As covid-19 instances spiral uncontrolled within the US, states are scrambling to struggle the virus with an more and more stretched arsenal. Lots of them have the identical weapons at their disposal: restrictions on public gatherings and enforcement of masks carrying, plus testing, tracing, and publicity notifications.

However whereas many states wrestle to get their methods to work collectively, Guam—a tiny US territory nearer to the Korean Peninsula than the North American mainland—could supply clues on the way to rally communities round at the least one a part of the puzzle: smartphone contact tracing.

With no funds, and relying nearly completely on a grassroots volunteer effort, Guam has gotten 29% of the island’s grownup residents to obtain its publicity notification app, a charge of adoption that outstrips states with way more assets. 

A collaborative effort 

Guam identified its first covid instances in March, however a couple of weeks later, it gained worldwide consideration—and a a lot larger case load—when a covid-stricken US Navy ship was ordered to dock on the Naval base on the island. Sailors who examined adverse had been quarantined in native lodges and forbidden from interacting with civilians.

Having so many constructive instances on the island drove residence how weak the island actually was—however it additionally created plenty of new volunteers in search of methods to assist out. 

Across the similar time, Vince Munoz, a developer on the Guam-based software program firm NextGenSys, bought a name. The island was being provided a partnership with the PathCheck Basis, a nonprofit that was constructing authorities contact tracing apps. Munoz instantly noticed a chance to assist his group struggle this new menace.

“It’s one thing you do to assist different folks,” Munoz says. “It empowers you to assist cut back the unfold of the virus.” 

Digital contact tracing is a doubtlessly low-touch approach for well being departments to scale back the unfold of covid-19 through the use of smartphones to trace who’s been uncovered. And even when publicity notifications aren’t the panacea many technologists hoped for, new analysis means that breaking even a couple of hyperlinks within the chain of transmission can save lives. 

So Munoz’s workforce of volunteers linked with PathCheck—which was based at MIT—they usually began constructing an app referred to as Covid Alert. Like the vast majority of America’s publicity notification apps, it makes use of a system constructed by Google and Apple and makes use of Bluetooth indicators to alert those that they’ve crossed paths with somebody who later assessments constructive. From there, they’re urged to contact the island’s native well being authorities and take acceptable motion. Every thing is finished anonymously to guard privateness. 

After a number of months of testing and tweaking, the app was prepared. However it was nonetheless lacking an essential piece: customers. In spite of everything, any contact tracing app wants as many downloads as doable to make a distinction. Munoz knew simply the folks to construct buzz: the Guam Guests Bureau. Tourism is massively essential to the island, which will get greater than 1.5 million guests every year—nearly 10 instances the native inhabitants. In pre-pandemic instances, the bureau helped vacationers plan journeys to Guam’s “star-sand seashores.” Employees jumped on the likelihood to assist.

With help from Thane Hancock, a CDC epidemiologist primarily based on the island, and Janela Carrera, public info officer for the Guam Division of Public Well being and Social Companies, the workforce began constructing a advertising marketing campaign.

“As a result of we didn’t have any funding, we determined to do a grassroots marketing campaign,” says Monica Guzman, CEO of Guam-based advertising firm Galaide Group, who works with the bureau. Guam is a really small group. We’re all both associated or neighbors or pals.”

Whereas PathCheck and Munoz’s growth workforce labored on constructing the app, the Guests Bureau started reaching out to group teams and nonprofits to construct consciousness. It hosted Zoom calls with organizations, faculties, and cultural teams throughout the island with the message that the app might assist suppress the virus, if sufficient folks had been keen to “be a covid warrior.”

“The colleges, the federal government companies, the media, all of them jumped on board,” Carrera says.

Collectively, these efforts are a part of what ethics researchers on the Swiss Federal Institute of Expertise lately referred to as the “piecemeal creation of public belief.” To get folks to make use of a novel expertise like publicity notification, it’s a must to attain folks the place they stay and get buy-in from group leaders. 

It takes a village (on WhatsApp)

As soon as the app was able to launch in September, it was time to get the phrase out. 

The day earlier than the official launch, Guests Bureau advertising supervisor Russell Ocampo despatched a message in regards to the app to Guam’s notoriously giant and unruly WhatsApp teams. That message ricocheted across the island, leading to nearly 3,000 downloads instantly. “I obtained it again like 10 instances from different folks,” he says. 

