In Iceland, almost 40 percent of the population has downloaded Rakning C-19, an application made available by the government for contact tracing via smartphones, with the aim of reducing the spread of the coronavirus epidemic on the island. The percentage of membership is very high, when compared with experiences in other countries, but so far the app has proved less useful than expected, confirming the suspicions of many observers on the overestimation of the potential of these technological solutions.
Iceland has so far detected 1,802 positive cases across the country and a dozen deaths from the coronavirus, out of a population of around 364,000 people. The government managed to keep the contagion under control by acting promptly, with a plan to detect positive cases early and isolate them, reducing the risk of spreading COVID-19.
Tests using swabs were performed on a rather large scale, in relation to the number of inhabitants, as well as people at risk or in contact with positive individuals were advised to remain in quarantine. The government has focused heavily on the collaboration of citizens, asking for physical distancing to be practiced, but without the need to impose particular restrictive measures and limitations for travel. The low population concentration has certainly helped, making it possible to control the situation more accurately than in countries with tens of millions of inhabitants.
While the tests, the selective isolation of the infected and the traditional tracing of contacts with health personnel trained for this purpose proceeded, the government set to work to develop an application for contact tracing. Rakning C-19 was made available to owners of iPhones and Android smartphones in early April, with the aim of making it even easier to track the infection.
Once downloaded and installed, Rakning C-19 asks you to provide your mobile number to receive a code to enter in the application, to register. The number is held in a centralized database of Sensa, a service company owned by Iceland's leading telecommunications company. The app then asks to have access to your geographic location, which is detected by your smartphone via GPS.
Things to know about the coronavirus The Coronavirus Post newsletter updates you on the latest news: it's free and arrives every Thursday at 18:00. To receive it, write your email address here and press the button below. Having read the information, I agree to send the Newsletter Once set, the application periodically detects your geographical position and saves it in a list of places that remains on your smartphone and is not shared with anyone else. The data on each position is kept for two weeks, i.e. the coronavirus incubation time, and subsequently deleted.
If you discover that you are positive for the virus through a swab provided free of charge by the health system, the Icelandic Civil Protection sends a request through the application to ask if you want to share the list of geographical locations recorded by Rakning C-19 in the previous 14 days . To provide your consent you must enter the identification number of a document (it is similar to our tax code), thus confirming your identity.
In this way, contact tracing staff can use the information on the movements of the person who tested positive, better verifying who they came into contact with and what chain of contagion they have initiated, if any.
Rakning C-19 works differently from the applications that several other countries are working on, such as Italy with Immuni, and based on Bluetooth technology instead of GPS. Bluetooth is believed to offer greater privacy guarantees, while at the same time offering a more complete system for knowing who has passed by a person who has since discovered that they are positive for the coronavirus. The Icelandic app's approach is to have information complementary to that normally collected by those who track contacts, with telephone interviews for those who tested positive and with people with whom they interacted in the previous days.
Within weeks, Rakning C-19 was downloaded by nearly 40 percent of Icelanders, making it one of the most used contact tracing apps in the world (relative to population). According to various experts, applications of this type can only be useful if used by a high percentage of the population, but the Icelandic experience seems to suggest that even with high adhesion, very appreciable results are obtained.
Gestur Palmason, who is in charge of coordinating the work of the contact tracing staff, explained that so far Rakning C-19 has proved useful in a limited number of cases: “For us it has not been a turning point”. The application allowed in some cases to obtain more information, but in the end it was the field work of the operators that made the difference in the reconstruction of the chains of contagion.
According to Palmason, a very targeted approach has worked above all in Iceland to identify positive cases, proceed with their isolation and with the search for their contacts potentially exposed to the coronavirus: “We worked with a collaborative approach with the population. There are laws and fines can be imposed, but we didn't: we trusted the willingness of our citizens to abide by the guidelines, and that model worked fantastic “.
Iceland has few inhabitants, small towns and low population density, all factors that have contributed to containing the epidemic, along with a targeted control of arrivals to the island. This partly explains the success of the initiatives taken by the government apart from Rakning C-19. However, several observers have invited us not to underestimate the Icelandic experience and the marginal role that the app has had for tracing contacts, joining those who had already suggested not to rely too much on these technologies especially in such an advanced phase of the pandemic.
Many countries, including Italy, are working to create applications for contact tracing and in recent weeks Apple and Google have started a collaboration, precisely to make the development of these apps easier. The first experiences in Australia, Singapore and South Korea have given mixed and not yet convincing results, with several studies indicating that apps alone cannot do much to keep the epidemic under control.
As also claimed on several occasions by the heads of the Istituto Superiore di Sanità in Italy, the best way to track contacts requires the presence on the territory of operators dedicated to these activities. Once the positive individuals have been identified, it is necessary to interview them about their meetings that took place in the previous days to proceed with the isolation of those exposed, in order to reduce the risk that they can infect other people in turn.
