Critical Overview of the Use of Contact Tracing Apps in the Context

of the COVID-19 Pandemic

Arturo Gonz

alez

1 a

, Christian von L

ucken

1 b

, Julio Paciello

2 c

, Tito Ocampos

2 d

and Juan Pane

2 e

Unversidad Nacional de Asunci

on, Facultad Polit

ecnica, San Lorenzo, Paraguay

Centro de Desarrollo Sostenible, Asunci

on, Paraguay

Keywords:

Contact Tracing, Mobile Application, COVID-19.

Abstract:

Contact tracing determines the chain of contacts of an infected person to isolate them. Implementing con-

tact tracing requires an enormous effort that generally falls on the different governments and their respective

health authorities. Emerging technologies can be quite useful in supporting contact tracing. The most relevant

advantages of using mobile applications based on digital technologies to perform contact tracing are the fast

collection of reliable data and the rapid detection of possible contacts at risk. However, despite these advan-

tages, many countries have not reported a high penetration of these tools. As a relevant and actual research

area, this paper presents a critical overview of the current literature regarding contact tracing applications to

answer the following research questions: What is the most used technology to develop contact tracing apps?

What were the main lessons on using contact tracing applications so far?, How are ethics, privacy, and security

issues handled?, What is the use that is given to the data collected by the applications, and what happens to

them? Who applies these types of tools, and what implications did they have?

1 INTRODUCTION

At the end of 2019, World Health Organization

(WHO) ofﬁces in Wuhan, Hubei Province of China,

received reports of pneumonia’s ﬁrst cases with an un-

known cause. A new virus from the coronavirus fam-

ily (CoV), called severe acute respiratory syndrome

coronavirus 2 (SARS-CoV-2), was identiﬁed. Conse-

quently, the disease was named by the WHO as Coro-

navirus Disease 2019 (COVID-19). From there, the

world would go through one of the worst crises after

World War II (Otoya-Tono et al., 2020).

As of this article’s writing date, the total num-

ber of infected by COVID-19 amounts to more than

90.759.370 and with a record higher than 1.963.169

conﬁrmed deaths. It is important to note that cur-

rently, the most contagious region is America, with

more than 40.187.505 infected, widely surpassing

Europe (29.510.450), Southeast Asia (12.370.101),

https://orcid.org/0000-0001-5672-3679

https://orcid.org/0000-0002-2198-1237

https://orcid.org/0000-0003-3196-5625

https://orcid.org/0000-0002-4924-5995

https://orcid.org/0000-0003-2607-4027

Figure 1: COVID-19 World Map (WHO, 2020).

and the Eastern Mediterranean (5.252.810), Africa

(2.210.137), and the West Paciﬁc (1.227.622), thus

becoming the epicenter of current infections (See Fig.

1) (WHO, 2020).

Since the beginning of 2020, in the absence of

effective treatment or vaccines for COVID-19, gov-

ernments worldwide have been taken many non-

pharmacological interventions (NPIs) to contain or

mitigate the spread of the disease with health, social,

and economic consequences. The test and trace strat-

González, A., von Lücken, C., Paciello, J., Ocampos, T. and Pane, J.

Critical Overview of the Use of Contact Tracing Apps in the Context of the COVID-19 Pandemic.

DOI: 10.5220/0010480400910099

In Proceedings of the 6th International Conference on Complexity, Future Information Systems and Risk (COMPLEXIS 2021), pages 91-99

ISBN: 978-989-758-505-0

egy, when applicable, becomes one of the best con-

tention alternatives to deal with the spread without re-

quiring more extreme measures (Jahnel et al., 2020).

Contact tracing determines the chain of contacts of an

infected person to isolate them. Implementing con-

tact tracing requires an enormous effort that generally

falls on the different governments and their respective

health authorities (Mbunge, 2020).

Emerging technologies can be quite useful in sup-

porting contact tracing (Ahmed et al., 2020). Digital

contact tracing through smartphones’ applications is

a viable alternative to support this work (Jahnel et al.,

2020). This possibility is practically a fact in sev-

eral countries such as Singapore, Australia, Austria,

Israel, Germany, Qatar, among others, which have al-

ready adopted the use, to a greater or lesser extent, of

different contact tracing applications.

