1/ With the omicron surge, I have had more friends send me screenshots of exposure notifications (EN) in the last week than I have in the last year. Here are some reflections based on the work I led at @Apple working with @Google and some thoughts on the road ahead. 🧵
2/EN was one of the most exciting projects I have ever worked on with an unbelievable amount of technical talent at both companies deployed to deliver in a matter of months. (Recent gathering of a small subset of the crew below)
3/ As we worked on the effort, it became clear to me that public health agencies did not fully grasp the power of the technology as a way to massively augment more traditional NPIs.
4/ It was always a challenge to convince someone that it was “as good as” contact tracing, which was like asking whether an email is as good as a nice holiday card. Of course they’re not the same, but I can send a nice e-card instantly to 100 people to get mostly the same result.
5/ The biggest pushback we got was why we wouldn’t allow governments around the world to use the API to collect a ton of data about users who had opted in since traditional contact tracing provided more precise insights on who had been exposed to the index case.
6/ Our reply of course was to protect user privacy since the identity and whereabouts of all of your friends could be sucked up by a bad government actor with a more centralized design — to build a social graph of all users with the pandemic as the justification.
7/ “Trust us, we are the government” was often the pushback. But of course, this wasn’t a theoretical concern but something that actually happened in both Singapore and Australia with systems that did not adopt our privacy-preserving approach. technologyreview.com/2021/01/11/101…
8/ Surprisingly, the UK and Europe were the most progressive, coordinated, and aggressive in their use of the technology while most people we talked to in the US couldn't be bothered as they stood up contact tracing call centers.
9/ The UK actually published data showing that the EN system worked to blunt the surge last winter: technologyreview.com/2021/02/11/101…
10/ Eventually, a patchwork of US states adopted the EN technology through their own apps or EN Express. Unlike most countries, we lacked a federal approach which could ensure a uniform message and rollout. This was probably the single biggest detriment to adoption in the US.
11/ Reading Michael Lewis’s Premonition on the pandemic response was both a revelation and made total sense in retrospect — the cognitive bias was strong that the “experts” had all the answers early on and that EN was an "unproven" technology that no one had validated before.
12/ When the public health experts at the CDC and other agencies asked for papers that we had published or evidence that we had gathered showing the technology saved lives, I could only silently scream, “it was just invented a few months ago”.
13/ Instead, the CDC and other agencies promulgated “evidence-based guidelines” on social distancing rules based on outdated research on 6 feet of distance and no more than 15 minutes of exposure, all of which we can throw out the window now.
14/ With the Biden transition, we all had hope that a different dynamic would take hold, but the incoming administration was on a singular mission to launch the vaccines -- with deaf ears for massively scaling testing and re-launching a national EN app.
15/ The vaccines-as-silver-bullet approach was wrong last summer when the Biden administration declared COVID “independence”, and it continues to be wrong today.
16/ There have been many “experts” who have declared that we are just around the corner from COVID finally being over. Almost all of these predictions have been wrong. Nobody knows for sure what will happen.
17/ It is a psychological barrier for all of us to accept that we are probably in the early part of the decade of COVID versus hoping that it will go away in a matter of months.
18/ The sooner we can accept this reality, the more likely that we can act with the force of conviction and commitment required to bring the virus under control.
19/ The testing mess we are in right now is the result of anchoring bias around the vaccines with so many missed opportunities over the last year to prepare for the current surge. I can only image the hemming and hawing about why anyone would care about testing anymore.
20/ While one should always hope for the best, it is a collective failure of imagination to not be prepared for the worst. Our current situation in the U.S. strikes me as "prepare for the best" and "surprised by the worst".
21/ There are people like @larrybrilliant who have consistently warned about the need to prepare for the worst.
22/ It is time to bring 21st century tools and technology to a 21st century virus. The vaccines are a piece of the puzzle, but we should be deploying every tool in our toolkit — N95 masks, boosters, rapid and ubiquitous testing, and yes, even EN.
23/ Technology brings 3 things to help balance the equation vs. COVID: speed, scale, and decentralization. EN can notify exposed individuals near instantly and provide rapid guidance about what to do, all without the government or “big tech” privy to your personal information.
24/The trifecta of mass rapid testing, EN, and oral therapies could be the killer combination against omicron and future variants. Anyone who gets an EN should get tested immediately, isolate/quarantine to break transmission, and get rapid access to a therapy if positive.
25/ My holiday wish is for everyone to stay safe and healthy and for us to ready ourselves for the potential variants to come.

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More from @cha_myoung

21 Aug
1/ Some thoughts on the #healthcareishard theme from last week based on my recent experiences at @Apple and now at @CarbonHealth 👇🏻
2/ The struggle is real, but this is true for anyone trying to make a dent in healthcare, whether at a startup or a large tech company. So I agree with @chrissyfarr, the takeaway isn’t “Health care is hard.” Of course it’s hard.
3/ There are a few important things that make it different living inside a tech company (and quite frankly any large company) versus a startup:
Read 25 tweets
21 Aug
1/ Not many people would call healthcare a hyper-growth market, but @CarbonHealth has figured out a model that people love and a flywheel that few companies in healthcare have tapped into.
2/ Patient volumes have grown more than 100% in the last six months, most of which has been driven by consumer word of mouth and patients who come back to visit us.
3/ “At the height of the pandemic, the clinic saw as many as 120 patients in a day, almost all of them for Covid testing and treatment. Now they see maybe 60 patients per day, for everything from Covid tests to women's health to basic checkups.”
Read 4 tweets

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