneous social actors, local interests, and power hierarchies, Health Code reassembles into multiple and contradictory assemblages at different periods and social localities. Finally, I examine how people game and bypass the algorithm’s surveillance with their agencies. Recognizing this messiness and heterogeneity contributes to a more nuanced and realistic understanding of states’ use of algorithms, including the risks. Doing so also urges us to rethink the politics of citizenship and inequality in the digital age beyond inclusion.

Utilizing Health Behavior Change and Technology Acceptance Models to Predict the Adoption of COVID-19 Contact Tracing Apps: Cross-sectional Survey Study

Background

To combat the global COVID-19 pandemic, contact tracing apps have been discussed as digital health solutions to track infection chains and provide appropriate information. However, observational studies point to low acceptance in most countries, and few studies have yet examined theory-based predictors of app use in the general population to guide health communication efforts.

Objective

This study utilizes established health behavior change and technology acceptance models to predict adoption intentions and frequency of current app use.

Methods

We conducted a cross-sectional online survey between May and July 2020 in a German convenience sample (N=349; mean age 35.62 years; n=226, 65.3% female). To inspect the incremental validity of model constructs as well as additional variables (privacy concerns, personalization), hierarchical regression models were applied, controlling for covariates.

Results

The theory of planned behavior and the unified theory of acceptance and use of technology predicted adoption intentions (R²=56%-63%) and frequency of current app use (R²=33%-37%). A combined model only marginally increased the predictive value by about 5%, but lower privacy concerns and higher threat appraisals (ie, anticipatory anxiety) significantly predicted app use when included as additional variables. Moreover, the impact of perceived usefulness was positive for adoption intentions but negative for frequency of current app use.

Conclusions

This study identified several theory-based predictors of contact tracing app use. However, few constructs, such as social norms, have a consistent positive effect across models and outcomes. Further research is required to replicate these observations, and to examine the interconnectedness of these constructs and their impact throughout the pandemic. Nevertheless, the findings suggest that promulgating affirmative social norms and positive emotional effects of app use, as well as addressing health concerns, might be promising strategies to foster adoption intentions and app use in the general population.