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Abbreviations Coronavirus disease 2019 (COVID-19) World Health Organisation (WHO) European Centre for Disease Control (ECDC) Digital contact tracing app (DCTA) United Kingdom (UK) Global positioning system (GPS) Closed-circuit television (CCTV) Republic of Ireland (ROI) Ideal digital contact tracing app (IDCTA) Randomised controlled trials (RCTs) Application programming interface (API) European Data Protection Board (EDPB) General Data Protection Regulation (GDPR) Low Energy (LE) Temporary contact numbers (TCN) Pan-European Privacy Preserving Proximity Tracing (PEPP-PT) Decentralized Privacy Preserving Proximity Tracing (DP-3T initiative) References
Source publication
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 tr...
Citations
... Most countries introduced their first version of the contact-tracing app in 2020 during the COVID-19 pandemic period [6]. The low adoption rates directly impacted the app's effectiveness since these apps typically require over 60% of people to utilise them to achieve efficacy [11]. ...
... Their availability has enhanced traditional contact-tracing by providing timely and automated notifications, ultimately supporting public health efforts to curb transmission of infectious diseases. Digital contact-tracing was first introduced in March 2020 in Singapore [6] during the COVID-19 pandemic, only being a feasible option due to the wide ownership of Smart devices. In 2011, over 4 billion mobile ...
(1) Background: Contact-tracing apps only achieve their aims if the majority of the population installs and actively engages with them. Such acceptance depends on public perceptions and are likely influenced by privacy and security concerns. Therefore, this review evaluates public perceptions towards the privacy and security of contact-tracing apps used during the recent COVID-19 pandemic, with a focus on identifying factors that influence acceptance. (2) Methods: A systematic literature review was performed. A total of 114 articles were retained as per the inclusion criteria, which included quantitative, qualitative, and mixed-methods studies. The data were analysed using thematic analysis. (3) Results: Eight main themes were derived: privacy,data protection and control, trust, technical issues, perceived benefit, knowledge and awareness, social influence, and psychological factors. (4) Conclusions: Improving privacy standards and the awareness of the digital contact-tracing process will encourage the acceptance of contact-tracing apps.
... Such smartphone apps were essential for overcoming COVID-19 [28,29]. Nevertheless, there were also limits to the use and acceptance of these apps, owing to various issues such as privacy, user experience, ethical issues, data protection, and lack of trust [30][31][32][33]. This means that public apps must be developed with their price value in mind, in terms of what users are likely to pay for them-even in cases such as infectious disease outbreak management, where people may not have a choice in the matter. ...
Background
In the wake of the coronavirus disease-19 (COVID-19) pandemic, research on the difficulties faced by epidemiologists conducting epidemiological investigations has been progressing steadily. However, few studies have developed applications (apps) that can directly support epidemiological investigations via information and communication (ICT) technology, and conducted usability evaluations on them via user responses. This has caused difficulties when developing such technologies. We introduced and evaluated two mobile apps that support epidemiological investigations. This study attempted to identify the predictors affecting the acceptance of infectious disease self-management apps.
Methods
We developed two infectious disease self-management smartphone apps for epidemiological investigations: KODARI (the Korean version) and MEDARI (in English version). We collected data from 248 users of KODARI by surveying Korean citizens. This study was conducted from November 15 to December 14, 2022. We used multiple regression analysis to identify the variables that affected continuous intention to use the KODARI app. We conducted two independent-samples t-tests to determine whether there were any differences in the perception of each variable in relation to demographic and COVID-19-related user characteristics.
Results
The factors that affected continuous intention to use the KODARI app, in order of relative importance, were: price value, satisfaction, performance expectancy, and facilitating conditions. Overall, male participants were more satisfied with the KODARI app than female ones, and more willing to continue using it. The male participants also evaluated facilitating conditions more positively than the female ones did. Married participants rated the app higher than single ones in terms of price value, performance expectancy, and continued intention to use.
Conclusions
The study suggests factors that increase the use of health apps and suggests that use of these apps may increase further in the event of a future pandemics. These results are expected to help researchers study other infectious disease apps in the context of public health surveillance.
