 Yeah, bingo. We're back. This is Think Tech Tech Talks. I'm Jay Fiedel. We're talking about Aloha Safe Alert. This is very important. So make notes and maybe we'll have a final exam at the end, you know, in a short answer, multiple choice. I'm only kidding. Here on Think Tech Talks. And we have Linnell Marble. She's the executive director of what Aloha Safe. Is that right? That's correct. The executive director of the Hawaii Executive Collaborative. Executive Collaborative, that's great. It's great to have multiple organizations involved in an effort like this. And Michael Kamida, tech lead of Aloha Safe Alert. Okay, I guess the next question is, of course, welcome to the show, both of you. Thank you for coming down. Thank you. The next question is, what is Aloha Safe Alert? Tell the people. Well, I'll start it off and then hand it over to Michael. Aloha Safe Alert is the Hawaii official State of Hawaii Exposure Notification Act. And it was created through a public-private partnership with the Department of Health, Hawaii Executive Collaborative, and AIO Digital, and a number of community partners who have come on board to a staff fit. And what the app does in short, and I know we'll get into a lot of detail in this next half hour, but in short, what it does is it helps to provide exposure notifications to people who may have been in contact with someone else within six feet over 15 minutes to COVID-19. And that allows them to get into quarantine hopefully sooner so that they can protect their family and their community. Wow. So from a functional point of view, an individual who has downloaded this app on my phone, any kind phone, any kind of smartphone, so it's running. Okay, it's running. What happens when it runs and I've been exposed to too long, I guess, or for a period, best of some concern, what happens? Yeah, so I can take this one. So your phone is going to be exchanging random basically codes with other devices using Bluetooth Low Energy. And these codes are random, as I said, and they change pretty frequently. So they're essentially anonymized or they're not going to be associated back with you. And so as you go about your day, your phone is going to be exchanging these random numbers with all of the other devices that it meets. So then later on, if you unfortunately test positive for COVID-19, the Department of Health is going to send you a text message that will allow you to share your diagnosis status with the app. And basically what that means is you would be taking all of those codes that you broadcasted out while you were infectious and sharing them with the Department of Health and the Association of Public Health Labs. And so essentially, there's this database of all of those positive codes, all of those codes that were broadcasted out that someone who later tested positive was sharing. And again, those are all random and constantly changing, so they're not linked back to any individual. So for all the people that were nearby you or were in close proximity to you, their app is going to check against that list of positive codes. And they're going to say, oh, I saw these positive codes for, and if it's at least 15 minutes and you were within sort of six feet of proximity, then it's going to give you a notification that says, hey, not so many words, but hey, you probably should go get a test. You may have been exposed to COVID-19. And it's going to give you links to the Department of Health resources to go get tested and the other steps that you should take. Okay. And so it's going to give me that notification immediately, I mean, after 15 minutes. Well, it's going to give you the notification after the person reports themself positive. So the hope is that if the person knows that they're positive, then they're not going to be going out and associating with people. And so this is that over the last 14 days, because that's when the infectiousness window is, you may have been in contact with someone that went on to test positive for COVID-19. And you're only going to get that notification if your threshold of exposure met those criteria. Certain number of minutes. And I suppose distance too. The Bluetooth will read the distance. Yeah. So the Bluetooth, it doesn't technically read the distance. It's technically reading the signal strength. But they've done a lot of studies to basically approximate distance based on signal strength. And the good thing about that is that if there are barriers in place, say you're only two feet apart, but there's a wall in place, because that wall is in place, the signal strength is going to make it look like it's much farther than two feet. So that's how, you know, they sort of accounting or there's some allowance for, you know, having walls or boundaries in place. Yeah. I mean, that's consistent with an accurate look at it. If there's a wall, you can't breathe through a wall. Most walls. Yeah, you hope. But, you know, there are still, you know, air vents and things like that where we've seen, you know, infections crossover. But yeah, we do hope that it's limited. If I'm, if I just got, you know, a report from my doctor or whatever that I have, that I am infected and I'm carrying the virus and I get this, I get this text message you say, what is it? The text message comes in, Jay, you, you, you have been, you've tested positive. Would you like to include this on your copy of Aloha, Aloha safe, right? And then you say yes, right? It doesn't