JMIR MHEALTH AND UHEALTH Cheng & Hao

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Case-Initiated COVID-19 Contact Tracing Using Anonymous

Notifications

Weibin Cheng1, MSc; Chun Hao2,3, PhD

1
Institute for Healthcare Artificial Intelligence Application, Guangdong Second Provincial General Hospital, Guangzhou, China
2
Department of Medical Statistics and Sun Yat-sen Global Health Institute, School of Public Health & Institute of State Governance, Sun Yat-sen
University, Guangzhou, China
3
Health Information Research Center and Guangdong Key Laboratory of Medicine, School of Public Health, Sun Yat-sen University, Guangzhou,
China

Corresponding Author:
Weibin Cheng, MSc
Institute for Healthcare Artificial Intelligence Application
Guangdong Second Provincial General Hospital
466 Xingangzhong Road
Guangzhou, 510317
China
Phone: 86 20 89168139
Email: chwb817@gmail.com

Abstract
We discuss the concept of a participatory digital contact notification approach to assist tracing of contacts who are exposed to
confirmed cases of coronavirus disease (COVID-19); the approach is simple and affordable for countries with limited access to
health care resources and advanced technology. The proposed tool serves as a supplemental contract tracing approach to counteract
the shortage of health care staff while providing privacy protection for both cases and contacts. This tool can be deployed on the
internet or as a plugin for a smartphone app. Confirmed cases with COVID-19 can use this tool to provide contact information
(either email addresses or mobile phone numbers) of close contacts. The system will then automatically send a message to the
contacts informing them of their contact status, what this status means, the actions that should follow (eg, self-quarantine,
respiratory hygiene/cough etiquette), and advice for receiving early care if they develop symptoms. The name of the sender of
the notification message by email or mobile phone can be anonymous or not. The message received by the contact contains no
disease information but contains a security code for the contact to log on the platform to retrieve the information.

(JMIR Mhealth Uhealth 2020;8(6):e20369) doi: 10.2196/20369

KEYWORDS
COVID-19; surveillance; contact tracing; digital contact tracing; notification; anonymous; labor-saving; stigma; privacy protection

Luca Ferretti and colleagues [1] modelled the potential effect

Introduction of a digital contact tracing approach that involved training an
Emerging evidence from the response to coronavirus disease artificial intelligence algorithm to analyze COVID-19 cases and
(COVID-19) in China [1], Singapore [2,3], and South Korea GPS-based population colocalization information. However,
[4] has indicated that efficient contact tracing reduces the delay the application of this powerful method may be hindered by
between infection and isolation and accordingly prevents further advanced technical requirements and violation of privacy
transmission of the virus [5,6]. Contact tracing, which includes regulations. Yasaka and colleagues [7] developed a
contact identification, listing, and follow-up, is a crucial aspect proof-of-concept smartphone app that allows users to create
of epidemic control and is usually driven by health specialists. “checkpoints” for contact tracing and also modelled the effect
Contact tracing is a tedious task that requires enormous staff of such an app under various adoption scenarios. This app
resources, and it is not possible to fully implement contact respects user privacy by not collecting location information or
tracing in regions with widespread transmission. Alternatively, other personal data. However, this approach relies on high levels
some parts of this task can be substituted and even augmented of vigilance and willingness to participate among a majority of
by technology. the population. Another concept of “privacy by design”
COVID-19 contact tracing via Bluetooth is being rolled out in
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Europe [8] which relies on Bluetooth data exchange between themselves (Table 1). This tool serves as a supplemental contract
two mobile phones to detect whether two people have come tracing approach to counteract the shortage of health care staff
into sufficient physical proximity to risk infection, and notifying while providing privacy protection for both cases and contacts.
those who have been in contact with an infected individual who This tool can be deployed on the internet or as a plugin for a
stays anonymous. This type of app has the same constraint of smartphone app. Confirmed cases with COVID-19 can use this
requiring user cooperation to have any chance of success, and tool to provide contact information (either email addresses or
it may be more useful in developed countries where smartphones mobile phone numbers) of close contacts; then, the system will
are widely used. automatically send a message to the contacts informing them
of their contact status, what this status means, the actions that
Health care staff resources have been scarce worldwide during
should follow (eg, self-quarantine, respiratory hygiene/cough
the COVID-19 pandemic, especially in developing countries,
etiquette), and advice for receiving early care if they develop
where technological resources may also be inadequate. We
symptoms. The name of the sender of the notification message
discuss a concept of a contact notification tool to assist tracing
by email or mobile phone can be anonymous or not. The
of contacts who are exposed to confirmed cases of COVID-19;
message received by the contact contains no disease information
this tool is simple and affordable for countries with limited
but contains a security code for the contact to log on the platform
access to health care staff and advanced technology.
to retrieve the information. This approach can prevent reading
of the message by people other than the intended recipient. The
Concept of the Tool personal identification data of both the confirmed case and their
The core functionality of our concept is to provide a usable, close contacts will not be recorded during the process.
labor-saving tool for contact tracing by confirmed cases Information provided by confirmed cases will also be encrypted.