An additional 6,000 folks signed up the subsequent day throughout a press convention, together with the governor, who downloaded it whereas stay on the air. 

The trouble obtained a present of help that many US states and territories might solely dream of. All three main telecom corporations on the island despatched free texts encouraging folks to obtain the app. An area TV station, in the meantime, ran a two-hour “download-a-thon,” to attempt driving uptake. The present featured performances by native musicians, interspersed with details about the app, together with debunking myths about privateness and different ongoing considerations. Viewers had been provided the prospect to win $10,000 in prize cash, a lot of it donated personally by Guam Guests Bureau members and others who labored on the app, if they may show they downloaded the app throughout this system. 

The Guam Guests Bureau has provided different money prizes for presidency companies whose staff rack up essentially the most downloads. And small companies, wanting to get the economic system again on its ft, have provided give-aways to clients — one purchasing middle is providing a field of candies to guests who obtain the app.


However, crucially, has the app labored? Regardless of a profitable launch, Guam’s covid-19 response has confronted main challenges total. Many individuals, particularly these from minority ethnic teams who got here to Guam from different Pacific islands, stay in multi-generational, overcrowded housing, usually with restricted entry to healthcare and even primary hygiene instruments like municipal sewage. The well being division lately launched door-to-door testing in these neighborhoods, and located positivity charges as excessive as 29%.

At the start of April, the governor’s workplace projected that the virus might kill 3,000 folks—nearly 2% of the island’s inhabitants—over the subsequent 5 months. That dire prediction has but to return true. As of Monday, Nov. 30, 112 folks have reportedly died of covid on the island. General, the territory’s trajectory has been typical of America itself: Instances remained low by means of a lot of the summer season, earlier than ticking steadily up by means of the autumn and spiking in early November. 

Whereas a big proportion of residents have downloaded the app, one main problem has been getting folks to add constructive take a look at outcomes. That is partially as a result of persons are usually in shock after they first obtain the information about their prognosis, in response to Janela Carrera, the well being division officer.

Contact tracers name everybody who assessments constructive, and a part of their script includes recommending that folks add their constructive outcome: That’s how the app is aware of to ship (nameless) publicity notifications to individuals who’ve been close to one another. However that first name can really feel extraordinarily nerve-racking, and it’s not a good time to recommend they check out a brand new app or undergo the method of coming into a particular numerical code that kicks off the chain of notifications. 

“Particularly in the event that they’re symptomatic, they could really feel like, ‘oh my gosh, I could not make it by means of this,’ or ‘I could be infecting others in my residence.’ So [contact tracers] observe up with them a couple of days later, as soon as they’ve had an opportunity to recuperate, and supply the code then,” Carrera says.

Clearly, although, some persons are importing the codes. “I’ve had co-workers inform me, ‘Janela, oh my God, I bought a notification!’” Carrera says. Ocampo himself obtained one in October, and quarantined for 14 days. 

That is boosted by the truth that when public well being employees do their door-to-door testing, they provide details about the way to obtain the app. On the similar time, different methods, usually shared by means of multilingual PSAs on native radio, could also be more practical for folks in these communities, who usually don’t use smartphones for something greater than texting, in response to Munoz.

Guam faces one different problem that’s quite common worldwide. It’s troublesome to know precisely what impact the app is having, says Sam Zimmermann, CTO of PathCheck Basis.

Zimmermann says: “As a result of Guam cares rather a lot about privateness and ensuring their methods are protected, their app doesn’t have any sort of analytics or logging,” like whether or not customers truly learn the way the app works after downloading it or whether or not they listen in the event that they obtain an publicity notification. 

Nonetheless, whereas the workforce launched the app hoping to realize a 60% obtain charge primarily based on an early mathematical mannequin, there’s now proof that even a a lot smaller portion of the inhabitants utilizing it could have a constructive impression.

Munoz, for one, hopes the app will assist take strain off well being officers doing labor-intensive outreach like door-to-door testing.

“Guide contact tracers have a really troublesome job. They’ll’t sustain with everybody who assessments constructive,” Munoz says. “Any little proportion helps.”

This story is a part of the Pandemic Expertise Mission, supported by the Rockefeller Basis.


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