# From Symptom Tracking to Contact Tracing:
## 1 Introduction  
Five months into the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, coronavirus disease 2019, COVID-19) pandemic, infection and deaths continue to increase globally, surpassing over two million confirmed cases in the United States and eight million worldwide as of June 20 [1]. Although there have been numerous statewide and nationwide efforts to contain and mitigate the spread of the virus, such as stay-at-home orders, social distancing, and lockdowns, there has been growing consensus for the need to combat the pandemic through a combined strategy of both medical and technological tools [2]. As a result, mobile health apps focused on education, symptom tracking, contact tracing, and access to telehealth services have risen to the forefront of the COVID-19-related apps to support users remotely and monitor the spread of the virus. While these tools hold enormous potential, little is known about the availability and offerings, and there remains a critical need for a thorough system of evaluation that can help interested users find a safe and effective COVID-19-related app to meet their needs. Numerous states and countries have attempted to create their own COVID-19 apps--some for contact tracing and others for self-help and to share information regarding local and national protocols, resources, and the coronavirus. Some apps, such as TraceCOVID, are designed primarily for contacttracing to limit the spread of the virus, while other apps are created for general constituent use, such as JamCOVID19, the national COVID-19 app for Jamaica, which not only includes a contact-tracing feature but also provides educational information and local news and updates regarding the governmental protocol. While some apps have become popular and well known within the COVID-19 apps space, such as the Apple COVID-19 apps, we currently do not have a broader understanding of what apps exist in the COVID-19 space and how many of these apps are created for contact tracing, educational purposes, symptom tracking, telehealth, and other resources to support users through COVID-19 pandemic. Most analyses of COVID-19 apps have focused primarily on contact-tracing tools. Given the lack of public willingness to engage with contact-tracing apps [3] and limited evidence of their efficacy [4], we sought to analyze the full swath of available apps for an individual searching for digital COVID-19 resources on the app store. We investigated the developers, features, functions, and privacy settings of the top-100 returned apps. In addition, it is unknown how these apps are changing and how turnover within the app stores affects the availability of emerging apps. High rates of turnover have already been characterized and emphasized in other health app domains, such as the mental health app space, but there has yet to be an estimation of how fast the availability of apps is changing in the COVID app space [5]. As new COVID-19 apps are continuously created and added to the app store, we sought to determine the rate at which the space is changing and identify which apps are stable. We conducted two analyses of the top-returned COVID apps a month apart, allowing us to both analyze app content and characterize the field's dynamic nature. In the absence of stringent FDA oversight of COVID apps, there is no comprehensive or standardized vetting system to evaluate apps and address the privacy concerns that have been raised [6]. Prior research has focused on the privacy issues around contact-tracing apps, many of which may collect and share users' personal data [7]. To date, however, no research has been conducted to understand the privacy and data collection considerations for all COVID-19 apps, beyond the contact-tracing ones. Given the input of potentially sensitive information, such as symptoms and health data, into COVID-related digital tools, we sought to explore the potential privacy concerns across the app space using a framework that can be replicated by users seeking to understand data use and privacy policies.