... Consequently, the KODARI application's key benefit is enabling individuals to selfmanage infectious diseases during endemic periods, exemplifying the characteristics of an ideal digital tracking application. 2,32,33 Third, the data were used to build big epidemiological data through donations. It is possible to build big data based on the status of patients with infectious diseases. ...
Objectives: Rapid epidemiological investigations are fundamental to prevent the spread of infectious diseases such as coronavirus disease 2019. An epidemiological investigation presents significant challenges for both epidemiologists and infected individuals. It requires creating an environment that enables people to independently manage infectious diseases and voluntarily participate in epidemiological investigations. Methods: We developed the KODARI application, an epidemiological investigation support system that users can voluntarily use. We developed the questionnaires based on literature reviews. We evaluated the application through an online survey from December 2 to 14, 2022. Results: The application automatically or manually collect epidemiological investigation information. The application improved data accuracy through accurate information collection. It voluntarily can transmit self-management information to epidemiologist terminals or users in real time. We collected 248 users from an online survey. Most users had high ratings and willingness to use. They have willingness to manage infectious patients was substantial. The application was evaluated as helpful for epidemiological investigations and could shorten the time required for epidemiological investigations by more than 30 min. Conclusion: The application proposes a model based on people’s voluntary participation. We demonstrated that the application could enhance epidemiological investigations and diminish the duration of existing epidemiological investigation processes.
... Due to its availability in smartphones, BLE is recommended for proximity sensing. 9 However, BLE combined with ultrasound technology is likely to enhance the accuracy of the app if used together. ...
Background
Bluetooth low energy (BLE)-based contact-tracing applications were widely used during the COVID-19 pandemic. However, the use of only the received signal strength feature for proximity calculations may not be adaptable to different virus variants or scalable for other potential epidemic diseases.
Objective
This study presents a novel framework in regard to evaluating and classifying personal exposure risk that considers both contact features, which include distance and length of contact, and environment features, which include crowd size and the number of recently infected cases in the environment. The framework utilizes a fuzzy expert system that is adaptable to different virus variants.
Methods
The proposed method was tested on two viruses with different close contact features, which used four membership functions and 256 fuzzy rule sets.
Results
The proposed framework classified personal exposure risks into four classes, which include low, medium, high, and too high risk. The empirical results showed that the fuzzy logic-based approach reduced the number of false positive cases and demonstrated better accuracy and precision than the current BLE-only approaches.
Conclusions
The proposed framework provides a more practical and adaptable method in regard to assessing exposure risks in real-world scenarios. It has the potential to be scalable and adaptable to different virus variants and other potential epidemic diseases by considering both contact and environment features. These findings may be useful in order to develop more effective digital contact-tracing applications and policies.
... However, the international experience of digital contact tracing apps during the COVID-19 pandemic demonstrated how challenging their design and deployment are, including ethical issues such as data protection and privacy. In this field, there is potential for promising advancements through the integration of blockchain technology, ultrawideband technology, and artificial intelligence in app design (O'Connell et al. 2021). ...
Aim
This scoping review explores key concepts related to the prevention, treatment, and rehabilitation of COVID-19, offering insights for future pandemic preparedness and response strategies.
Subject and methods
A scoping review was conducted using electronic databases including PubMed, EBSCO (CINAHL, APA PsycINFO), and Cochrane. The results were filtered for papers published in English, German, Italian, Spanish, and Dutch until 31 December 2022. Eighty-one articles were selected for the scoping review. Moreover, gray literature on guidelines was retrieved from reports by each country’s main institution for pandemic management, European Centre for Disease Prevention and Control (ECDC), and the World Health Organization (WHO).
Results
From the analyzed articles several key points emerged, highlighting main issues facing the COVID-19 pandemic. The challenges in prevention include emphasizing airborne precautions, addressing diverse adherence to social distancing, and overcoming challenges in digital contact tracing. In the realm of treatment, essential considerations include personalized patient management and the significance of holistic care. Rehabilitation efforts should prioritize post-COVID conditions and explore suggested management models. Addressing the social impact involves recognizing psychological effects, advocating for quality improvement initiatives, and for the restructuring of public health systems.