quite say that because it would be a HIPAA violation to disclose the person's actual status. So the text message, I believe, just says, anonymously share your test result with with Aloha safe alert to help your community. And then it provides you, yeah, and then you have to opt in and then there's like two more layers of consent that you have to go through. And this is part of the Apple and Google system, which is really focused on both, both privacy and consent. You know, in a perfect world, it wouldn't be concerned about all this privacy and consent business. You know, if we're talking about saving lives here, and I think that's one of the issues that has been raised by COVID, you know, we're talking about saving lives. For example, you know, this whole thing about vaccine, I prefer not to take the vaccine. What? You know, it's not for you, we're giving you the vaccine. It's we're giving you the vaccine for the community. It's like, you know, the like 30% of the military, they don't want it. What? You know, what about the rest of the guys in the military? What about having a fighting force that's not sick? How about that? And I really find, you know, that we have concepts about HIPAA and privacy and consent that may be a little outmoded. We're lucky this time. But in a more difficult time, we would have to look at the issue of whether we really need to be so careful about privacy and consent, especially when it affects other people. I would say that the different countries have taken different approaches to it. And America is, you know, we have a constitution in where we tend to be on the privacy focused side. And yeah, there are limitations because, you know, anonymity and privacy are so preserved in this system. It is sort of limiting you can't track who's doing it. People aren't forced to opt in. But in some ways, you know, that's a good thing that, you know, we're not going full big brother in response to the pandemic. Yeah, we'll see next time, whether it's different. Well, now you're going to say something on this. No, I was going to say, I totally understand what you're saying, but what this does is I think it can assure the community because a lot of what we're hearing is that concern. Well, are they going to know exactly where I was? Businesses are concerned. Are they going to identify my restaurant or my place of business of where this happened? And because of the privacy measures, it does not do that. It doesn't identify the location. But what instead it does is just tells you here's, you know, you need to go ahead and get into quarantine. You could be on the bus and you don't know who you were next to. So if you get infected, you can't say I was in the bus next to a certain person. But what this does is it gives you an alert that you were exposed and you should get into quarantine. And hopefully that gives, you know, stops that interaction and stops the spreading further as a disease. Yeah. So how does this product, this app, how is it different from the one organized by Apple and Google? So this is organized by Apple and Google. So this is using the Google Apple exposure notifications API. And it's on the same system as, you know, every other state that is using the exposure notification system. So this system we're talking about is the system for the United States anyway. I mean, you have different implementations in different states. But the system itself, the technology is national, am I right? Yeah. I mean, basically in response to the pandemic, Google and Apple came together. And it was really them that needed to come together because they control all of the smartphones, right? You can't really do anything on a smartphone without ideally both of them cooperating. And the phones really weren't designed for this purpose. And so they had to make changes to the operating system in order to enable this functionality. I only just think loosely with you here. Suppose we didn't rely on either Apple or Google. Suppose we created this national database from information in the cell carriers. And the cell carriers collaborated in having a national database based on information transmitted by the phones through the cell carriers. Wouldn't that also work? It would do a different thing. So the Google and Apple system does not collect location data. It's actually prohibited from accessing a lot of those sensors. And so the Google and Apple system is checking device to device contacts. Whereas a location-based system would be location-based. It would help you track where people went. The problem with that is that GPS has limited accuracy. And that in a lot of cases, the GPS data isn't really useful. For example, in like a hotel, you could have someone test positive on the first floor, but the people on the 15th floor, you know, don't need to quarantine. And so a pure location-based GPS-based system, you know, wouldn't really be able to distinguish those those instances. So this is better. The Bluetooth is better. It's better in some ways and worse in others. You know, this system is designed to be complementary to traditional contact tracing. So it's not replacing the actual contact tracer's job. It's helping them notify people faster, and it's helping them identify people that like a contact tracing interview isn't going to help. But it doesn't, you know, replace trying to go back words and try to figure out where people got it and find identify hotspots like that. But on the