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Bringing COVID-19 exposure notification to the public health community

People interacting in a park while looking at their cellphones.

Starting in 2006 with the Public Health Laboratory Interoperability Project (PHLIP)—one of the first systems that allowed public health entities to exchange standardized data—APHL has worked to make connections between public health laboratories and agencies more efficient. Those efforts took a dramatic step forward with the APHL Informatics Messaging Services (AIMS) platform, which has evolved from a one-way router of critical health information to a secure, cloud-based platform that transports, translates, validates and hosts data for federal, state and local public health agencies.

 The emergence of COVID-19 required swift action to develop systems and processes that support public health agencies and their pandemic response efforts. In the last seven months, APHL has worked to create new connections, develop new message formats, standardize language and host a variety of solutions to aid in the COVID response. This blog post, regarding exposure notification, is the first in a series that outlines and explains these efforts.

How Does Exposure Notification Work?

To limit the spread of COVID-19, information must travel faster than the virus can. The scope and transmission rate of COVID-19 makes this a monumental challenge for public health agencies. Exposure notification technology, however, is a potential game changer. By providing rapid alerts to individuals who may have been in close proximity to someone who has COVID-19, exposure notifications allow the spread of information to stay one step ahead.

Working in conjunction with Apple, Google and Microsoft, APHL is taking a major step to support public health agencies that want to provide focused, privacy-preserving and user-controlled exposure notifications at scale using the Apple | Google Exposure Notifications System. APHL’s presence on the project gives the US public health community a capable and accountable partner for hosting key components of this groundbreaking technology.

The Apple | Google Exposure Notifications System (A|G ENS)

To augment traditional COVID-19 contact tracing efforts around the world, Apple and Google co-developed the A|G ENS, which consists of an Exposure Notification Application Protocol Interface (API) that is available on both the iOS and Android operating systems. Apps developed by public health agencies can then use the Exposure Notification API to help determine if a user may have been exposed to another user who subsequently tested positive for COVID-19. This is accomplished through the use of privacy-preserving randomly generated numbers also known as keys, which in turn generate temporary IDs that are transmitted between devices using Bluetooth Low Energy signals. Apps using this system are not permitted to collect or use location data from the device, and user identities are not revealed to other users, Apple, Google or APHL.

Rather than each state and territorial public health agency bearing the burden of building and hosting its own key servers, a national server can securely host the keys of those affected users, eliminate duplication and enable notifications across state borders. APHL is also championing the effort to build and host a national key server on behalf of the public health community. This will allow users to continually benefit from exposure notifications as they travel across state lines, and help state and territorial agencies deploy their apps quickly.

“APHL’s participation is key to the success of these efforts,” said Washington State Secretary of Health John Wiesman. “Without a national key server, each state that chooses to implement such an application would be responsible for its own data sets. APHL’s centralized and secure national server will be accessible to every state public health agency.”

Microsoft is supporting the partnership by working with APHL to host the national key server, based on the open source reference design created by Google Cloud. Through Microsoft’s Azure cloud platform, Microsoft will provide cloud services that will allow APHL to host the key server and securely enable interstate operability for the apps that public health agencies deploy.

Only users who choose to download an app developed by their public health agency and voluntarily opt in can receive exposure notifications. If users are alerted to a possible exposure, the app will also provide information about what to do next.

“We’re honored to partner with Apple, Google and Microsoft to make this groundbreaking technology accessible to state and territorial public health agencies,” Bill Whitmar, president of APHL and director of the Missouri State Public Health Laboratory, said. “Apps using this technology will rapidly inform users of a potential exposure to COVID-19 and provide them information they can use to protect themselves and their families.”

APHL develops technological innovations that support public health agencies at the federal, state and local level. For more information on how your agency can benefit from a partnership with APHL, contact



