By Paul Alan Wetter, MD, FACS, FACOG

Within the next few weeks, Apple and Google will be distributing new software that will fill an urgent and vital need to track our movements and allow people to know whether they have come in close contact of someone who later tests positive for COVID-19.

Most people who know of me know I’m a surgeon who has been working in the fields of robotics, laparoscopy and education. But my involvement with computers dates before my time in medical school, in the late 1960s when, in a previous career in banking, IBM mainframes where showing up in large banking institutions and filling an entire climate-controlled room for the sole purpose of adding and subtracting large columns of numbers. This was previously done by humans with pencil and ledger cards in paper spreadsheets. So, in parallel with my medical career, I’ve been peripherally involved with circuits and programs ever since then, and was among the first app developers for Apple, a group that has now grown to more than 12 million people.

The cellphones that most people carry in their pockets are the equivalent of what were called supercomputers just a few years ago, with more than 8 billion transistors in each new device. The nanotechnology that we hear about at medical science meetings is already present in these devices with sensors and micro-communications. We, as physicians, know that two things that are urgently needed to get COVID-19 under control: universal testing and universal tracking. Both of these seem like monumental tasks that might involve millions of medical and social workers to accomplish. The good news is that the technology is already available, and it’s very possible to assist in tracking.

ADVERTISEMENT

Apple and Google recently announced their joint effort to create a platform to allow health care authorities to track spread. From what I know from years of working on Apple devices and programs, that’s great news, because it can be implemented rapidly, rolled out and scaled quickly, and has the promise of filling the need for tracking and controlling spread—two things that are desperately needed to gain control over the virus. The system will work by using near-field Bluetooth radio signals in the Bluetooth low-energy beacon system that is found in all modern phones. This allows the computer chips in our phones to securely communicate with each other, and track and record the other phones (people) who have come within a few feet of us. The final program may not log locations using the GPS signals our phones receive from satellites, only proximity to people who later test positive. The record of proximity contacts would be encrypted, and therefore secure, for a period of weeks or more. Because the records are encrypted and constantly changing, they cannot be used to work back to a person’s identity, thus ensuring privacy. 

Wouldn’t we all like to know if we came near someone who has tested positive? Yes, we would, but it’s not just for us, but for the people who we come into close contact with after that encounter. It’s for tracking and stopping the spread of this very contagious virus. People can then be notified, stay in quarantine, and get tested. Also, the codes you collect only reside on your phone, so there is no list of who is having interactions with whom. There is greater complexity here than this simple overview, but the system has great promise and is one of the best things to happen in our fight against this virus. This type of protocol will help testing, too, as there will not be enough tests to test everyone, but there could be enough to test those most likely to be exposed.

The current time line for agencies to receive a release of the software is mid-May, and this may come just in time as the first wave will be waning, and people will begin going off quarantines and thus become more exposed. Based on the way things are playing out politically, you may first see this distributed by state governments a few weeks later, but there are plans to have these programs as part of regular software updates in Android and iOS. As with other apps, it will still require the user’s permission. As with other apps, there are potential downsides, but with both Apple and Google working together with the system I have described, those will be minimal, and no different from the occasional issues that arise with our phone apps now.

We have been so busy dealing with hospital beds, ventilators and personal protective equipment that there has not been time to create the much-needed tracking system by other means. I can’t emphasize enough how important this could be for us to defeat this highly contagious virus and the potential for this to do the job better than anything that has existed in the past. There is even more good news on the horizon. Look for micro-temperature sensors among other sensors in future devices. Just imagine how those small additions will revolutionize medical care. The computing power is there, just waiting.

—Dr. Wetter is chairman emeritus, Society of Laparoscopic and Robotic Surgeons; professor emeritus, the University of Miami Miller School of Medicine; steering committee member, International Society for Medical Innovation and Technology; and member, WHO Global Initiative for Emergency and Essential Surgical Care committee.