The most relevant advantages of using mobile ap-

plications based on digital technologies to perform

contact tracing are the fast collection of reliable data

and the rapid detection of possible contacts at risk.

However, despite these advantages, there have not

been many countries reporting a high penetration of

these tools (MIT, 2020). The global debate revolves

around the relevance and usefulness of contact trac-

ing applications, so it is always timely to address this

issue. In this sense, this work presents a critical de-

scription of contact tracing applications based on a

systematic review of the literature related to the area.

The objective of this work is to understand the expe-

riences and assessing the implications of contact trac-

ing app’s in the framework of COVID-19.

This work organization is as follows. Section 2

provides a brief overview of the recent contact trac-

ing applications and their uses in COVID-19; Section

3 is concerned with the research methodology applied

into the study; Section 4 presents the survey results

and discussions; and ﬁnally, Section 5 gives a sum-

mary and conclusions.

2 BASIC CONCEPTS AND

BACKGROUND

2.1 Applications and Their Uses in

COVID-19 Contact Tracing

Contact tracing consists of identifying and following

the possible routes of transmission of a particular in-

fection in a population to determine people who have

been exposed and inform them in such a way they can

isolate themselves (Yasaka et al., 2020). The strategy

has the clear potential to reduce contagion. In general,

contact tracing is carried out by the countries’ health

authorities, either by a manual interview or not, of

conﬁrmed or suspected cases to collect data on possi-

ble contacts that the infected person had with others

(Ahmed et al., 2020).

Given the situation experienced by the COVID-19

pandemic, many researchers have sought to ﬁnd tech-

nological solutions to automate the entire contact trac-

ing process in such a way as to reliably and quickly

obtain the contacts of people infected in such a way

to minimize risks (Ahmed et al., 2020). In this con-

text, contact tracing based on smartphones and appli-

cations presents a possible solution that would limit

the transmission of both COVID-19 and other dis-

eases; however, there are several concerns regarding

this type of tools (Yasaka et al., 2020).

Digital tools can be extremely useful to support

the measures recommended by the World Health Or-

ganization (WHO), which are a test, trace, isolate, and

put in quarantine. At least it would be very useful

to improve data ﬂows digitally and also for proxim-

ity tracing via geolocation, which would signiﬁcantly

speed up the reporting and contact tracing processes

(Vokinger et al., 2020).

According to (Vokinger et al., 2020), the typology

of different applications and technologies in the con-

text of COVID-19 that are aimed at the general public

are:

• Proximity Tracing Apps: store upcoming con-

tacts in a certain period of time. They can include

notiﬁcation systems and alerts in case of conﬁr-

mation of COVID-19 diagnoses.

• Patient Diaries: a platform for monitoring the

symptoms and risks of exposure to a speciﬁc pop-

ulation or group.

• Crowd-sourced Surveillance: a platform for

monitoring symptoms at the population level.

• Tele-health: Platform for self-assessments and

online consultations with medical professionals.

• Mental Health Interventions: digital platforms

to support mental health.

As for the architecture generally adopted for the data

collection aspects of the tracing applications, there are

three. These systems are the most used to develop

applications. These are the approaches (Ahmed et al.,

2020) (See Table 1 for some examples):

• Centralized: There is a central server that per-

forms basic functions such as storing personal in-

formation, generating contact records, risk anal-

ysis platform, and notiﬁcation of identiﬁed close

contacts.

COMPLEXIS 2021 - 6th International Conference on Complexity, Future Information Systems and Risk

• Decentralized: This architecture proposes the

transfer of central functionalities to the user’s de-

vices, leaving the server with minimal participa-

tion in the entire contact tracing process.

• Hybrid: The hybrid architecture proposes that

these functionalities be divided between the server

and the devices.

Table 1: Some examples of applications with the three ar-

chitectures mentioned (Ahmed et al., 2020).

Architecture App Description

Centralised TraceTogether TraceTogether was

the ﬁrst major Blue-

tooth contact tracing

app.

Centralised CovidSafe

(AU)

Australian experts

have criticized

the government

for a lack of

transparency and

non-responsiveness

to privacy issues.

Decentralised CovidSafe-

PACT (WEST-

COAST)

Is a tracing proto-

col proposed by re-

searchers from the

University of Wash-

ington.

