COVID-19 Exposure Apps: Digital PPE for Responders

First responders face increased risk of exposure to SARS-CoV-2, which is the virus that causes COVID-19. In September 2020, the U.S. Fire Administration (USFA) declared COVID-19 the leading cause of U.S. firefighter fatalities^1. Current projections continue to show increases of illness and death: Line-of-duty-deaths (LODD) across all public safety groups are expected to double by the end of the year.

Close public contact is an everyday part of public safety occupations. Exposures can occur across a range of activities, including medical and nonmedical calls for service, public assistance encounters, interactions with healthcare workers and extended periods of time on-shift, living in close quarters with other crew members. Further increasing their risk, firefighters are the public safety group that is least likely to wear masks indoors, despite overwhelming evidence that masks reduce transmission risk².

First responders are accustomed to strict use of PPE in the line of duty to protect themselves from hazards in the workplace, including infectious disease exposure. As local, state and national authorities work to innovate COVID-19 solutions and modernize the nation’s public health infrastructure, a new category of protective resources is emerging.

Digital PPE

Digital PPE refers to the use of connected devices, including smartphones, smartwatches and other wearables, to support traditional public health response. Examples of digital PPE include smartphone- or wearable-based exposure-notification systems and the use of wearables for presymptomatic risk-assessment or disease-detection.

In the past three months, 17 states - released free exposure-notification smartphone apps that are available on the Android and Apple app stores³. These apps can help to track proximity of individuals to one another and to send an alert when users were near someone who tested positive for COVID-19. All states’ exposure-notification apps were built using resources that were created by Google and Apple that only can be accessed by developers who work on behalf of a recognized public health authority⁴. Designed to protect personal data privacy, the apps don’t collect location data or any personally identifiable information. Instead, the apps use Bluetooth technology to exchange anonymous information with other smartphones and to create a temporary, two-week record of “close contacts”⁵. Close contact is defined as having been within six feet (of a person who doesn’t live in your household) for at least 15 minutes, over 24 hours⁶. If a user tests positive for COVID-19 and that individual shares the results in the app, a broadcast notification is sent to close contacts in the temporary record, alerting them to the potential exposure and providing follow-up instructions and access to additional resources.

These apps are free and readily available in the Google and Apple app stores and can be set up in minutes. Once installed, the app runs quietly in the background and doesn’t require any input during monitoring. If a user tests positive for COVID-19, that person anonymously can share the test result to notify close contacts with one click.

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You can find a list of states using Apple/iOS and Google/Android apps below:

*Enabled in iPhone Exposure Notifications settings.

Oregon & South Carolina have apps currently in development.

Alaska, Arkansas, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Massachusetts, Minnesota, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Mexico, Ohio, Oklahoma, Rhode Island, South Dakota, Tennessee, Texas, Utah, Vermont, West Virginia, and Wisconsin do not have apps available.

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Simulations and other models of COVID-19 transmission show that the use of an exposure-notification app, if carefully implemented alongside other measures, has the potential to substantially reduce the number of new coronavirus cases. These models show that adoption of these technologies at any level of uptake can have a protective effect⁷.

Get out the word

For all states where these apps are available, there is an immediate opportunity: Promote the use of COVID-19 exposure-notification apps by first responders as digital PPE. Agencies and departments that utilize these apps could provide protective benefits to their responders and the communities that they serve by providing continuous exposure-monitoring during calls for service and while in personnel quarters.

In November 2020, RTI International partnered with the North Carolina Office of the State Fire Marshal to conduct a survey of 1,107 fire departments across the state to assess awareness of the North Carolina Department of Health and Human Services’ (NCDHHS) SlowCOVIDNC app and of organizational readiness to adopt digital PPE. The survey results show that a majority of responding fire departments believe that these apps would be useful and easy to deploy and that firefighters have a high likelihood of downloading and using these apps. Critically, the survey found that fire departments are in need of guidance and resources (e.g., standard operating guidelines, templates) to help to govern how to manage exposure notifications and make decisions about who to quarantine and for how long. The survey results also are used to develop a statewide communications campaign with the North Carolina Division of Public Health to promote and better enable first responder digital PPE adoption.

Demonstration projects in the states that offer digital PPE ultimately could inform a more coordinated, national strategy for protecting first responders. Existing COVID-monitoring initiatives for firefighters (e.g., IAFF⁸, USFA⁹, National Institute for Occupational Safety and Health¹⁰) have been limited by the lack of reliable, standardized reporting. These apps could reduce the administrative burden of outreach and communication during an exposure event by automatically delivering alerts to first responders who might have been exposed to COVID-19. The apps also could be used by departments in support of workers’ compensation filings or in support of LODD reporting. National adoption might be considered as a part in the COVID-19 response strategy of the incoming Biden-Harris administration¹¹, increasing the likelihood that this would be successful for first responders.

The early adoption of Digital PPE by first responders in 16 U.S. states provides an important opportunity to explore new ways to improve accuracy of tracking COVID while enhancing protections for emergency services personnel.

References

1. https://www.osha.gov/SLTC/covid-19/hazardrecognition.html
2. https://www.firerescue1.com/personal-protective-equipment-ppe/articles/face-masks-heres-what-cops-firefighters-medics-and-cos-have-to-say-about-use-policy-and-effectiveness
3. https://www.themedicalcareblog.com/digital-technologies-for-covid-19/
4. https://covid19.apple.com/contacttracing
5. https://developer.apple.com/documentation/exposurenotification
6. https://www.cdc.gov/coronavirus/2019-ncov/php/contact-tracing/contact-tracing-plan/appendix.html#contact
7. https://www.bdi.ox.ac.uk/news/new-research-shows-tracing-apps-can-save-lives-at-all-levels-of-uptake
8. https://www.iaff.org/coronavirus/
9. https://apps.usfa.fema.gov/firefighter-fatalities/fatalityData/incidentDataReport
10. https://www.cdc.gov/niosh/fire/default.html
11. https://www.rollcall.com/2020/11/17/covid-19-tracking-apps-may-get-a-boost-from-bidens-task-force/

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Adapted from: https://www.rti.org/insights/digital-ppe-first-responders-covid-tracking