On August 12, 2020, the Association of Public Health Laboratories (APHL) launched the national key server on Microsoft’s Azure cloud platform to support the Apple | Google Exposure Notifications System in the United States. Since then, APHL has added a second server hosted on the Google cloud platform, on-boarded 27 jurisdictions and continued to work with Apple, Google and Microsoft to improve and support this vital COVID-19 response tool. Emma Sudduth, senior consultant on APHL’s informatics team, has been almost exclusively focused on this project. As we pass the one-year anniversary of the Exposure Notifications system, we asked her to both reflect and look toward the future.
Q: What are exposure notifications?
Exposure notifications are a phone-based tool that can approximate the distance from and duration in which your phone is near other phones, and later alert you if a possible close contact tested positive for COVID-19. Apple and Google co-developed the Exposure Notifications System to augment traditional COVID-19 contact tracing efforts around the world. Available on both iOS and Android devices, the Exposure Notifications System is currently in use in over 70 countries, US states and territories.
Q: What is APHL’s role in the Exposure Notifications System?
APHL hosts and maintains the critical infrastructure needed for exposure notifications to work in the United States. Two servers are necessary: the multi-tenant verification server, provided by Google, is necessary to confirm a positive COVID-19 case and the national key server, provided by Microsoft, is necessary to notify the close contacts of a potential exposure. APHL hosts these servers on behalf of public health agencies at no cost to them, which alleviates a significant burden for public health agencies, and for many made the launch of exposure notifications possible.
In addition to reducing the burden on public health agencies, the national key server provides another significant benefit: because the server is centralized and now used by all participating US jurisdictions except Guam, it allows notifications across state lines. If, for example, you reside in Virginia and use their COVIDWISE app but work in Maryland and travel to Hawaii, your notifications are interoperable. A possible exposure in a jurisdiction other than where you live will still generate an alert.
APHL also has a dedicated team that maintains the servers, manages all code releases, provides 24/7 technical and security monitoring, offers help desk support and addresses all incidents. Without these shared servers, all of this would be the responsibility of each jurisdiction.
Q: How has the Exposure Notifications System changed over the last year?
The Exposure Notifications System has become both easier and better.
Initially states had to develop custom exposure notification apps, create elaborate marketing campaigns and have case workers manually verify positive COVID-19 cases. Now, states can launch the Apple | Google Exposure Notification Express solution in a matter of weeks rather than building a custom app. They can leverage automated availability alerts to market their launch. And many have automated the process to verify all positive COVID-19 cases reported to the state.
Google, who provides the open-sourced code for both key and verification servers, has consistently made improvements and added features to make exposure notifications better and easier for all. This is reflected in the 40+ server code releases we have managed this year!
Q: How has the value as a pandemic response tool changed?
The public health value has evolved as well. When the system first launched, many people were very slowly moving towards resuming their typical daily activities. Many people were still working remotely, school systems were still teaching virtually, large gatherings were still on hold in many areas, etc. So people were not out-and-about or they were just starting to do the essentials. At that time when users toggled on their exposure notifications on their phones, many people still weren’t around large numbers of others. For some, the need for exposure notifications was still quite low. Now over a year later, more people have resumed those typical day-to-day activities. More businesses and offices are open, more schools are in-person, community events are happening again and more. That makes exposure notifications even more valuable.
Q: What have you and your team learned from this effort?
We have learned more than we ever thought possible about Bluetooth signals, added at least 20 new acronyms to our vocabulary and finally figured out how to successfully schedule a meeting across Google, Apple, Microsoft and APHL platforms.
By far, the most valuable lesson has been the strength that comes from a partnership between public health and private industry. The engineering excellence that these leading technology companies have provided has been heroic. Coupling that with the public health experience and respect held by APHL and the local, state and territorial public health agencies has enabled expedient and valuable advances.
Q: What does the Exposure Notifications System look like in year two?
It’s hard to say. I do know that APHL will continue to host and maintain the US servers, will work closely with Google, Apple, Microsoft and other partners to improve and advance exposure notifications, and will support all of our participating public health agencies in their continued use of this important tool.
I want to reiterate that exposure notifications continue to be a vital tool for combatting the COVID-19 pandemic and that remains true in this second year. As I said above, social distancing measures have decreased around the country making Exposure Notifications one of the most valuable tools for keeping all of us informed of possible close contacts.
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