Contact Tracing and Tech: An International Comparison

Jul 9, 2020 by BBB National Programs

To confront coronavirus, governments across the globe have devised approaches for tracing its spread and quarantining individuals known to be carriers, also known as “contact tracing.” While almost all strategies rely on traditional means of contacting and recording the movements of infected individuals, many employ modern communications technologies: sensors, Bluetooth, GPS, thermal recognition, facial-recognition, and geofencing.

In the United States, the tech giants Google and Apple have developed a Bluetooth-based plan for contact tracing, hoping that governments across the world will adopt this “decentralized” model which purports to maximize user privacy. Our last article covered the practical and technical limitations of these plans.

Some U.S. states and many governments in Europe are developing mobile apps based around “centralized” contact tracing, in which information about coronavirus infection and movement is shared with a third party, such as a public health authority. These attempts aim to balance privacy with robust data sharing.

In East Asia some governments have adopted centralized models for contact tracing that use a variety of electronic surveillance methods to identity, track, and quarantine individuals who have tested positive for the virus, focusing on the collective benefit of stopping the virus as quickly as possible. 


The American Approach

The Private Sector

U.S. tech corporations have proposed several contact tracing plans, with one of the most well-known models coming from Apple and Google. This exposure notification framework, launched in May 2020, proposes changes to the Android and iOS operating systems and an accompanying application program interface (API). These can be used to create apps which use Bluetooth LE to record when an individual comes into contact with others and provide an alert if one or more contacts is later diagnosed with coronavirus.  

Other corporations have proposed their own Bluetooth-powered models, focusing on contact tracing in the workplace or helping governments conduct contact tracing through traditional recordkeeping. Finally, some companies that specialize in location data marketing have promoted using GPS data to track the spread of coronavirus.



The U.S. federal government has not launched any dedicated contact tracing app, as it has worked to support states with guidelines, research, and medical resources to contain the pandemic. The Trump Administration has commended steps taken by Apple and Google’s Bluetooth plan, though it has voiced some privacy concerns. 



U.S. states have relied on several contact tracing strategies. Some states, like New York, Massachusetts, and California, have opted for a more traditional contact tracing strategy, relying on personnel conducting phone calls to infected individuals to learn about their movements and encounters. Other states have developed contact tracing apps which take a combination of centralized and decentralized approaches.

  • Alabama: Announced development of an app based on the decentralized Google-Apple framework.
  • Utah: Launched  Healthy Together app that tracks users’ proximity and location through Bluetooth and GPS and shares this data with public health officials. This represents a centralized approach.
  • North Dakota: First launched CARE19 app that tracks users’ locations using GPS and gives users the option of sharing their information to the North Dakota Department of Health. This represented a partially decentralized approach, though after some researchers recently identified privacy issues with this app, the state is planning on launching a second app that follows the Google-Apple framework.
  • Rhode Island: Launched CRUSH COVID RI, which allows users to opt-in to the collection of their location data. Like the North Dakota app, it stores contact tracing data locally on the phone with the option of sending information to the Rhode Island Department of Health. This also represents a partially decentralized approach.
  • South Carolina: Recently announced it was developing a contact tracing app based on the Google-Apple framework.  



The European Approach


In the United Kingdom, the National Health Service (NHS) has launched its own contact tracing app, NHSX. NHSX relies on Bluetooth to collect data and notify contacts of possible coronavirus infection. The UK has launched the app in the Isle of Wight and is planning for the app’s use to be voluntary. Unlike Apple and Google’s proposed contact tracing solutions, NHSX takes a centralized approach, sending data to the NHS for research purposes.



Similar to the United Kingdom, France has also taken a centralized, Bluetooth-based approach with its StopCovid app. Their protocol, ROBERT, will share contact data from apps with a central government database for tracking the spread of the disease. This has prompted concern from French privacy and security experts. As the French government weighed privacy concerns regarding its ROBERT protocol, it asked Apple to allow iOS to let Bluetooth run in the background while a phone is locked to ensure that its ROBERT model functions efficiently. To date, Apple will only allow background Bluetooth activity for contact tracing solutions that incorporate the Google-Apple model. 



Previously, Germany had coordinated with France on its centralized ROBERT model for contact tracing, but indicated in April 2020 that the country would take a decentralized approach in line with Apple and Google’s proposal. This is partially as a result of the proposed ROBERT framework depending on iOS being able to run Bluetooth in the background, and Apple’s refusal to make the requested changes. 


