Apple and Google's ambitious COVID-19 contact tracing tech can only help contain the pandemic if used widely. But so far, only 3 states have agreed — and none have started to use it. (AAPL, GOOG, GOOGL)

But public health agencies in the US have been reluctant to adopt the technology.
Business Insider contacted officials in all 50 states and the District of Columbia; only three states confirmed they plan to use the technology from Apple and Google. Meanwhile, 16 states ruled out the possibility of building contact tracing apps entirely.
The slow uptake casts doubt on the viability of containing coronavirus with contact tracing apps, which require the majority of people to participate in order to function.
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On March 19, California became the first state to go into lockdown in order to slow the spread of COVID-19. The rest of the country soon followed, but nearly three months later, cases of the coronavirus are still rising in several US states .

As coronavirus cases were spiking in the United States in April, Apple and Google announced an ambitious new partnership: The long-time rivals would work together to create Bluetooth contact tracing technology that could be used by public health authorities to track the spread of COVID-19, the disease caused by the novel coronavirus.

But more than four months after the US reported its first coronavirus cases, after more than 110,000 deaths, and weeks after Apple and Google completed the software , few of the promised technological solutions have been rolled out.

According to a Business Insider survey of state health agencies, including all 50 states and the District of Columbia, very few states intend to use the technology proposed by Apple and Google, and many states are not planning an app at all. Some states said they planned to rely only on human contact tracers.

As states start to reopen, the lack of adoption could hobble the effectiveness of Apple and Google's technology. And with privacy concerns and growing efforts to regulate the technology, it's looking like these tech giants might not play a major role in the nation's coronavirus response after all.

States' reluctance to use Apple and Google tech poses a challenge for the companies

Just three states Alabama, South Carolina, and North Dakota have committed to using Apple and Google's contact tracing tech. Seventeen states said they are considering using contact tracing apps but have not made a decision, and 16 states told Business Insider they're not planning to create an app or use smartphone-based contact tracing at all.

The remaining 14 states have not clarified any plans to use contact tracing apps or did not respond to Business Insider's questions. The District of Columbia said it will be using human-based contact tracing and did not indicate any plans for an app.

Google declined to comment. Apple did not return Business Insider's request for comment.

The technology from Apple and Google is not an app rather, it's software that public health authorities can build their own apps on top of.

The tech harnesses Bluetooth in people's smartphones to keep a log of other devices that come in close proximity. When integrated with an app, this can be used to notify a user who crossed paths with someone who tested positive for coronavirus.

But the low adoption rate is a problem for Apple and Google's initiative. In order for smartphone-based contact tracing to work, experts say it has to be adopted by at least 60% of a country's population. Singapore, one of the first countries to roll out a Bluetooth contact tracing app in March , only saw 25% adoption, and COVID-19 cases spiked in the country despite the app's rollout.

Some states, including Virginia, Washington, Illinois, and Utah, are planning to use contact tracing apps but haven't decided whether to use the technology from Apple and Google. That could create its own set of problems, according to Ellie Daw, a cryptography consultant and researcher in Washington, D.C.

Daw is a member of the TCN Coalition , a think tank founded in April that advocates privacy protections and collaboration between the makers of different contact tracing apps. She warns that if different states develop contact tracing apps using different Bluetooth protocols, there could be gaps in data on people who travel across state lines, and widespread adoption is less likely.

"If we have multiple apps per country, and they're not apps that are interoperable, then we can never reach that threshold," Daw told Business Insider.

Instead, some states plan to rely on human contact tracers

Many states that are not using the tech from Apple and Google are instead relying on armies of human contact tracers who interview COVID-19 patients. New York has hired 17,000 contact tracers, and California is in the process of hiring 20,000 currently, neither state has committed to using a contact tracing smartphone app.

Georgia, Maine, and Indiana are also among the states which told Business Insider they are relying solely on human systems right now.

With human contact tracing, public health officials will interview someone who tests positive for COVID-19 or exhibit symptoms to find out who else has been exposed to them.

They will then contact those people and tell them to monitor their symptoms or quarantine. Some of these systems, such as the one being used in Georgia, also make use of an online portal that patients can use to enter their symptoms and other information.

However, using an app means the smartphone keeps a record of the people the patients has come in close contact with, and can automatically alert them once the patients tells the app that they have tested positive.

The system has its own flaws. For example, relying on the Bluetooth signal risks producing false positives and negatives. But apps could speed the process of contact tracing up and would mean less reliance on human tracers, although experts have warned that smartphone-based systems shouldn't remove human tracers altogether.

Apple and Google consulted with several public health groups to improve their contact tracing technology, including the CDC Foundation, the Centers for Disease Control and Prevention, and the Association of Public Health Laboratories.

Privacy concerns plague app rollouts

Throughout its development, both Apple and Google have emphasized that privacy is top of the agenda with their technology, but there remain concerns about contact tracing technology and its ramifications for user privacy. A recent review by Jumbo found that North and South Dakota's contact tracing app was sharing user data to Foursquare.

A new piece of US legislation could introduce federal rules to prevent these types of privacy violations from happening. The bill, titled the "Exposure Notification Privacy Act," would require all tech companies working on contact tracing applications to collaborate with public-health authorities. It would also mandate that data collected by contact tracing apps could not be used for commercial purposes.

But privacy may not be the only major obstacle here. A new study reported in The Guardian found that people who think they have had COVID-19 are less likely to download a contact tracing app.

As states enter the preliminary phase of reopening, the adoption of contact tracing apps across the US is still incredibly low, and some of these states have no plans to adopt contact tracing technology.

Texas, one of the first states to relax its stay-at-home order has also just reported a record number of coronavirus hospitalizations, according to CNBC . The state is currently expanding its COVID-19 testing but told Business Insider that it has no intentions to adopt app technology. "DSHS will not be using a phone app for contact tracing," a spokesperson said.

Here are the states that have committed to using contact tracing tech from Apple and Google:

Alabama
North Dakota
South Carolina

Here are the states that told Business Insider they have not yet made a decision about using Apple and Google's contact tracing technology.

Arkansas
California
Illinois
Kansas
Kentucky
Maine
Massachusetts
Michigan
Minnesota
Montana
Nevada
West Virginia
Wisconsin
New York
Pennsylvania
Rhode Island
South Dakota
Virginia
Washington

Four of the above states Rhode Island, South Dakota, Virginia, and Washington have already started developing contact tracing apps that do not use Apple and Google tech. Rhode Island 's app will use both GPS tracking and Bluetooth proximity tracking, while Washington's app relies on Bluetooth. South Dakota's app, Care19 , tracks location data and has come under fire for sharing that data with third parties. Virginia has not yet disclosed how its app will work.

Here are the states that told Business Insider they have no plans to build a smartphone-based system.

Colorado
Delaware
Florida
Georgia
Hawaii
Indiana
Louisiana
Maryland
Missouri
New Mexico
North Carolina
Ohio
Oregon
Tennessee
Texas
Vermont

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