April 14, 2020

When Big Tech rivals Apple and Google announced a joint partnership aimed at using a tool most Americans already have at their disposal—Bluetooth-enabled smartphones—to trace the spread of Covid-19, most people in the industry had strong reactions. "This is a big deal," wrote Bloomberg columnist Tae Kim, before heralding the effort as "the first step in moving society back to a more normal life." Former CMS Administrator Andy Slavitt also praised the project, saying it "will make us capable of finding and limiting growth of the virus," and that he hopes "EVERYONE opts in for one another."

What 'Apple Health Care' could look like in 5 years

But not everyone was enthusiastic. President Trump raised privacy concerns the same day the project was announced, telling reporters, "It's very interesting but a lot of people worry about it in terms of a person's freedom. We're going to take a look at that, a very strong look at it." Clearly, the issue of Big Tech potentially gaining access to private health data is fraught. So what does the tool actually do? And what benefits—and risks—does it pose? Let's dive deeper.

What does the new tool actually do?

The tool uses the infrastructure of people's smartphones to alert them if they might have been within close proximity of someone who has tested positive for Covid-19. Once someone has opted in, their phone will create a unique, anonymous code that is sent using Bluetooth Low Energy (BLE) signals to any other phones nearby—which store a log of these codes and when they received them. If a person receives a positive diagnosis for Covid-19, they can submit their ID code as positive to a central database. All other phones will then check back in to the database and see if there's a match to an infected person. If so, the user will get an alert saying they've potentially been exposed.

Think of it like sharing raffle tickets with every person you come in contact with. When an infected number is called, your phone will automatically check your tickets to see if there's a match.

For the first phase, which launches in mid-May, users will need to download a third-party app built by state-level health agencies to participate in the program. Apple and Google for their part, will release an application programming interface (API) that allows Apple's iOS and Google's Android apps to communicate. In the second phase, the tech companies will seek to build the tool into their underlying platforms allowing users to toggle on participation in their phone settings.

Why are people excited about it?

We know that contact tracing is essential to reopening the country. As CDC Director Robert Redfield told NPR on Thursday, "very aggressive" contact tracing is key to ending this period of extreme social distancing. And while traditional contact tracing relies on a huge network of public health workers to interview everyone infected and find those they may have been in contact with, these efforts are enormously resource intensive.

Tom Frieden, the former head of the CDC, has argued we'd need "an army of 300,000 people" to effectively carry out a nationwide effort. Using technology to do the same, while plagued with its own logistical difficulties, is far cheaper and easier to scale than traditional contact interviewing. Plus, hiring all the people needed to make traditional tracing effective over the next couple weeks appears unrealistic. This technology could be adopted on a much wider scale with less manpower needed.

It also has other potential benefits—specifically that it relies less on fallible human memory. For instance, while people may forget who they’ve talked to in the last couple weeks and likely won't remember every person they’ve passed on the sidewalk, in the grocery store, or on the way to work, technology has the ability to remember.

But not so fast… the 5 potential limitations of the tool

However, despite the promise of Google and Apple's solution, industry experts have been quick to raise a number of possible limitations:

  1. It's not clear how well the Bluetooth will work. Bluetooth signals can theoretically travel up to 100 meters, but are often only effective at much shorter distances and easily blocked. As Askan Soltani, former chief technologist at FTC, noted, the new tool "might slip up in dense environments such as apartment buildings where phones could pick up signals through walls and give false positive results." It might also give a false positive if, for instance, contact between two individuals was blocked by something like a car window or other protective surface.

  2. Low adoption rates jeopardize the efficacy. A similar effort in the U.K. estimated that at least 60% of the adult population would need to download the app for it to be effective on a population basis. In Singapore, where a separate technology-backed effort is underway, a top official said 75% of the country would have to adopt the technology. But so far, only 20% of Singapore's population has followed through, meaning officials have only been able to assess the origin of half of cases.

    The idea that a majority of Americans would opt in to such a feature is unlikely, especially given the recent backlash against tech companies' privacy policies. However, if the U.S. government suggested that all Americans download the apps, its possible participation could be high enough to have a significant impact. About 92% of U.S. citizens have reported being compliant with social distancing orders, and if people believe contact tracing would help them get back to a normal life, they might be willing to try it.

  3. It could be hard to win back lost privacy. Although Apple and Google attest that they won't keep any records, are not using location tracking, and won't be able to personally identify anyone using the tool, true data anonymity can never be fully guaranteed. It's possible that people are willing to give up some privacy to stay safe during a pandemic, but critics argue that once privacy is relented, it's hard to get back (even if users remember to turn off the feature). This technology can be applied to many different use cases outside of pandemics, such as law enforcement, and that could make users uncomfortable.

  4. The system could amplify false positives—and rely on strong testing capacity. We know that the United States still doesn't have enough tests for every person with potential symptoms, and the tool relies on this testing capability to track potential spread. Testing capability will have to ramp up and turnaround times will have to shorten for the tool to be effective. Even if the testing situation improves, state agencies will have to find a way to verify that someone who sends an alert saying they've tested positive actually has the virus. Otherwise, it's possible that people will lie about a positive result, mistakenly, if they are worried well or intentionally, if they want to spread misinformation. Possible solutions include requiring a health care professional to validate the diagnosis or provide those with positive test a special code they must use to submit a diagnosis.

  5. It could come too late. Google and Apple are only launching the first phase in the next month and the second phase "in later months." And the apps using the technology, despite a head start from MIT, have yet to be built. Meanwhile, the peak of infection is predicted to arrive in mid-April so there's a possibility that we won't fully reap the benefits of the tool until, potentially, it could help the country combat a later wave in the fall.

What will this mean for Big Tech in health care moving forward?

Ultimately, Apple and Google have an opportunity to show they are serious about their commitment to improving health. It's rare to see two companies that have historically been fierce competitors team up for the greater good.

Both companies have been expanding rapidly into health care, and this tool—as well as many others they've launched in response to Covid-19—will provide them a deeper foothold into the industry. If this helps rebrand them as a health care player in the minds of consumers, it may have implications for years to come. In addition, it could establish greater cross-industry trust that Big Tech can safeguard health data—potentially accelerating partnerships with providers, pharma companies, or health plans.

Crucially, it could make patients more comfortable sharing their medical data. If tools like these make Americans consider giving up privacy in order to better assess their health risks, it could also accelerate their interest in participating in large-scale digital research trials, sharing patient-generated health data with their doctors, or even downloading their medical records on their smart phone. The growing movement towards generating more real-world evidence would likely accelerate.

At the same time, the potential for big reward comes with big risk. If this solution were to be hacked or there's a serious privacy breach, it would likely accelerate the "tecklash" (or backlash against Big Tech) in health care.

In all, just like masks and social distancing, the truth is that Apple and Google's tool is not going to be a perfect solution, but it may help. The remaining question is whether it will help enough or be effective enough to brand Apple and Google as the health care powerhouses they want to be.

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