plus side, you know, there's privacy preservations here. I mean, it depends on how you look at that. But, you know, I think especially in here, you know, those privacy protections are really important for getting adoption. And so that's that's part of the part of the reason for the emphasis on privacy and anonymity is that a lot of people that would be hesitant to join in otherwise, you know, are going to be willing to because of those protections. And so this system is sort of like a happy medium between, you know, going full big, you know, if we had a full big brother surveillance state, then the contact tracers could very easily say, you know, every person that you were in contact with over the last 14 days, and they would have a database of that that information. And like, yes, that would help the contact tracers that would be in the interests of public health. But it's hard to imagine that that system wouldn't be abused for other reasons. What about this what about this moment when I get a message from my phone, and it says my text message, you know, you should go you should go get tested. You may have been exposed. I mean, it doesn't have to be hard. Yeah, hard, hard requirements, you may have been exposed. Does anybody else get that message? Does the state have that information? No, they say, Jay, you should really go down, you know, you got this message. It's up to me. It's completely up to me. Correct. Yeah. So with the way that the system works is that that comparison. So as I said earlier, there's like a basically a database of all those random positive codes. It's your individual device that downloads that positive codes list and makes that check. So that check to see whether or not I've met the threshold for notification, that's happening on my device, and only on my device, you know, and no one else is notified, unless I decide to, you know, which I should, you know, call my health care provider and reach out and something like that. Yeah, well, you know, which is, you know, you're right to do so, I imagine. Well, the other thing is out of out of there's 1.4 million people in the state. And I don't know how many of those are adults, you know, who walk around with smartphones, but you have something close to 400,000 installs here. Am I right? How many people, how many people are capable of having it installed, but haven't? So when we got data from D-Bed and Michael, you can help correct me here, but we looked at, tried to look at cell phone users, smart cell phone users, and it's about a million people in the state who are smart phone users. So that's the amount that hopefully- So you have 600,000 to go? Yes. I think Michael and I are going to say the same thing, but he'll probably say it better than me, so you go. Well, yeah. Well, so first off, most estimates say that it's around 80% of the population has a smartphone. Okay. And studies have shown that this technology is effective even at low levels of adoption. So even at about, you know, 12, 15%, there's, you know, a noticeable reduction in cases. And you know, in England, it was about 30%, and they, you know, have had a significant reduction in cases. For example, in England, counties that had higher adoption than their neighbors by 1%, 1% more adoption led to a 2.3% reduction in cases. So, you know, in comparing the neighboring counties, higher adoption led to, you know, less cases by, you know, 2.3% for every 1% increase in adoption. And so the studies are saying, you know, this isn't going to be a perfect cure. Like, yes, I think, so if 80% of the population is using the app, models do predict that this would be enough to quell the pandemic on its own, but that's really not what we're asking. You know, this is a another tool in the Department of Health's arsenal, along with manual contact tracing, along with testing, along with the vaccine, you know, and so we don't need, you know, would be nice to have that level of adoption. And the more people are using it, the more effective it will be. But, you know, the studies and our, you know, recent results have shown that it's still effective even at lower levels of adoption. Sure. But I'll tell you that, you know, you have these days, you have phones which have security capability where you can look at the phone and it opens. I think the phone opens when you look at it, because it recognizes your face. Okay, while it's recognizing your face, it could recognize whether you're wearing a mask on your face. And it could say to you, Fidel, what's wrong with you, Fidel? Why don't you wear a mask today? Would that be a violation of somebody's rights? Tell me true now. I don't think that that would be a violation of somebody's rights. But I think if Apple made it so that when you tried to use Face ID, it reprimanded you, I think that a lot of people would cancel them, or would be less inclined to buy Apple products if they were, you know, more overtly preaching like that. Well, Apple is very concerned about privacy. I don't know if you remember, there was a terrorist on the West Coast, and the FBI got the guy's phone and asked Apple to crack the phone so they could see if he was talking with other members. I know a lot about Apple refused to do it. Well, Apple didn't just refuse to do it. Apple was unable to do it. And not only that, like, I know, I work in the computer forensics industry, so I know a lot about that. And you know who cracked the phone? Yeah. Yeah. Yeah. And I'm