Decentralised SwissCoviD -

DP-3T

Is a protocol pro-

posed by a consor-

tium of universities

and organisations

from Europe led by

EPFL, Switzerland

Hybrid ConTra

CORONA

Is a hybrid proto-

col proposed by

German researchers

from the FZI

Research Center

for Information

Technology and

Karlsruhe Institute

of Technology

Hybrid EpiOne Has been proposed

by a team of re-

searchers led by the

University of Cali-

fornia at Berkeley

At the time of writing this article, (MIT, 2020) pre-

sented a very up-to-date (and freely accessible) list of

the most used applications in some countries. It can

be clearly seen that, in countries like India, although

there are a large number of users for the “Aarogya

Setu” application, it only represents 12.05% of the

population. On the other hand, the “TraceTogether”

application in Singapore has achieved 80% penetra-

tion in its population (See Table 2).

Table 2: Contact tracing applications with the largest num-

ber of users. (MIT, 2020).

Country App Users Penentration

India Aarogya Setu 163.000.000 12,05%

Vietnam BlueZone 20.000.000 20,93%

UK NHS COVID-

19 App

19.000.000 28,51%

Germany Corona-Warn-

App

18.000.000 21,68%

Turkey Hayat Eve

Sı

gar

14.186.000 17,30%

Italy Immuni 9.769.449 16,19%

Japan COCOA 7.700.000 6,09%

Australia COVIDSafe 7.160.909 28,64%

Saudi

Arabia

Tawakkalna 7.000.000 20,77%

Canada COVID Alert 5.314.026 14,03%

Indonesia PeduliLindungi 4.600.000 1,72%

Singapore TraceTogether 4.511.200 80,00%

Qatar Ehteraz 2.531.620 91,00%

Finland Koronavilkku 2.500.000 45,31%

2.2 Related Works

A systematized study to identify the applications for

smartphones used to ﬁght COVID-19 was carried out

by (Collado-Borrell et al., 2020), which can be seen in

the early 2020s of the trend of this type of tool. At the

time of the study, the vast majority of developed ap-

plications are run by governments, and approximately

two-thirds of all applications were made in Europe

and Asia.

On the other hand, (Davalbhakta et al., 2020) car-

ried out a complete systematic review of the smart-

phone applications used in the framework of the

COVID-19 pandemic, the main result of which is a

very useful characterization of the most successful ap-

plications in different regions of the world to date. For

a particular case study in India, (Bassi et al., 2020)

conducted a general review of applications available

for use in the framework of COVID-19.

In the study carried out by (Ahmed et al., 2020),

the authors focused on a review of the applications

for smartphones and addressed the subject in a very

comprehensive way. The work approaches the most

common architectures of contact tracing applications,

issues related to privacy and security aspects, issues

concerning users, and even the path of future research.

3 METHODOLOGY

This research presents a critical overview of COVID-

19 contact tracing mobile applications. The primary

objective is to report the use of contact tracing apps

Critical Overview of the Use of Contact Tracing Apps in the Context of the COVID-19 Pandemic

in the framework of COVID-19 in countries and criti-

cally describe their implications. To achieve this goal,

research questions were elaborated and a systematic

literature review was carried out. The ﬁnal result is

a document where the results obtained are presented

in a summarized way. The process is detailed in Fig.

2 and it was conducted following the methodological

framework of (Arksey and O’Malley, 2005; Lobato

et al., 2013).

Figure 2: Steps of the Applied Methodology.

Step 1. Deﬁnition of the Research Questions. The

starting point was the deﬁnition of the following re-

search questions (See Table 3).

Table 3: Research Questions.

RQ# Description

RQ1 What is the most used technology to develop

contact tracing apps?

RQ2 What were the main lessons on using contact

tracing applications so far?

RQ3 How are ethics, privacy and security issues han-

dled?

RQ4 What is the use that is given to the data collected

by the applications and what happens to them?

RQ5 Who applies these types of tools and what im-

plications did they have?