Conclusion
This scoping review emphasizes the profound impact of the COVID-19 pandemic on the global and European population, resulting in a significant death toll and widespread long-term effects. Lessons learned include the critical importance of coordinated emergency management, transparent communication, and collaboration between health authorities, governments, and the public. To effectively address future public health threats, proactive investment in infrastructure, international collaboration, technology, and innovative training is crucial.
... These systems allow monitoring of the location and movements of healthcare personnel within healthcare facilities. This can be particularly useful in the context of healthcare-associated infections (HAIs), as it enables rapid identification of healthcare workers (HWs) who had contact with infected patients and taking necessary measures to limit the spread of infections within healthcare facilities [39]. ...
... They can support the training and education of healthcare staff, thereby improving their skills and awareness regarding HAI prevention practices. Additionally, the data can provide insights for evaluating the effectiveness of preventive measures implemented in healthcare facilities, such as proper use of personal protective equipment (PPE) or compliance with hand hygiene procedures [16,39,40]. ...
Background: Pandemic management and preparedness are more needed than ever before and there is widespread governmental interest in learning from the COVID-19 pandemic in order to ensure the availability of evidence-based Infection Prevention and Control measures. Contact tracing is integral to Infection Prevention and Control, facilitating breaks in the chain of transmission in a targeted way, identifying individuals who have come into contact with an infected person, and providing them with instruction/advice relating to testing, medical advice and/or self-isolation. Aim: This study aims to improve our understanding of the use of contact tracing technologies in healthcare settings. This research seeks to contribute to the field of Infection Prevention and Control by investigating how these technologies can mitigate the spread of nosocomial infections. Ultimately, this study aims to improve the quality and safety of healthcare delivery. Methods: A systematic literature review was conducted, and journal articles investigating the use of contact tracing technologies in healthcare settings were retrieved from databases held on the OvidSP platform between March and September 2022, with no date for a lower limit. Results: In total, 277 studies were retrieved and screened, and 14 studies were finally included in the systematic literature review. Most studies investigated proximity sensing technologies, reporting promising results. However, studies were limited by small sample sizes and confounding factors, revealing contact tracing technologies remain at a nascent stage. Investment in research and development of new testing technologies is necessary to strengthen national and international contact tracing capabilities. Conclusion: This review aims to contribute to those who intend to create robust surveillance systems and implement infectious disease reporting protocols.
... Hence, decentralized protocols are privacy-preserving. The first generations of COVID-19 contact-tracing applications were launched in Asia [5,6,11,21,25,30]. However, most of the COVID-19contact-tracing applications launched in Asia rely on centralized protocols. ...
... However, most of the COVID-19contact-tracing applications launched in Asia rely on centralized protocols. In contrast, most of the launched COVID-19contact-tracing applications in Europe and the USA use decentralized protocols to preserve the privacy [1,6,21,25,32]. ...
Digital contact tracing substantially improves the identification of high-risk contacts during pandemics. Despite several attempts to encourage people to use digital contact-tracing applications by developing and rolling out decentralized privacy-preserving protocols (broadcasting pseudo-random IDs over Bluetooth Low Energy---BLE), the adoption of digital contact tracing mobile applications has been limited, with privacy being one of the main concerns. In this paper, we propose a decentralized privacy-preserving contact tracing protocol, called DP-ACT, with both active and passive participants. Active participants broadcast BLE beacons with pseudo-random IDs, while passive participants model conservative users who do not broadcast BLE beacons but still listen to the broadcasted BLE beacons. We analyze the proposed protocol and discuss a set of interesting properties. The proposed protocol is evaluated using both a face-to-face individual interaction dataset and five real-world BLE datasets. Our simulation results demonstrate that the proposed DP-ACT protocol outperforms the state-of-the-art protocols in the presence of passive users.
... Therefore, it is important to establish a strong privacy by design and default approaches as set out under the GDPR. 73 Complying with the principles of successful data protection and privacy by design is important to persuade target populations to download and use digital contact tracing applications (O'Connell et al., 2021). Embedding GDPR requirements into the designed application could drastically reduce the risk of breach of the GDPR requirements. ...
