Adherence and Association of Digital Proximity Tracing App Notifications With Earlier Time to Quarantine: Results From the Zurich SARS-CoV-2 Cohort Study

Menges, Dominik; Aschmann, Hélène E; Domenghino, Anja; Fehr, Jan; Puhan, Milo A.; Wyl, Viktor von

doi:10.3389/ijph.2021.1603992

Cited by 17 publications

(28 citation statements)

References 17 publications

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“…Nevertheless, the sample is likely well reflective of the population of app users as the sociodemographic characteristics associated with a higher propensity for electronic survey participation and SwissCovid app use likely overlap [ 17 ]. In contrary to the findings of another study [ 31 ], however, our database managed to cover all relevant segments of the Venn diagram, including groups of exposed contacts who received exposure notifications but did not respond to the warning. With even larger sample sizes, researchers can fulfill large enough subpopulation sizes to generate possible direct inference on digital proximity tracing effectiveness from the associated denominators.…”

Section: Discussionmentioning

confidence: 99%

Using Venn Diagrams to Evaluate Digital Contact Tracing: Panel Survey Analysis

Daniore¹,

Nittas²,

Moser³

et al. 2021

JMIR Public Health Surveill

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Background Mitigation of the spread of infection relies on targeted approaches aimed at preventing nonhousehold interactions. Contact tracing in the form of digital proximity tracing apps has been widely adopted in multiple countries due to its perceived added benefits of tracing speed and breadth in comparison to traditional manual contact tracing. Assessments of user responses to exposure notifications through a guided approach can provide insights into the effect of digital proximity tracing app use on managing the spread of SARS-CoV-2. Objective The aim of this study was to demonstrate the use of Venn diagrams to investigate the contributions of digital proximity tracing app exposure notifications and subsequent mitigative actions in curbing the spread of SARS-CoV-2 in Switzerland. Methods We assessed data from 4 survey waves (December 2020 to March 2021) from a nationwide panel study (COVID-19 Social Monitor) of Swiss residents who were (1) nonusers of the SwissCovid app, (2) users of the SwissCovid app, or (3) users of the SwissCovid app who received exposure notifications. A Venn diagram approach was applied to describe the overlap or nonoverlap of these subpopulations and to assess digital proximity tracing app use and its associated key performance indicators, including actions taken to prevent SARS-CoV-2 transmission. Results We included 12,525 assessments from 2403 participants, of whom 50.9% (1222/2403) reported not using the SwissCovid digital proximity tracing app, 49.1% (1181/2403) reported using the SwissCovid digital proximity tracing app and 2.5% (29/1181) of the digital proximity tracing app users reported having received an exposure notification. Most digital proximity tracing app users (75.9%, 22/29) revealed taking at least one recommended action after receiving an exposure notification, such as seeking SARS-CoV-2 testing (17/29, 58.6%) or calling a federal information hotline (7/29, 24.1%). An assessment of key indicators of mitigative actions through a Venn diagram approach reveals that 30% of digital proximity tracing app users (95% CI 11.9%-54.3%) also tested positive for SARS-CoV-2 after having received exposure notifications, which is more than 3 times that of digital proximity tracing app users who did not receive exposure notifications (8%, 95% CI 5%-11.9%). Conclusions Responses in the form of mitigative actions taken by 3 out of 4 individuals who received exposure notifications reveal a possible contribution of digital proximity tracing apps in mitigating the spread of SARS-CoV-2. The application of a Venn diagram approach demonstrates its value as a foundation for researchers and health authorities to assess population-level digital proximity tracing app effectiveness by providing an intuitive approach for calculating key performance indicators.