Step 2. Search for Relevant Studies

. The pur-

pose of this study is to be as complete as possible in

the identiﬁcation of primary studies to answer the re-

search questions; for this, the Scopus database was

Obs: The two BibTex ﬁles resulting from the searches,

are available in: http://bit.ly/3inkPTJ

chosen since it is one of the most used and compre-

hensive among all available. Within this database,

two search iterations were performed considering the

following selection commands (See Table 4). The

search was conducted in late November 2020.

Table 4: Search Queries Made.

# Query Results

1 TITLE-ABS-KEY(”contact”

AND ”tracing” AND ”COVID-

19”)

546 docu-

ments

2 TITLE-ABS-KEY(”contact”

AND ”tracing” AND ”COVID-

19” AND ”apps”)

46 docu-

ments

Step 3. Selection of Studies. The following inclusion

and exclusion criteria were deﬁned (See Table 5).

Table 5: Exclusion and Inclusion Criteria.

Selection criteria Exclusion criteria

Articles that study and/or

propose the use of applica-

tions for contact tracing

Posts found in the search

that could not be accessed

Articles of position and

commentary on the subject

Publications with a little

approach to the subject

Review articles that ad-

dress the topic

Posts from Unknown

Sources

Studies that answer at least

one research question.

Step 4. Classiﬁcation of the Studies. Applying the

inclusion and exclusion criteria, an exhaustive reading

of the identiﬁed articles was carried out. There were

selected 39 articles which are presented in the work

results.

Step 5. Bibliometric Analysis. To obtain an

overview of the search results, a bibliometric analy-

sis on the query outcomes using the Biliometrix tool

(Aria and Cuccurullo, 2017) was used.

Step 6. Data Extraction. Table 6 presents the list

of analyzed documents. Within these work, the nec-

essary information to address the research questions

was extracted.

Step 7. Research Synthesis. in this step, it was

possible to summarize, integrate, combine, and com-

pare the results of different studies on a topic based on

the different speciﬁc research questions presented in

this work (Arksey and O’Malley, 2005; Lobato et al.,

2013).

COMPLEXIS 2021 - 6th International Conference on Complexity, Future Information Systems and Risk

Table 6: Documents analyzed in this work.

Type Articles

Editorial,

Com-

ment and

Position

Articles

(Parker et al., 2020), (Morley et al., 2020),

(Editorial, 2020), (Rowe et al., 2020),

(Michael and Abbas, 2020), (Ciofﬁ et al.,

2020), (Rizzo, 2020), (Klar and Lanzerath,

2020), (Lucivero et al., 2020), (Hsu, 2020).

Review

Articles

(Ahmed et al., 2020), (Davalbhakta et al.,

2020), (Collado-Borrell et al., 2020),

(Bassi et al., 2020).

Technical

Articles

(Yasaka et al., 2020), (Vokinger et al.,

2020), (Kitchin, 2020), (Trang et al.,

2020), (Urbaczewski and Lee, 2020),

(Nanni et al., 2020), (Liang, 2020),

(Mbunge, 2020), (Bhatia et al., 2020), (Ra-

makrishnan et al., 2020), (Jahnel et al.,

2020), (Galloway, 2020), (Yamamoto

et al., 2020), (Aus

ın and Mart

ınez, 2020),

(Sharma et al., 2020), (Joo and Shin,

2020), (Borra, 2020), (Rowe, 2020), (Hoff-

man et al., 2020), (Goggin, 2020), (Kling-

wort and Schnell, 2020), (Vitak and Zim-

mer, 2020), (Scassa, 2021), (Altmann

et al., 2020), (Kaspar, 2020).

4 RESULTS AND DISCUSSIONS

4.1 Bibliometric Analysis

As a result of searches made in the context of this

work, Fig. 3 shows that most of the literature found

corresponds to works carried out in the US, UK, Ger-

many, and others. In general, the scientiﬁc produc-

tion that addresses this topic is mainly concentrated in

Europe and North America, including expanding the

network of contacts between researchers. The country

production and collaboration map is in Fig. 4.

Figure 3: Country-Keywords-Sources Relations.

From Fig. 4, it is worth to note that most of the studies

related to contact tracing applications concentrate in

high-income countries, where the use of smartphones

may be considered ubicuos. In comparison, large re-

gions such as Latin America and Africa report few

works.

Figure 4: Country production and collaboration map of con-

tact tracing applications studies.