The first global pandemic in the age of digitalism indicated that there might be new types of privacy risks stemming from the processing activities taking place within the scope of digital contact tracing activities. While the right to life of all individuals living in the community should be primarily protected, their right to privacy should also be considered. Therefore, a balance between privacy and public health should be struck by both regulators and data controllers. The purpose of this review is to analyze the compliance efforts of data controllers in Europe with the existing EU data protection regulations, and guidance, and draw lessons for the use of contact tracing applications within the scope of potential disaster scenarios that may arise in the future by reviewing the existing literature and the privacy policies of the applications.
... Another important aspect that has been observed empirically but that is often disregarded in CT app models is the presence of heterogeneities in the app adoption process and its use [16][17][18] . App adoption is a dynamic process, where individuals can install/uninstall the app at will, changing their decision as the epidemic evolves. ...
Albeit numerous countries relied on contact-tracing (CT) applications as an epidemic control measure against the COVID-19 pandemic, the debate around their effectiveness is still open. Most studies indicate that very high levels of adoption are required to stop disease progression, placing the main interest of policymakers in promoting app adherence. However, other factors of human behaviour, like delays in adherence or heterogeneous compliance, are often disregarded. To characterise the impact of human behaviour on the effectiveness of CT apps we propose a multilayer network model reflecting the co-evolution of an epidemic outbreak and the app adoption dynamics over a synthetic population generated from survey data. The model was initialised to produce epidemic outbreaks resembling the first wave of the COVID-19 pandemic and was used to explore the impact of different changes in behavioural features in peak incidence and maximal prevalence. The results corroborate the relevance of the number of users for the effectiveness of CT apps but also highlight the need for early adoption and, at least, moderate levels of compliance, which are factors often not considered by most policymakers. The insight obtained was used to identify a bottleneck in the implementation of several apps, such as the Spanish CT app, where we hypothesise that a simplification of the reporting system could result in increased effectiveness through a rise in the levels of compliance.
... According to the temporary law, the Finnish app would be voluntary and free for the public to use [5]. These principles are in line with findings in a review on best guidance for DPT apps [6]. The national legislation and the European guidelines defined the handling of personal data and directed the Finnish app to use a decentralized model and the Google and Apple Exposure Notification system without collecting location data [5,7]. ...
Exposure notification applications (ENAs) or digital proximity tracing apps were used in several countries during the COVID-19 pandemic. In this viewpoint, we share our experience of implementing and running the Finnish ENA (Koronavilkku), one of the national ENAs with the highest proportion of users during the pandemic. With the aim of strengthening public trust and increasing app uptake, there was a strong prioritization of privacy and data security for the end user throughout the ENA development. This, in turn, limited the use of the app as a tool for health care professionals and deeper insight into its potential effectiveness. The ENA was designed to supplement conventional contact tracing, rather than replace it, and to serve as an early warning system and a trigger for action for the user in case of potential exposure. The predefined target of 40% uptake in the population was achieved within 3 months of the ENA launch. We consider easy-to-understand information produced together with communication experts crucial during the changing pandemic situation. This information educated people about the app as one component in mitigating the pandemic. As the pandemic and its mitigation evolved, the ENA also needed adapting and updating. A few months after its launch, Finland joined European interoperability, which allowed the ENA to share information with ENAs of other countries. We added automatic token issuing to the ENA as of mid-2021. If added earlier and more comprehensively, automatization could have more effectively saved resources in health care services and prevented overburdening contact tracing teams, while also notifying potentially exposed individuals quicker and more reliably. In the spring of 2021, the number of active apps started to gradually decline. Quarantine and testing practices for asymptomatic vaccinated individuals following exposure to the virus were eased and home tests became more common, eventually replacing laboratory testing for much of the population. Taken together, this led to decreased token issuance, which weakened the potential public health usefulness of the app. A self-service option for token issuance would likely have prolonged the lifespan of the app. The ENA was discontinued in mid-2022. Regularly conducted surveys would have helped gain timely knowledge on the use and effectiveness of the app for better responding to the changing needs during the pandemic.
