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Sarah Tuneberg: Don't Fear COVID-19 Phone Exposure Notifications

Sarah Tuneberg leads Colorado's coronavirus innovation response team.
Sarah Tuneberg leads Colorado's coronavirus innovation response team.

During Governor Jared Polis's September 8 update on the fight against COVID-19, Sarah Tuneberg, who leads Colorado's containment and testing team, teased a new cell-phone feature that would inform people if they were near someone with the novel coronavirus for a concerning length of time.

The exposure notification service, which was supposed to be available around the end of last month, took a little longer to perfect than anticipated. But the Colorado Department of Public Health and Environment began rolling it out yesterday, October 25, and the process will continue over the next day or so for those with iPhones and Androids — although implementation differs.

"The technology works the same on both phones, but the way the user interacts is based on the operating system," Tuneberg explains. "On Apple IOS devices, you will enable the service in your settings menu just like you'd do to enable Bluetooth or airplane mode. In that menu, you'll see 'exposure notifications,' and you'll slide it across, just like the other ones. After that, you'll have to identify your location, so the phone will know you're part of the Colorado program, and consent to participate. And for the Android experience, you have to download a free app from the Google Play store. You'll get a push notification and be sent to the store if you identify that you want to use it. But in either circumstance, you can turn it off and turn it on. We'd love for people to leave it on, but if you want to disable the service, you can do that."

Such reassurances are part and parcel of Tuneberg's current task: to tout the benefits of the notifications and assure folks who may see it as a Big Brother-style intrusion on their privacy that nothing could be further from the truth.

"Everything about this service and the way it's been built and the way it's being deployed in Colorado is about personal choice and privacy protection," she stresses. "Individuals can choose at any point to enable or disable the technology, and to share their status anonymously or not to. It's really individual choice, which is the classic Colorado spirit."

Here's how Tuneberg explains how it works: "The service uses Bluetooth and some technology that automatically generates random strings of letters and numbers, which we call tokens. When two phones that have enabled this service are within close proximity as defined by the CDC [Centers for Disease Control and Prevention], these tokens are periodically shared with one another and stored."

These figures become important in scenarios like one Tuneberg constructs around a fictional pair she dubs Bob and Alice (apparently Carol and Ted, the other title characters from a memorable 1969 film, were busy elsewhere).

"Let's say Bob is at a cafe and he crosses paths with Alice," she begins. "They have a nice conversation, but they're a little too close for too long, and their phones exchange these tokens. Then Bob has symptoms, and when contact tracers talk to him, they ask, 'Do you have the exposure notifications app on this phone? Would you like to alert individuals who you've been in proximity with that they might have been exposed to COVID-19?' He can make that choice, and if he says, 'Yes, I'd love to do that,' the local public-health agency will send a text to Bob — a short, three-question process by which he will essentially enter a key that unlocks the tokens. And the phones that have the matching part of the tokens will get an alert saying, 'You might have been exposed to COVID-19 and here's where to get a test.'"

Polis offers a similar recitation in the following video:

The ability to choose whether to let others know about possible exposure is similar to typical contact-tracing procedure. Tuneberg points out that "COVID-19 is a mandatory reportable communicable disease, and when you test positive, your public-health agency is notified and your name and phone number are provided, because it's dangerous. When an investigator calls an individual, we obviously want people to answer the call and speak freely and honestly and transparently about where they've been or who else might have been exposed. But if an individual doesn't want to disclose that perhaps they went to a party, we can't compel them, because we don't know their behavior. But we want them to — and we want them to know they're not going to be in trouble. This is about protecting other people's health, and nobody's going to be in trouble for what they disclose in a case."

Tuneberg continues: "Contact tracers are never, ever, ever going to share any personally identifiable information. If Bob and Alice were in that cafe and Bob happened to have Alice's phone number and they decided to talk again, and he provides that number to an investigator, the investigator would never say to Alice, 'Bob gave me the phone number.' Public health is about privacy protection as much as possible, and this technology is also about privacy."

As for concerns that the service will allow shadowy government types to trace a person's every movement, Tuneberg emphasizes that "one of the most interesting and, to me, compelling parts of the technology is that it can't track you. There is no personally identifiable data, and it does not use GPS. If someone were to hack into a phone and see the data associated with it, it would truly be a series of randomized letters and numbers with a date and a time stamp on it, and that's it. You would be unable to reconstruct anything about anybody or their whereabouts. This was key to Colorado joining and utilizing and deploying this technology — that it wouldn't have any privacy concerns and it would be impossible to track someone."

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Of course, Tuneberg knows that the sort of people who've politicized mask usage, often by using misinformation, may not believe that the service is benign. "It's disheartening, for sure," she concedes. "We're in a very different state of affairs, where things have become very political, and where public-health actions are seen as being less about helping other people and being empathetic. But ultimately, case investigations and participating in programs like this one are an empathetic gift to others — mostly friends and family, but also strangers."

Colorado is combating COVID-19 with what Tuneberg characterizes as "the Swiss cheese model. No intervention is 100 percent effective, so what we have to do is layer together as many interventions as we can, so that one layer of Swiss cheese covers the holes in the other ones. So this is another layer of Swiss cheese in our containment strategy, and it's a good one."

Indeed, Tuneberg says that if even 15 percent of Coloradans enable the exposure notifications, disease transmission is expected to go down by as much as 8 percent, with an attendant 6 percent dip in fatalities. "We would be thrilled to have that level of adoption, and anything above it increases those numbers significantly. So we're going to shoot for the stars here."

Learn more about Colorado exposure notifications here.

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