At the time of writing this work, the ten most cited ar-

ticles that address contact tracing apps’ development

issues are those in Fig. 5. Thus, these works can be

seen as an introductory reading guide to entering the

subject. Also, it is worth noting the high dynamism

of scientiﬁc production in the area.

Figure 5: Most cited documents addressing contact tracing

apps.

4.2 Survey Results

4.2.1 RQ1: What Is the Most Used Technology

to Develop Contact Tracing Apps?

All Contact tracing Applications are mainly based on

each person’s location and the proximity of them to

other people. That requires, in essence, the location

Critical Overview of the Use of Contact Tracing Apps in the Context of the COVID-19 Pandemic

via GPS and Bluetooth for close contacts. In addition,

to add precision, QR codes can be used to establish

people’s access points, among other tools (Kitchin,

2020; Borra, 2020; Ahmed et al., 2020; Hsu, 2020;

Scassa, 2021; Mbunge, 2020).

The use of the technologies mentioned above and

their possible beneﬁts and implications in decision-

making for policymakers was widely debated, and it

remains only to improve the efﬁciency and effective-

ness of new technologies as a response to COVID-19

(Ramakrishnan et al., 2020; Mbunge, 2020).

It is very difﬁcult to provide an up-to-date ﬁgure

and even more so in refereed publications given the

high dynamism of technology use in contact tracing

apps. But based on (Woodhams, 2020), at the end

of October 2020, approximately 26% of applications

were registered with a unique base in GPS technol-

ogy, 51% with a unique base in Bluetooth, and 23%

used both technologies. It is possible to freely access

the (MIT, 2020) database to follow the applications

used worldwide in a very up-to-date manner.

4.2.2 RQ2: What Were the Main Lessons on

using Contact Tracing Applications So

Far?

Contact Tracing Apps are an important tool in the

ﬁght against COVID-19. Numerous cases can be de-

termined from countries where contact tracing ap-

plications have been recorded, mainly in the United

States and countries in Europe and Asia (Ramakrish-

nan et al., 2020; Mbunge, 2020; Scassa, 2021; Hoff-

man et al., 2020). However, at present, very few

countries have exceeded the barrier of 60% penetra-

tion (See Table 2) required for these applications to

be really effective (MIT, 2020).

Several studies have been conducted to quantify

people’s motivation to use Contact tracing Apps. The

Study conducted by (Kaspar, 2020) showed very low

motivation to use the applications. On the other hand,

(Joo and Shin, 2020) identiﬁed the issue of privacy as

a predominant factor in the use of these types of tools.

Other models like (Rowe et al., 2020) shows a

model of the causes of failure of the public address

regarding the use of contact tracing applications. In-

stead, (Trang et al., 2020) shows the phenomena and

topics for mass acceptance of applications.

There is still much debate about the effectiveness

and usefulness of using contact tracing platforms.

From the basic problem of privacy and security to

matters such as the representativeness of users, even

this would make the tools not useful in the ﬁeld (Gog-

gin, 2020; Klingwort and Schnell, 2020).

4.2.3 RQ3: How are Ethics, Privacy and

Security Issues Handled?

Issues concerning privacy and subsequently ethics

and security were addressed, to a greater or lesser

extent, in practically all the articles selected and re-

viewed.

Since the ﬁrst semester of 2020, ethics, privacy,

and security were the focus of debates in what would

be the beginning of the Contact tracing Applications.

Contributions from (Editorial, 2020; Parker et al.,

2020; Morley et al., 2020; Klar and Lanzerath, 2020;

Lucivero et al., 2020) emerged as initial points in

the debate, where the possible advantages, disadvan-

tages, implications and challenges to be faced were

discussed.

In the second half of 2020, the privacy debate be-

came a hotly debated topic. In France, the implica-

tions of the use of applications had a strong impact on

privacy, which subsequently impacted the low num-

ber of users (Rowe, 2020). In the United States, Aus-

tralia, Singapore, and other countries with outstand-

ing starts in terms of downloads, they did not continue

that path in terms of the use of contact tracing appli-

cations and the feeling that these platforms present a

high risk, generates mistrust, and affects to its use di-

rectly (Michael and Abbas, 2020; Ciofﬁ et al., 2020;

Hsu, 2020; Rizzo, 2020).