surprised that they did not talk to celebrate immediately. I work with celebrate in my day job quite frequently. And yeah, that should have been their first option. That was a ploy by the FBI director to get rid of civil liberties. That wasn't an actual need for that. Linnell, I want to know how this all came together. Okay, you saw it come together. You saw it come together through the, I guess, the spring, summer and fall. And then you guys, you know, you get the institutional steps necessary to make it happen. Can you tell our viewing audience exactly how that worked? Where did it start? How did it evolve? And, you know, the run up to, as you guys told me, which I think is so cute, the run up to the rollout day, which happened to be January 6, 2021. Can you talk about that? Yeah, absolutely. You know, this, this app was really developed through a community effort. I mean, Michael is one of the key people, is a part of it. And it started last summer. It's not a little earlier where it was, what can we do to pull together to try and help to control the spread of this disease? And so we got a lot of smart community-minded people together, again, Michael being one of them, Brandon, Robert Cree, Sue being a few others. And they started developing this technology and talking with Department of Health and talking about the, the impact that it could have. The Department of Health came on board and said, yes, this is a good matter layer of the disease that, that could be developed, or that could help to mitigate the spread. And so in November, we decided to pilot this app on the nutty. So it got piloted there, got rolled out to all of Maui County in December. Hawaii Island, right before the end of the year, then rolled it out to their islands. And then we went statewide on January 6. Our goal, our initial goal based on some of the studies that Michael shared, one out of Oxford said that if you get 15% of the community to download the app, then it'll decrease infections by 8% and death by 6%. So our goal was about 150,000 downloads. It was being effective, but of course, if you get to that, it'll, it'll become even more effective for the community. And now we're, you know, at over $300,000. How does it integrate with contract, excuse me, contact tracing? Where, where does that enter into the, you know, the analysis? Yeah. So this system sort of runs in, in parallel. One of the, one of the concerns that the Department of Health had was that they didn't want to add to the work that they were already doing. So, you know, it, it basically just relies on the Department of Health as the verifiers of who tests positive and what their infectiousness window is. And that's about it. The reason I'm asking the question is that in the middle of, in that period when I was talking about it, we had some problems about contact tracing. And the Department of Health wasn't really doing contract tracing. I'm not sure what it's doing these days. But the question is, is that part of the formula of the algorithm by which this system works? Or is it, is it just, it's just, you know, demonstrated cases of infection? I think what was key, and Michael, you can jump into, I think what was key was what we did was incorporate an automatic notification system so that it wasn't dependent on a contact tracer having to call a person to say, hey, here's the code, put it into the app so that you can anonymously share your results. So now what the Department of Health does is when they get their daily case information, it, that's where the text message automatic notification comes in. So it becomes more efficient. And as Michael said, it runs parallel to the contact tracers. They're doing what they're doing continuing to do so. But now people can get that automatic notification a lot faster. Yeah, I mean, I would add my reaction is that contact tracing, however well you do it, you know, whether you do it really well, or maybe not so well, it doesn't, it's, there's a certain, I'm going to call it, there's a certain subjective quality to it. This is scientific what you're doing now. This is electronic, rational science, and a specific electronic algorithm working, contact tracing, that's not quite like that. So it wouldn't, wouldn't necessarily be helpful. You know, we should, we should go through your, your drawings, your graphics. Can we do that? Let's show some and you guys can explain these are for the public to understand how this system works. And I think that'd be very valuable in this discussion. Let's show, let's show the pictures and see, okay, no, that's just a, what is it? What is that? That is a community, a flyer that was developed. People can go to aloha safe alert.org. There's a toolkit. So any businesses, individuals, if you want more information, sort of a quick overview, you can go onto the website, download the toolkit, share it, and it gives them a quick overview of, of how the app works and how you can download it. Okay, so I can go on my phone right now this minute, and I can look for aloha safe, and I can download it right now. It takes a minute and now I, now I'm in the system. It's that simple? Correct. Okay, terrific. Okay, what more pictures? We got more pictures. Okay, what's this one? Yeah, so this is, as I was saying, you're only going to get that alert if, if you meet that minimum exposure threshold. And then I sort of explained how distance and signal strength works. And then the duration is 15 