  • I would be surprised to know that North Carolina was one of the 20 states involved in this. If they are it would be for face value.
    I called our local city Health Department – Public Health also known as the Department of Health and Human Services (DHHS) County Health Department, the NCDHHS State Health Department, (I e-mailed a woman in that office, too) as well as several community clinics and our local hospital for assistance as a result of being exposed to COVID19. This was about 8 weeks ago. As of today September 25, 2020, I have not been tested and neither has anyone I mention in this SOS. Except the girl who had the virus.
    I was exposed to COVID19 by way of a young lady, my 18 year old neighbor. I didn’t find out until she was released from our local hospital 4 days later. I went to my calendar and counting backwards, I matched up the previous 2 weeks that I had been in the same room with her, her 3 year old daughter, their grandmother/great grandmother and her husband/grandfather/great grandfather, the grandmothers father, grandmothers 2 older daughters, one of which has an 8 year old daughter the other has 2 little girls, who are 4 and 5 years old. At various times over the 2 week period I looked at, I had been in very close proximity (same room for 1 to 3 hours) with each of these people. The grandmother is my friend and she spends a lot of 1-1 time with the 3 year old. I spend a lot of time with them. There were four days specifically that I spent 2 afternoons with them and they had spent two afternoons at my house. I have a lady who has been staying at my house who is on oxygen 24-7 and has several health issues besides compromised lungs with Stage 4 COPD. She has a 30 year old nephew who visits an hour or 2 nearly every day after work. He lives next door with his mom and step-dad, neither of them have good health. The son/nephew? He works full time at a local Hardees(Carl’s Junior). Can you imagine? Of 100 counties in the state of North Carolina, Raleigh tells us that we are 1 of 4 HotSpots. Already defined as a “hot spot” and with this information it seems to me a RED HOT hot spot. And 1 agency returned my call.
    I spoke with our local Health Department, manager I believe he said. I gave him the scenario as well as the social information below. I also mentioned that as of that week I had seen on the NCDHHS website a proposal they were required to write to qualify for State COVID19 Federal funding and a newly created Task Force invented (turns out that’s exactly what it was – invented but not created) a COVID test-trace program to be implemented that week. The amount escapes me but was in the multi -100s of thousands. The public health gentleman laughed out loud and said, “If there was that kind of money in this state, he sure would know about it.” A few days later, I went back to read the proposal for a 3rd or 4th time. to NCDHHS. No answer.
    For further impact the large family is a mix of 100% white, 100% Asian, 100% black = from there its a combination of all of the above. I’m white. Our neighborhood population is around 46-46% black and white, the balance is Asian. Our ages are 3 – 103 and a new one on the way. Income ranges from no income to low hourly wage income, to low middle and then fixed incomes with retirees and some disabled folks. We are homeowners. We pay property tax and every other fee that’s tacked onto the city water bill. Several of my older neighbors bought their property over 60 years ago and the home they live in now is the home they built themselves from the ground up while working in local meat factories, fabric and sewing businesses as well as Wayne Hospital. They’ve paid their fair share of tax, too.
    I reported this exact story over and over again.
    To add insult to injury… I watched a taped County Board of Directors/Supervisor meeting a week or so ago. It was live 2 nights prior. I about fell out of my chair. Throughout the meeting COVID references were made. Two officials from the Public Health Branch of County Government gave a COVID19 Presentation. The graph presented had data they said was collected in June when they didn’t know a lot (?) and at the time of this meeting in September 2020, that ‘there were still a lot of unknowns.’ There was a lot of scoffing from the Public Health Presenters and the “Board” and snide looks and remarks throughout. The same remarks the United States citizens have become accustomed to hearing on a daily 24-7 basis from government leadership and political commentators. But not usually from the Public Health Care sector.
    They pointed out that the “spike” evident on the chart, was because the prison population was included and gave a false high number for our county. They also made a few special references, a few times, to the Hispanic and black populations who “gather” in large groups and live in cramped housing with whole families and they get together with the positive COVID19 test results were not really showing what was reality. They mentioned that the testing sites were placed in these areas since this population (actually I think the word “population” is coming from me, because I do not remember what the health people used to describe the “test subjects.” )Although I’m pretty sure I’d rather hear population and subjects than these educated health people stumble over what label would sound most politically correct.
    The other group in the data were white people. This group was touched on first and skimmed over quickly since the outcomes were predicted.
    My synopsis is this:
    I’ll start with the last, first. NewsFlash! If you don’t test white people you won’t have white people positives. We haven’t had one testing site near this neighborhood. I heard about a testing site near some new construction area? We are a stretched out rural area but small in miles from A to B. I rely on a bus system that does the best they can with what they’ve got.

    ation re a testi It was ending in
    The CDC (as fallible as it is since their mandate is coming from the very top of a political administration and is no longer guided by the high
    standards o
    f medical ecollecting data. In June the

    up-to-date c
    delines. I’m willing to bet the prison populations
    had been extrapolated from other states’ data by then. At the time of this presentation there were 3 months when our public health officials could easily extrapolate that data (CDC Guidelines) and give the County as well as its citizens a bit more and up-to-date information. It is widely reported that state and private prison populations, as well as county jail populations from across this nation are being counted as a distinct group in itself. CDC Guidelines. Worthy notation: Inmates are being tested while in
    custody and
    prior to their release. CDC Guidelines. All of this wou
    ld have been worth mentioning in the presentation, rather than “We don’t know” “so many unknowns. ” If these presenters, and it is my understanding that at least one of the two were doctors, if they were unable to p

    e most accu
    rate data to this County, then they have no business being in any trusted serva
    nt or public health position. I was utterly shocke

    d upon hearing that either of

    them were doctors. (MD or Ph.D.) Idk. Both were
    anti-science and both made this very clear. They

    had to have been far removed from actual testing, collecting data and crunching numbers t
    were presenting and seemed proud of their accomplishments.There was no mention of anyone else’s name or organization who could have bee
    n involved, and th

    ey took the credit themselves, even explaining a

    y she could point out the large peak and at the same time seemed almo
    ers were further inaccurate
    since people dying in car accidents, and other untimely deaths, but tested positive for COVID19 were wrongly included in COVID19 da

    while working in local meat factories

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