Certainly, the possibilities of the usefulness of

contact tracing applications are enormous but ethi-

cal aspects, especially privacy and security, play too

important a role for the successful implementation in

many countries and it is something that must be taken

into account (Scassa, 2021).

4.2.4 RQ4: What Is the Use that Is Given to the

Data Collected by the Applications and

What Happens to Them?

The main idea of contact tracing applications lies in

the rapid monitoring of the virus transmission chains

for the early detection of outbreaks in a fast, safe and

efﬁcient way (Nanni et al., 2020). This requires data

that must necessarily respect users’ privacy, that they

are of quality, and that they are representative (large-

scale). The big issue here is the handling of the data

and what would be the utility of these.

In China, for example, the use of health codes

(multi-color QR codes) in public spaces is a success-

ful case of using user-generated data for rapid out-

break detection (Liang, 2020). On the other hand,

(Vitak and Zimmer, 2020) asserted that the data gen-

erated by the applications must go through a compre-

hensive analysis since the convenience of sharing lo-

COMPLEXIS 2021 - 6th International Conference on Complexity, Future Information Systems and Risk

cation and health data depends on who will have ac-

cess to the aforementioned data.

Another very interesting view on the data gener-

ated as a source of data from different models to char-

acterize the contagion dynamics in different regions

with people of different backgrounds, with the use

of different methodologies, is a considerable possibil-

ity that should not be neglected and it is approached

in several studies, and conceptual proposals (Yasaka

et al., 2020; Yamamoto et al., 2020; Sharma et al.,

2020; Urbaczewski and Lee, 2020).

4.2.5 RQ5: Who Applies These Types of Tools

and What Implications Did They Have?

Most of the promoters and implementers of con-

tact tracing applications are the governments of each

country (Mbunge, 2020). In general, the application

is tied to local public policies and how each place

addresses the pandemic, as well as national privacy

and security regulations (Bhatia et al., 2020; Vokinger

et al., 2020).

After having exhausted the quarantine policies,

many of the policymakers in the different coun-

tries have returned to the traditional contact tracing

(Scassa, 2021). In particular, the case of Latin Amer-

ica, which at the time of writing this article has be-

come one of the most contagious regions, does not

present an implementation of any contact tracing ap-

plication, or at least in a representative way (MIT,

2020).

5 CONCLUSIONS

The COVID-19 pandemic is part of the present and

the near future; therefore, it will continue to affect the

activities of all people worldwide. All contact tracing

tasks currently carried out in all countries are of vital

importance to slow the advance of this disease.

A critical and fairly comprehensive report on the

use of contact tracing applications has been made, an-

swering clearly and summarizing the research ques-

tions proposed for this study. The general report of

the current situation gives a general overview of the

technologies used for developing the different appli-

cations (GPS, Bluetooth, and GPS / Bluetooth) ob-

viously with different complements architectures and

protocols.

In general, ethical issues, especially privacy and

security, play a fundamental role in the literature’s

current debate. The value of the data and its usage

can generate distrust and caution in some users and

cause these digital tools not to achieve the required

penetration for a practical and useful operation.

Despite all the available technology and the many

digital tools for contact tracing, it has not been

successfully implemented at a level representative

enough in at least the vast majority of countries, in

such a way that it can represent a real aid of ﬁghting

against COVID-19.

As a recommendation for future work, and based

on the presented work, it could be important to con-

sider a focus on developing contact tracing tools or

applications for those who have a greater risk of con-

tagion and, therefore, more signiﬁcant potential for

transmitting the infection, as are medical doctors,

nurses, and so on. Also, it may be useful to use con-

tact tracing to determine the relations existing in cor-

porate ofﬁces and industries to determine those who

are more exposed or change the ﬂow of activities to

reduce the contacts that some users may have. In ad-

dition, it is important to know the current situation of

the use of contact tracing applications in developing

countries, especially in Latin America, in such a way

as to consider the possibility of complementing pre-

vention, contact tracing and case containment efforts

of COVID-19 in the countries of the region.

ACKNOWLEDGEMENTS

This work is supported by CONACyT-Paraguay under

the PINV20-184 project grant.

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