minutes. And the time is, you know, within the last 14 days while you were infectious. And those variables are determined differently by, by each state. And so, you know, basically following CDC guidance for six feet 15 minutes. And so here's sort of an example of, of how aloha safe works, you know, the people are all hanging out, they're exchanging those random IDs. And then if the person tests positive, then people who were nearby are going to get that notification. And the friend that didn't have the app, you know, isn't going to be able to get the notification that he may have been exposed in the past 14 days to someone that had COVID-19. Okay. That it? Right. Oh, here's more. Yeah. So, so this is using that Google Apple exposure notification system. And all of the different states that are on the system, and I think this is out of date, I think they're up to like 24, 25 now. But basically half of the different states are using the system currently. And any other state that is coming on is also going to be part of this Association of Public Health Labs partnership. And so that's actually a partnership between Google, Microsoft and the Association of Public Health Labs. And what that that means, I think the real value there is say someone from New York comes and hangs out in Hawaii and ends up getting sick when they return. They then share that positive result. And because it's interoperable through all the different apps and through those different states, people in Hawaii who have made them in contact will get that alert. That's not that's really good that there's an interoperability aspect to it. Let me let me ask you one question that I think is clear. We have we have vaccines now. And you know, with vaccines come complacency. And with this order of the CDC yesterday, today, about how it's okay now, you know, you can go outside, you can talk to people, just like you were before, I'm I'm troubled by that, if you want to know my personal reaction to that, that's two, two people are vaccinated, then it's okay that they operate the pre COVID. But how does that affect your app? How does that affect the usefulness and the acceptance of your app to A, to have to have the vaccine in general, of course, with all the variants that are so threatening, and B, to have the CDC, and I guess the State Department of Health also, saying, you know, you can go back to pre COVID conduct if if you have, you know, two people who've been inoculated. How does that affect your app? I mean, it hopefully it reduces the necessity of it, you know, and that's sort of what we want, right? We want anything that makes any COVID prevention things unnecessary. And, you know, but, but it's sort of a Swiss cheese defense, I think, is the metaphor where, you know, lots of different layers of defense. And so even if there are some holes that something might get through, that there's, you know, another layer behind it that has holes in different places or something like that to catch things. And, you know, there might be lots of people that, you know, aren't going to take it, the vaccine and, you know, we don't know how it affects long term or stuff like that, you know, and we're hoping to take some of the stuff that we're learning and work that into the app, you know, so you'll get a different notification maybe and different like quarantine suggestions if you have been vaccinated or not, you know, take that vaccine status into account in the reporting and the notifying and stuff like that, you know, so we just have a platform where we can expand it as, as, you know, the needs and those thresholds change. Boy, this is pretty exciting. Yes, Lina, sorry. No, I was going to say I also think that, you know, we're not in the clear yet, you know, and we're in tier three. So things are opening up, but this is now when we can really see the efficacy of the app. The fact that we have almost 400,000 downloads, the fact that people are going out more and there's, you know, the limits are expanding a bit more, now is when people should really start using that app to help get people notified quicker. So what's the future of this, this whole program here? I mean, there's a lot of people around, including in Washington and say we don't lick this whole thing, we'll go finish with it by what, the summer of the fall and you won't see, you won't see, you know, coronavirus anymore. What's the future of this program given that possibility? Then the program would, would mostly go away. So the Google Apple exposure notifications API that the underlying system that we're using, it is in the fine print from Google and Apple that in the event that this pandemic ceases, they are going to shut that functionality off. So, you know, that that is, you know, knock on wood, something that happens. But, you know, I'm not counting on it in the short term or at least in the immediate future. No, I wouldn't count on it either. Certainly. And this is something I wanted to cover with you guys before we ran out of time. And that is this, it seems to me that this is groundbreaking, you know, on a number of, a number of reasons. I mean, one is it's an example of the community coming together with all the privacy considerations and all that coming together and doing something in a community collaborative, where you can actually have some benefit with, with the electronics, which are, of course, you know, there everywhere. But, you know, we're not finished