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Section: Discussionmentioning

confidence: 99%

Using Venn Diagrams to Evaluate Digital Contact Tracing: Panel Survey Analysis

Daniore¹,

Nittas²,

Moser³

et al. 2021

JMIR Public Health Surveill

Self Cite

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“…We previously found that receipt of SwissCovid ENs was associated with earlier time to quarantine among nonhousehold contacts [23]. Here, we provide more granular data that allow a detailed assessment of the events and actions taken along the notification cascade among 285 case-contact pairs.…”

Section: Principal Findingsmentioning

confidence: 91%

“…This study is based on data from the Zurich SARS-CoV-2 Cohort study, a prospective, case-ascertained study of 1106 individuals infected with SARS-CoV-2 (cases) and 395 of their contacts. A detailed description of the study design, its inclusion criteria, and its procedures are reported elsewhere [23]. In brief, all cases and their contacts in the canton of Zurich were identified through mandatory laboratory reporting and routine MCT by the Cantonal Department of Health and invited if they were ≥18 years old, residing in the canton of Zurich, had sufficient knowledge of the German language, and were able to follow the study procedures.…”

Section: Study Design and Participantsmentioning

confidence: 99%

“…Such findings are concerning since DPT effectiveness is built on the premise that users (ie, cases after receiving the upload authorization code or contacts after receiving the EN) will undertake the necessary actions to prevent further transmission. In this context, we recently highlighted the importance of the exposure setting in prompting individuals to undertake recommended actions after receiving an EN in a study of cases and contacts identified by MCT in the canton of Zurich [23]. We found that receipt of ENs was associated with a faster time until the start of quarantine when the transmission risk occurred in nonhousehold settings, while there was no effect on time to quarantine in same-household exposure settings, where information flows are bound to be faster.…”

Section: Introductionmentioning

confidence: 99%

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Individual-Level Evaluation of the Exposure Notification Cascade in the SwissCovid Digital Proximity Tracing App: Observational Study

Menges¹,

Aschmann²,

Jung³

et al. 2022

JMIR Public Health Surveill

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Background Digital proximity tracing (DPT) aims to complement manual contact tracing (MCT) in identifying exposed contacts and preventing further transmission of SARS-CoV-2 in the population. Although several DPT apps, including SwissCovid, have shown to have promising effects on mitigating the pandemic, several challenges have impeded them from fully achieving the desired results. A key question now relates to how the effectiveness of DPT can be improved, which requires a better understanding of factors influencing its processes. Objective In this study, we aim to provide a detailed examination of the exposure notification (EN) cascade and to evaluate potential contextual influences for successful receipt of an EN and subsequent actions taken by cases and contacts in different exposure settings. Methods We used data from 285 pairs of SARS-CoV-2-infected cases and their contacts within an observational cohort study of cases and contacts identified by MCT and enrolled between August 6, 2020, and January 17, 2021, in the canton of Zurich, Switzerland. We surveyed participants with electronic questionnaires. Data were summarized descriptively and stratified by exposure setting. Results We found that only 79 (58.5%) of 135 contacts using the SwissCovid app whose corresponding cases reported to have triggered the EN also received one. Of these, 18 (22.8%) received the EN before MCT. Compared to those receiving an EN after MCT (61/79, 77.2%), we observed that a higher proportion of contacts receiving an EN before MCT were exposed in nonhousehold settings (11/18, 61.1%, vs 34/61, 55.7%) and their corresponding cases had more frequently reported mild-to-moderate symptoms (14/18, 77.8%, vs 42/61, 68.9%). Of the 18 contacts receiving an EN before MCT, 14 (77.8%) took recommended measures: 12 (66.7%) were tested for SARS-CoV-2, and 7 (38.9%) called the SwissCovid Infoline. In nonhousehold settings, the proportion of contacts taking preventive actions after receiving an EN was higher compared to same-household settings (82%, vs 67%). In addition, 1 (9%) of 11 ENs received in the nonhousehold setting before MCT led to the identification of a SARS-CoV-2-infected case by prompting the contact to get tested. This corresponds to 1 in 85 exposures of a contact to a case in a nonhousehold setting, in which both were app users and the case triggered the EN. Conclusions Our descriptive evaluation of the DPT notification cascade provides further evidence that DPT is an important complementary tool in pandemic mitigation, especially in nonhousehold exposure settings. However, the effect of DPT apps can only be exerted if code generation processes are efficient and exposed contacts are willing to undertake preventive actions. This highlights the need to focus efforts on keeping barriers to efficient code generation as low as possible and promoting not only app adoption but also compliance with the recommended measures upon an EN. Trial Registration International Standard Randomised Controlled Trial Number Registry 14990068; https://doi.org/10.1186/ISRCTN14990068

