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Disease surveillance is the systematic collection, analysis, and interpretation of health data essential to the planning, implementation, and evaluation of public health practice. This process integrates data dissemination to entities responsible for preventing and controlling disease, injury, and disability. Surveillance systems provide crucial information for action, helping public health authorities make informed decisions to manage and prevent outbreaks, ensure public safety, optimize...
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Updated: Aug 23, 2025

Swabbing the Urban Environment - A Pipeline for Sampling and Detection of SARS-CoV-2 From Environmental Reservoirs
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Defining Key Performance Indicators for the California COVID-19 Exposure Notification System (CA Notify).

Eliah Aronoff-Spencer1,2,3, Camille Nebeker3,4, Alexander T Wenzel5

  • 1Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, La Jolla, CA, USA.

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California

Keywords:
COVID-19contact tracingdigital exposure notificationdigital technologyinternet-based interventionuniversal design

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Area of Science:

  • Public Health
  • Epidemiology
  • Digital Health Interventions

Background:

  • COVID-19 pandemic necessitated rapid scaling of public health tools.
  • Traditional contact tracing faced challenges with efficiency and reach.
  • Exposure notification (EN) systems offered a supplementary digital approach.

Purpose of the Study:

  • To propose a key performance indicator (KPI) framework for evaluating statewide exposure notification systems.
  • To discuss lessons learned from implementing California's CA Notify system.
  • To assess the performance of the CA Notify exposure notification system.

Main Methods:

  • Defined six key performance indicators: adoption, retention, code sharing, contact identification, behavior change, and impact.
  • Analyzed data from the CA Notify system (December 10, 2020, to July 1, 2021).
  • Utilized the Google Apple Exposure Notification framework.

Main Results:

  • CA Notify achieved nearly 11 million smartphone activations.
  • 27% of users with positive COVID-19 tests shared their unique codes.
  • Identified at least 122,970 potential contacts through the system.

Conclusions:

  • Smartphone-based exposure notification systems are valuable additions to public health interventions.
  • Refining methods for system performance measurement is crucial.
  • Maintaining user trust and privacy is paramount for digital public health tools.