with viruses. If we learn one thing in the past year, we became all of us, you know, completely aware. We learned, we learned that viruses are everywhere, they ubiquitous, and they mutate. And a little bit of a, a little bit of a pandemic turns into a rolling pandemic. And so, and so I think we're, we're, we're going to be in a virus world for the rest of our lives. And the question is how well we manage that. And as you said, Michael, I mean, it's a matter of a portfolio, a ditty bag of all kinds of things, inventory, by which we can deal with, with them, you know, the pandemic or the viruses going forward, there will be more coronavirus in the future, maybe not the same, but nevertheless, as threatening, potentially. So this kind of technology, it seems to me, is going to be with us too. It is one of those things in the ditty bag. Do you agree? And how would you change it? How would you envision that, modify it, make it more robust in the future? This technology and the lessons we've learned, I think, are mostly going to be in sort of pandemic response and in how to use the, the technology at our disposal. A lot of what this is, is really bound by the limitations of the smartphone hardware and the amount of people that have smartphones and what the smartphones, you know, can do without having no battery lifer or whatever. And so there's a lot of ways that, that those that were limited. I think what, what long term, I think Google and Apple are transitioning to being medical device companies. And I think we're going to see a lot more of, of that. You know, in recognizing that, you know, in the way that Apple has with the iWatch and stuff like that, that, you know, there's an opportunity for more healthcare sort of uses, based on, you know, these little computers that we're carrying around in our pocket. Is it trouble you that Apple and Google, private companies, operated by their management and stockholders, have control of this? They have control of the development of these devices? And this GAEN, what is it? Yeah, Google Apple exposure notification. They have control of that? It does bother you that they wanted to turn it off? They can do that without any approval by anybody? Or turn it on? The same thing? This system, not so much. This system is really designed to be as private and privacy preserving as possible. And so Google and Apple, and even the Department of Health, don't have a lot of insight into, into things. And so this system is pretty safe. It is, you know, dedicated only to the pandemic. And it, and it also in the fine print is that it can't be commercialized and, and things like that. So, so we know that this is safe. But, but Google and Apple, they've got a lot of better ways to learn stuff about you, and they don't need this in order to know all of those, those things. I mean, I was not, I would come, I was not advised of this earlier. Only joke joke. So, you know, I think what was really good about this was that it showed that Google and Apple could come together along with, you know, Microsoft and other, you know, very large companies. And they would be able to put in, you know, just nonprofit hours to assist Department of Health, you know, worldwide in, in developing a response. And it really, it really had to be Google and Apple because, you know, they control the hardware and soft, you know, and so without their partnership, you know, they're, this couldn't have been done. Yeah, true, true fact. Okay, we're out of time, Laila, and I want to give you the last word here. So say what you wanted and then tell us what you want to leave, the message you want to leave with the public. Well, I think it's one in the same. My last words and the message I want to leave to the public is that this technology is, like you said, it's very key, it's groundbreaking. If it makes us smarter, God forbid, any other pandemic or any other disease like this happens again, hopefully we can get control of it faster with the help of technology like this. But in the end, it's really about the user opting in. When you get that text message saying to share anonymously, share your results, share that so that you can help protect your community. So the fact that everyone stepped up to download it, I hope they also take that next step to use it should they get any kind of notification. And it wouldn't have been possible without everyone who's doing it. So let's just continue to move ahead and continue to utilize this technology. Yeah, just as the situation, the pandemic has forced us to develop vaccines in a rapid speed that we never saw before has also forced us to do this electronic development as well. And it's interesting that the start and finish of the development efforts in both cases took about the same amount of time. It both came out within a few weeks of each other. Michael, I feel bad that I haven't given you the opportunity to give a last word. You want to give a last word too? You know, just that this is safe and this is privacy preserving and that, you know, if we don't use this system, you know, we might have to go full big brother. And so, you know, we hope people that will use this system so that, you know, we aren't tempted to or don't need to go full big brother to combat this pandemic. Yeah. It's all about voluntary collaboration and caring for your neighbor. Thank you so much, Lin-Ellen Elmarbo and Michael Camino. Really appreciate your time. Thank you so much. Thank you.