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“…Recent evidence suggests that these tools can help mitigate the spread of COVID-19 [3][4][5]. However, their performance relies, in part, on sufficient adoption by smartphone owners [6].…”

Section: Wa Notifymentioning

confidence: 99%

Equity and Accessibility of Washington State’s COVID-19 Digital Exposure Notification Tool (WA Notify): Survey and Listening Sessions Among Community Leaders

Bonnell¹,

Revere²,

Baseman³

et al. 2022

JMIR Form Res

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Background In November 2020, WA Notify, Washington State’s COVID-19 digital exposure notification tool, was launched statewide to mitigate ongoing COVID-19 transmission. WA Notify uses the Bluetooth proximity–triggered, Google/Apple Exposure Notification Express framework to distribute notifications to users who have added or activated this tool on their smartphones. This smartphone-based tool relies on sufficient population-level activation to be effective; however, little is known about its adoption among communities disproportionately impacted by the COVID-19 pandemic or what barriers might limit its adoption and use among diverse populations. Objective We sought to (1) conduct a formative exploration of equity-related issues that may influence the access, adoption, and use of WA Notify, as perceived by community leaders of populations disproportionately impacted by the COVID-19 pandemic; and (2) generate recommendations for promoting the equitable access to and impact of this novel intervention for these communities. Methods We used a 2-step data collection process to gather the perspectives of community leaders across Washington regarding the launch and implementation of WA Notify in their communities. A web-based, brief, and informational survey measured the perceptions of the community-level familiarity and effectiveness of WA Notify at slowing the spread of COVID-19 and identified potential barriers and concerns to accessing and adopting WA Notify (n=17). Semistructured listening sessions were conducted to expand upon survey findings and explore the community-level awareness, barriers, facilitators, and concerns related to activating WA Notify in greater depth (n=13). Results Our findings overlap considerably with those from previous mobile health equity studies. Digital literacy, trust, information accessibility, and misinformation were highlighted as key determinants of the adoption and use of WA Notify. Although WA Notify does not track users or share data, community leaders expressed concerns about security, data sharing, and personal privacy, which were cited as outweighing the potential benefits to adoption. Both the survey and informational sessions indicated low community-level awareness of WA Notify. Community leaders recommended the following approaches to improve engagement: tailoring informational materials for low-literacy levels, providing technology navigation, describing more clearly that WA Notify can help the community, and using trusted messengers who are already engaged with the communities to communicate about WA Notify. Conclusions As digital public health tools, such as WA Notify, emerge to address public health problems, understanding the key determinants of adoption and incorporating equity-focused recommendations into the development, implementation, and communication efforts around these tools will be instrumental to their adoption, use, and retention.

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Adherence and Association of Digital Proximity Tracing App Notifications With Earlier Time to Quarantine: Results From the Zurich SARS-CoV-2 Cohort Study

Cited by 17 publications

References 17 publications

Using Venn Diagrams to Evaluate Digital Contact Tracing: Panel Survey Analysis

Using Venn Diagrams to Evaluate Digital Contact Tracing: Panel Survey Analysis

Individual-Level Evaluation of the Exposure Notification Cascade in the SwissCovid Digital Proximity Tracing App: Observational Study

Equity and Accessibility of Washington State’s COVID-19 Digital Exposure Notification Tool (WA Notify): Survey and Listening Sessions Among Community Leaders

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