COVID-19 response in India can be strengthened by developing mobile health solutions: Study

India’s response to COVID-19 can be strengthened by developing comprehensive mobile health solutions for frontline healthcare workers and public health authorities, a study said, stressing on the need for "necessary but least intrusive" measures for disease surveillance.

Published online in the Indian Journal of Medical Research (IJMR), the study also said there is a need for the mass installation of a single contact tracing mobile phone application.

Under the study, conducted by researchers of Delhi-based George Institute for Global Health, Google Play and the Apple app store were searched using terms such as 'COVID-19', 'coronavirus', 'pandemic', an 'epidemic'.

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In addition, a search was run for COVID-19-related apps using the phrase ‘COVID-19 mobile apps in India’. The search was conducted in the first week of April and updated on May 3, as per the study.

It said a list of COVID-19 specific functions was compiled based on the review of selected apps, the literature on epidemic surveillance and national and international media reports.

WHO guideline on Digital Health Interventions was also used to classify app functions under the categories of the general public, health workers, health system managers and data services apps in India, it said.

During the study, the researchers found that governments, including the Centre, have invested in the development of mobile apps to deal with this crisis.

The search yielded 346 potential COVID-19 apps, of which 50 met the inclusion criteria, the study said.

Besides these, dissemination of untargeted COVID-19-related information on preventative strategies and monitoring the movements of quarantined individuals was the function of 27 and 19 apps, respectively.

Eight apps had contact tracing and hotspot identification function, the study said.

While there were differences in state-specific information in the apps developed by different states, the system architecture and many of the functionalities, including self-testing, quarantine monitoring and contact tracing, were common between these apps.

The Ministry of Electronics and Information Technology has taken proactive measures to promote installation and usage of the Aarogya Setu app, which is currently available in 11 Indian languages, the study said, highlighting that penetration of the app is critical to the success of technology-enabled contact tracing.

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Evidence suggests that 70 per cent of the population should have the app installed for digital contact tracing efforts to be effective, the researchers said.

"The current technological plurality in the absence of robust data exchange mechanisms and Centre-state coordination can be detrimental for technology-assisted contact tracing in a heterogeneous country like India, especially once the lockdown ends and free movement of people starts," the study said.

Overcoming this challenge requires Union and state governments to ensure the mass installation of a single contact tracing app collaboratively, it said.

In terms of privacy, the study said contact tracing and quarantine monitoring apps reviewed in this study collected user data such as name, phone number, real-time location, and Bluetooth interactions with other app users.

While the collection of location data is essential for mapping hotspots of disease transmission, privacy experts are concerned about this data being a hazard for an individual’s privacy and national security, it said.

The Aarogya Setu app’s privacy factor was recently questioned by opposition parties, following which the government opened the source code of its coronavirus tracing app.

The researchers said the collection of location data in South Korea and China sparked global concerns related to privacy and potential mala fide use of the data. To counter this, countries like Singapore and Argentina used tracking apps that only collect Bluetooth interaction data to preserve user privacy.

"To ensure transparency, Singapore and Israel have shared their app source code with researchers for an independent audit. In the absence of a data protection law in India, the central and state governments need to address these privacy-related concerns to garner public trust that would ensure the deployment of these apps at scale," the study said.

The review of app functionalities further revealed that information dissemination regarding preventative measures was the primary function of the majority of the existing apps in India, it said.

The apps reviewed in this study did not have specific strategies to deal with the infodemic.

The Union health ministry has formally recognized remote consultation through ‘Telemedicine practice guidelines’, with a growing number of COVID-19 cases, the study said.

There is urgent need to create integrated teleconsultation options within these apps to assure quality healthcare services, including those with pre-existing conditions, it said.

This study despite limitations has important implications for informing the development of future COVID-19 mHealth initiatives in India.

"In a hysteric environment and a severe shortage of testing facilities, the self-risk assessment function available in the apps may help spot the patients at risk for COVID-19," the researchers said in the study.