The "contact tracing" apps don't do "contact tracing" - they do "exposure notification." Contact tracing is a labor-intensive shoe-leather process built on relationships and it is stubbornly resistant to automation.

https://pluralistic.net/2020/05/02/rewriting-our-imaginations/#exposure-notification

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The highest covid app penetration is in Iceland, which HAS managed to largely contain its outbreak, but public health officials there say the app did little to help in this process.

https://pluralistic.net/2020/05/12/evil-maid/#fjords

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Meanwhile, America's top public health officials are lukewarm on apps (the time to try an unproven, untested solution is not in the middle of a once-in-a-century pandemic). Instead, they're deploying armies of human contact tracers.

https://pluralistic.net/2020/05/08/volcano-gods/#shoe-leather

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What is that "shoe-leather" work like? Turns out it's simple enough to learn, but also surprisingly varied in its day-to-day operation. What's more, it's very effective, even when it's imperfect.

https://www.propublica.org/article/you-dont-need-invasive-tech-for-successful-contact-tracing-heres-how-it-works#955400

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"Isolating symptomatic cases would reduce transmission by 32%... combining isolation with manual contact tracing of all contacts reduced transmission by 61%. If contact tracing only could track down acquaintances, but not all contacts, transmission was still reduced by 57%."

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But contact tracing only works in concert with "robust testing capacity," and somewhere for sick people to quarantine. The path to glory is "Test, trace, isolate."

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And contact tracing pays another dividend: it generates reliable data about the disease that can improve our models and help evaluate therapeutics, prophylaxis and other techniques for containing and mitigating the disease.

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Meanwhile, the idea of using Bluetooth-enabled proximity-sensing apps remains untested. From the unreliability of Bluetooth to the lack of a well-defined "epidemiologically significant contact period," these apps are an evidentiary void.

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As Iceland found apps can be "a welcome labor mulitplier" to help stretch contact trackers' shoe-leather. Tech has a boring, vital role to play ("text messages to ask exposed contacts how they’re feeling can reduce the number of daily follow-up calls for a health worker").

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The success of a contact tracing effort relies on trust and goodwill from the population being traced, on voluntary compliance and truthfulness. This is totally uncontroversial in public health circles, and, if anything, it's the worst news for our own outlook.

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America's institutions - including the for-profit health sector, but also suspicious, accusatory public relief sector - are widely mistrusted for good reason. Trumpism's go-to tactic is exploiting that mistrust for partisan gain. It's a frightening situation indeed.

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