Other European Countries

Switzerland, Austria, and Estonia have backed a decentralized approach to contact tracing called DP-3T, which will allow integration with the Google and Apple API. At the end of May 2020, Switzerland launched its pilot app, SwissCovid, and in early June 2020 Italy also launched an app also based on the Google-Apple framework. 


The East Asian Approach


Following the initial outbreak of coronavirus in Wuhan, China leveraged its large tech platforms to engage in centralized contract tracing measures. For example, Chinese tech platforms including Alipay, Baidu, and WeChat pushed out “applets” on their main products that generate QR codes for Chinese citizens. Each QR code provides a color-coded risk assessment that Chinese users must display to access certain goods and public services. The color codes are based on location data and other records that assess whether a user was in contact with an infected person. Each time a code is scanned, a user’s location is reported to government-controlled servers.

For returning international travelers, China has also issued location tracking wristbands paired with an app that relies on geofencing (a type of digital boundary) to enforce a 14-day quarantine period. China has also deployed advanced thermal detection and facial recognition technology to  identify individuals with fevers and those not wearing masks.

These tech-focused efforts took place alongside other strict quarantine and testing measures, and the mustering of a large workforce to engage in traditional interview-based contact tracing.

Notably, China has also integrated its coronavirus response into its social credit system. For example, citizen’s social credit scores can be penalized if they don’t download particular reporting apps or follow rules regarding quarantine.


South Korea

Through an aggressive, centralized means of contract tracing, South Korea was very successful at halting the spread of coronavirus. However, the country deployed several strong surveillance tools to achieve this. For instance, the Korean government directed credit card companies to pull information regarding individuals who were in contact with known infected persons. The government then ordered such individuals to quarantine and install contact tracing apps which track users’ precise location using GPS. Healthy users were also informed through these mobile apps of their proximity to locations traversed by infected individuals, and contact tracers examined CCTV records in order to identify possibly exposed individuals. Like China, South Korea has recently begun utilizing QR codes to enter and exit certain businesses and facilities.

“Some of the strongest responses we’ve seen in East Asia, such as South Korea and Taiwan, we’re looking back to the age of MERS, being a little bit more recent than SARS. In 2004 when SARS broke out the whole infrastructure around the [public health system] wasn’t quite as developed in South Korea in particular,” said Emma Rafaelof, Senior Manager with the Information Technology Industry Council. “From that experience of MERS, contact tracing gained quite a bit in terms of the organizational efficiency of government to carry that out. Now, they’re equipped with other tools. The mobile environment in general has gotten a lot better in recent years. Because of the general level of connectivity and the development of those mobile networks, [South Korea] has a lot of success with being able to more uniformly achieve policy goals with that program.”



Taiwan, which was able to fend off a significant outbreak, employed geofencing technology to quarantine returning travelers, in coordination with checkups from social and health workers. This centralized approach relied on telecom providers to detect the location of individuals through cell tower triangulation, alerting police when users break the geofence.

“SARS in particular with Taiwan left a little bit of a scar on the memory of public health,” said Emma Rafaelof. “There was definitely a build up of lessons over time. SARS in some ways was the first warning sign, but at the time of MERS, there was a lot more technology available to really accomplish more advanced forms of contact tracing.”


Other Nations


Australia recently launched its COVIDSafe app, which is based on Singaporean contact tracing app TraceTogether. COVIDSafe, which adopts a centralized approach, uses a combination of Bluetooth and stored contact data to alert users of possible contact with an individual suffering from coronavirus. Australia is aiming for at least 40% of its population to download the app, though recently reported software bugs may impact its effectiveness.



Singapore uses the Bluetooth-based Trace Together app, in which contact tracing data is stored locally on the phone. If a user is infected with the virus, they are required to share data from the app with government contact tracers. Like China and South Korea, the government has also experimented with other forms of tech interventions including bluetooth-based wearables and QR codes for entry and exit to public places. 



India has also created a contact tracing app, Aarogya Setu, which relies on both GPS and Bluetooth. The app has already been downloaded over 90 million times, with some regions in the country threatening strict penalties for those who do not install it. Like many of its European counterparts, data generated from use of the app is stored on centralized servers. The app has been criticized for a feature that allows users to view concentrations of people who may have coronavirus, which could theoretically be used to confirm the diagnosis of particular individuals.


Contact Tracing, Privacy, and the Broader World

Because coronavirus is a global problem, inevitable questions arise about the level of global coordination that is needed to contain the virus. As the world develops varying policy approaches to contact tracing which rely on a range of technologies and are built around different norms regarding privacy, communities should look to one another for new ideas and methods to contain the virus.  

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