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The federal COVID Alert app is seen on Oct. 5, 2020 in Montreal.Ryan Remiorz/The Canadian Press

Alberta and British Columbia, the only two provinces that have not activated Canada’s COVID-19 exposure notification app, say they won’t adopt the federal system until they are satisfied that it will help, not hinder, their contact-tracing efforts.

B.C.'s Health Minister warned this week that if the federal app were adopted with its current deficiencies, it could put unnecessary strain on the province’s public-health system just as case counts have skyrocketed.

“Our goal is to ensure that any additional app in B.C. contributes to the situation and doesn’t make it harder to do contact tracing," Adrian Dix said.

In Alberta, Premier Jason Kenney walked back the province’s commitment to join the federal system, arguing it is not as effective as his government’s own app because it does not connect with the province’s contact-tracing network. However, on Thursday, Alberta’s system imploded, and contact tracers are no longer using the provincial app to reach out to an infected person’s close contacts unless that individual falls into one of three priority groups.

The federal app, COVID Alert, has been downloaded more than five million times across the country and has been touted as an efficient means of alerting people who may have come into contact with someone who has tested positive for COVID-19.

As case counts rise across the country and contact-tracing teams struggle to keep up, B.C. and Alberta are under pressure to join the national system. But some experts say the provinces' concerns have merit, such as questioning whether the information the app provides is so vague that it risks bogging down contact tracing rather than complementing it.

Ottawa launched COVID Alert in late July, with Ontario signing on first. The program relies on Bluetooth signals to track a user’s phone in relation to others. A user who tests positive for COVID-19 can voluntarily key a code into the app, which then sends exposure alerts to phones that were within two metres of the infected person’s device for at least 15 minutes in the previous two weeks.

Out of privacy concerns, the exposure notification does not provide identifying details such as the name of the infected person or where the exposure may have occurred – which may explain why its uptake has been so high.

As of Nov. 2, users had keyed codes into the app 3,305 times, and 2,016 of those came from Ontario residents, according to Sebastian Skamski, a spokesman for Peter Bethlenfalvy, Ontario’s Minister Responsible for Digital Government and Data Transformation. As a result, the app notified “tens of thousands of Ontarians of potential exposure to COVID-19, directing them to their provincial health authority and allowing them to take necessary public-health precautions,” said Mr. Skamski, who also credits the app with almost 72,000 visits to the province’s COVID-19 exposure website.

Alberta and B.C. have said COVID Alert issues notifications too indiscriminately by reaching back 14 days, as someone with the virus would not be infectious that whole time. Ottawa refined the app last week so infected people can disclose when their symptoms started or the date of their COVID-19 test.

Réka Gustafson, B.C.'s deputy provincial health officer, said that, based on COVID Alert’s current features, it would not add value to the province’s contact-tracing system.

“It is unable to notify and tell [users] when, how long, what they need to do, how intense that contact was, how close that contact was, when it occurred and what they need to do about it,” she said at a briefing. B.C. also wants location information.

Devin Gray and his wife are COVID Alert users in Ontario. When their daughter was two weeks old, Mr. Gray received a “matched key count” alert. “We freaked out," he said. But the family couldn’t figure out what, exactly, the alert meant and what they were to do next. Mr. Gray went for a COVID-19 test, just in case. “I felt uncomfortable holding my new baby and going near my family until I got the results.”

About a month later, long after his test came back negative, federal officials told him a “matched key count” meant his phone’s Bluetooth signal had connected with signals from a phone belonging to someone who tested positive for COVID-19 but that the contact wasn’t considered proximate or prolonged. The app, he said, should provide clearer information.

Richard Lester, an associate professor in global health in the division of infectious diseases at the University of British Columbia, said the federal app has some innovative merit but believes it should not be relied upon as a key strategy to control the pandemic.

He said that by making the information it gathers so anonymous to protect privacy, it curtails the ability of public-health officials to verify and follow contacts, undermining the very purpose of a contract-tracing program.

As well, he said, the app relies heavily on people self-reporting their infections and requires that their phones be compatible and turned on most of the time.

“This means it will likely not have the necessary uptake to be truly informative of what is happening in the broader population and may be biased against [members of the] public with less smartphone access, especially those that are most vulnerable,” he said.

Alberta launched its own app in May and remains the only jurisdiction in the country with its own smartphone tool. ABTraceTogether’s initial version proved unpopular because it could not run in the background on iPhones, stirring concerns about privacy and draining batteries. The problem was fixed in September, and the app now has 250,957 registered users in a province of about 4.4 million people.

Until Thursday, if someone tested positive for COVID-19 in Alberta, contact tracers would ask that person if they use the app and, if so, to voluntarily upload encrypted data. The tracers would then use that information to identify and reach out to other app users who had come into contact with the infected person.

But Alberta’s contact-tracing system crumbled Thursday after being overwhelmed with cases. Investigators will now only conduct contact tracing for health care workers, minors and people who work or live in congregate or communal facilities. Infected individuals who are not in these categories will be asked to do their own contact tracing.

What Alberta and B.C. consider flaws in the national system are, to others, selling points, according to Michael Geist, a law professor at the University of Ottawa and a member of the federal advisory group on science, technology and ethics during the pandemic. He says COVID Alert simply provides more privacy than systems such as ABTraceTogether.

“It comes down to whether or not you believe the app is about giving a tool to individual Canadians to better protect themselves, and [be] aware as to whether or not they are at risk, or is it about giving government a tool to engage in contact tracing after the fact,” he said.

UBC clinical professor Peter Philips noted that the success of any app depends on widespread adoption.

A study by a team at Oxford University’s Nuffield Department of Medicine found that app-based contact tracing can stop transmission if approximately 60 per cent of the population uses the app and can still slow transmission with lower uptake rates.

“So if too few people have the app downloaded, then it doesn’t have a chance of really working,” he said.

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