Table 1. Concept framework for the development of a tool for COVID-19 contact tracing.
Concept Descriptions and considerations
Products Smartphone app
Web-based platform
Operating systems Windows and Apple
App compatible with the latest smartphone operating systems
Target users Suspected and confirmed cases with COVID-19
People who receive messages from the platform
People who are concerned about COVID-19 infection
People who need guidance regarding the control and prevention of COVID-19
Policy makers and public health specialists
Functionality Contact notification (eg, email, SMS text messages, autochatbot); can be anonymous or not
Shared exposure query database
COVID-19 information hub (optional but strongly recommended)
Application scenarios Cases when in-person investigation cannot be implemented
Regions and countries where manual contact tracing is not in place
Supplement to manual contact tracing, especially in regions of widespread transmission where people with no
or mild symptoms are self-quarantined at home
Navigation and use of the tool Clear definition of close contacts of COVID-19
Guide for generation of close contacts
Official email account or telephone number
Template notification messages
Rights and responsibilities
Online consultation
Other considerations Paramount protection of personal privacy
Strict adherence to general data protection regulations, careful oversight of data, and effective protections around
the use of data
Guaranteed equity of access to testing and treatment
Careful design and monitoring to prevent malicious use

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Another key functionality is a shared exposure query database United States and United Kingdom. This tool can help save
for people whose close contacts cannot be reached by health care resources, freeing staff to provide more urgent testing
messaging. This design is a crowdsourced database that allows and clinical care for patients with COVID-19. Although mild
patients to input their trajectory information, including public cases who self-isolate at home may not associated with the
transportation used and times and locations of the patient’s spread of COVID-19, promptly informing contacts of possible
movement prior to and after onset of symptoms. Trajectory risks to take proper precaution measures seems to be necessary
information can either be provided by the confirmed patient or and reasonable during a disease outbreak.
obtained during confirmation and uploaded by an
epidemiologist. This trajectory information can be visualized Considerations for Successful Use
on a map, which may be useful for the public to determine their
possible exposure to COVID-19. The tool should be simple and Several considerations should be taken into account to guarantee
easy to access so that it can be used in areas with limited the successful use of this tool. First, the main purpose of this
resources. For example, people can visit the website and search tool is to provide a supplementary approach for patients with
by date and route for possible close contact with a patient with COVID-19 to inform their friends, colleagues, and neighbors
COVID-19. This tool can also serve as a hub to access about possible contact while maintaining their privacy. Second,
instructions and information about COVID-19 and health an accessible COVID-19 testing and care network is needed to
services. guarantee equity of access to testing and treatment to meet the
surging demand and relieve the anxiety of people who have
Benefits of the Tool received notifications and are anxious about possible infection.
Third, privacy protection for both the sender and the recipient
We envisage that this tool will be useful for people who are are equally important. The General Data Protection Regulation
concerned about personal privacy and stigmatization related to must be strictly followed, and careful oversight and effective
COVID-19. Persons of Asian descent have faced stigma and protection of the use of data must be ensured. Last, we need to
discrimination in many places [9]. A person can also be be alert to possible malicious use of this tool. People who do
subjected to stigma after they have been released from not have COVID-19 may use the system to send messages to
COVID-19 quarantine even though they are not considered to others for evil purposes.
be at risk of spreading the virus to others. Several digital contact
tracing approaches have been explored worldwide [10]. Despite Conclusion
the potential of digital contact tracing, its potential impact is
limited because it may conflict with patient data privacy The successful application of this tool relies heavily on public
regulations. Our approach is different from other digital contact social responsibility and credibility, and it remains to be seen
tracing methods in two ways. One is that it can be function as if the public would adopt such a tool and what mechanisms are
a website that does not need to be installed on the user’s required to prevent misuse. This is a simple tool that does not
smartphone. This will substantially lower the threshold for users require complicated computer techniques despite strict user
to access the tool. The other is that no data processing, privacy protection design with respect to countries and regions.
recording, or analysis occurs on the central server, which reduces Additionally, this tool can help avoid coercive surveillance,
concerns regarding personal privacy. facilitate the allocation of health resources, and prioritize clinical
service for patients with COVID-19. Information obtained from
Meanwhile, this approach can be used as a supplement contact the platform can also increase our understanding of the
tracing tool in regions of widespread transmission where many epidemiology of COVID-19.
undiagnosed mild cases are self-isolating at home, such as the

Conflicts of Interest
None declared.

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Abbreviations
COVID-19: coronavirus disease

Edited by G Eysenbach; submitted 18.05.20; peer-reviewed by F Zhong, D Wu, E Da Silva; comments to author 27.05.20; revised
version received 02.06.20; accepted 04.06.20; published 22.06.20
Please cite as:
Cheng W, Hao C
Case-Initiated COVID-19 Contact Tracing Using Anonymous Notifications
JMIR Mhealth Uhealth 2020;8(6):e20369
URL: http://mhealth.jmir.org/2020/6/e20369/
doi: 10.2196/20369
PMID:

©Weibin Cheng, Chun Hao. Originally published in JMIR mHealth and uHealth (http://mhealth.jmir.org), 22.06.2020. This is
an open-access article distributed under the terms of the Creative Commons Attribution License
(https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium,
provided the original work, first published in JMIR mHealth and uHealth, is properly cited. The complete bibliographic information,
a link to the original publication on http://mhealth.jmir.org/, as well as this copyright and license information must be included.

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