COVID-19 Contact Tracing
Overview
Faced with one of the most unprecedented challenges of the 21st century, COVID-19 brought the world to a halt. Masks and contact tracing were two solutions that were explored to curb the spread of the virus. Due to the ever changing nature of the virus, contact tracing proved to be a way to keep tabs on the spread. Contact tracing, as described by the CDC, “ [I]s an effective disease control strategy that involves identifying cases and their contacts then working with them to interrupt disease transmission”[1]. However, due to the nature of COVID-19, contact tracing becomes more difficult. As stated in a medical article about contact tracing, "[T]he short time between symptom onset in the infector and that in the infected and the virus’s propensity for asymptomatic transmission posed challenges for contact tracing"[8].
The use of technology has been explored heavily as an option to reduce the long and tedious manual work done by human contact tracers. Hopeful writers of a medical article suggest," Modeling studies suggested that if digital contact-tracing apps were combined with other mitigation measures, Covid-19 epidemics could be slowed and theoretically even ended" [8]. Along with this digitization, however, comes ethical concerns regarding privacy and citizen rights.
The Process
The process of contact tracing involves multiple steps involving the positive patient, contact tracers, and close contacts of the positive testing individual.
- All of this information is taken from the CDC website [1]*
Please note that this information is constantly changing, and one should check the CDC website regularly for updates regarding proper next steps.
STEP 1 of the Process: First, the positive patient should contact everyone who they have been in close contact with and notify the appropriate party (contact tracers). The contact tracers will ask you about your recent whereabouts and if you could have transmitted the virus. If you are one of the people who have been identified as a close contact to someone who tested positive, you should receive a call from a contact tracer notifying you of this exposure and request that you get tested as soon as possible.
STEP 2 of the Process: It is recommended that you quarantine for fourteen days after the possible exposure. Even if the suspected close contact individual does not have symptoms, they should still self-isolate to limit the risk considering they are an asymptomatic case.
STEP 3 of the Process: Take a PCR Covid-19 test. The rapid tests may not be as accurate, so continue to test using PCR and monitor symptoms. If the result is positive, refer to step 1 of the process. It is advised that you continue to quarantine and take precautions for the remainder of the fourteen days.
STEP 4 of the Process: Make sure to monitor your health and temperature throughout the self-isolation time to ensure no (new) symptoms have arisen since the beginning.
Ethical Concern Overview of Digital Contact Tracing
The use of technology has been explored heavily as an option to reduce the long and tedious manual work done by human contact tracers. Hopeful writers of a medical article in the New England Journal of Medicine suggest," Modeling studies suggested that if digital contact-tracing apps were combined with other mitigation measures, Covid-19 epidemics could be slowed and theoretically even ended" [8]. Along with this digitization of contact tracing, however, comes ethical concerns regarding privacy and citizen rights.
Contact tracing has been tackled differently around the world. Some countries choose to respect individual privacy above all else, whereas some choose to prioritize the health of the community. Also, variations in government systems and autonomy have caused varied results regarding the success of digitization. Much of this controversy over privacy concerns stems from digitization. Writers from Sage Journal on Digital Health say, “Use of digital methods firstly raises policy related questions around sovereignty and privacy, especially when a government is collecting data with regards to travel history, credit card spending, CCTV footages, movements and contacts of a person; and in some cases the measures also restrict the mobility of an individual posing challenges to freedom and the basic rights of living in a country” [10]. Not all countries have decided to take the approach of using all of the above data in order to track the spread of COVID-19, but the idea still poses these risks. Although the concept of contact tracing has been around for many years, people worry that digitizing it will impede on their privacy [10]. The question is asked: How might governments balance their citizens’ right to privacy with the need to protect community health? Three main countries (China, United States, and South Korea) have been brought to light regarding their efforts to slow the spread of COVID-19 using digital contact tracing.
Government Intervention
China’s Approach to Digital Contact Tracing
Various government systems have handled digital contact tracing differently. China, a socialist country, has drawn praise for its ability to slow the spread of the virus. China is successful because it is able to aggressively monitor its citizens due to its form of government. Alipay, a robust platform that has dominated the webspace in China, has proven to help streamline digital contact tracing. Alipay and company, Ant Financial, developed a way to determine the COVID risk of individuals by using data such as travel history and private encounters [2]. Citizens must download a wallet app called Alipay in order to use the contact tracing software. Coined as Alipay Health Code by the Chinese news platform, this software gives people a color (red, yellow, or green) indicating whether they can enter a facility or if they have to go home and quarantine [2]. This is determined by information that is filled out by users prior to entering a public space. After filling out the information, they are presented with a QR code with one of the three colors based on the data collected through the form as well as previous travel history and contacts. Green indicates that an individual is safe to enter a building and is not a risk. Yellow signifies that they may be at risk because of close contacts or symptoms and should be prepared to quarantine for a week, if necessary. Finally, red means that the individual should quarantine immediately for two weeks as someone they have come in contact with contracted COVID-19 [2]. According to sources and analysis from the New York Times, Alipay also shares this data with law enforcement. In an effort to make sure that as many citizens are tracked as possible, the government, in collaboration with Ant and Alipay, have been working to make it necessary to register oneself before entering public spaces [5]. When the QR code is scanned, the software tracks that the individual was in that location in case of potential spread. Government officials have not provided adequate explanations as to how exactly they get the data to assign individuals to colors. All that is known is as soon as an individual allows the Alipay Health Code software to look at personal information and data, citizens are sharing virtually all of their information with head authorities [5]. Many citizens are left frustrated and confused as they may not know why their color has changed from green to red in a matter of a day. In many cases like this, residents are not able to travel and must cancel plans at the last minute. Some citizens argue that this software already possesses much personal data, so having this system in place does not change much besides attempting to curb the pandemic. However, some believe that it is an utter invasion of privacy, as various government officials are able to access their data with little to no explanation of how the system actually works [5]. In a country where digital privacy is nearly nonexistent and personal data searches have been known to cause turmoil with citizens and law enforcement, the question is raised: how will the government successfully implement a system that bypasses citizens’ privacy for the sake of health safety?
United States’ Approach to Digital Contact Tracing
On the other end of the spectrum is the United States where personal freedom, liberty, and privacy are constitutional rights. Here, digital contact tracing with limited privacy deems improbable. Despite cases topping over twelve million, there is no national digital contact tracing system in place. As a result, states such as North Dakota, Alabama, and South Carolina are handling matters at a state level with two private companies, Apple and Google [3]. In a survey done by Avira, a company focused on security software, they found that, "32 percent said they would trust apps from Google and Apple to keep their data secure and private—but just 14 percent said they would trust apps from the government" [7]. Rather than implementing a more centralized system like China, these states, working with Apple and Google, have devised a plan for a more localized system using bluetooth technology [3]. Known as the GAEN (Google/Apple Exposure Notification System, "The system records Bluetooth transmissions between phones in close proximity to one another, and stores that data as anonymized beacons on each phone for a limited time. If one phone user tests positive for COVID-19 and enters that positive status in a mobile app built upon GAEN, the system will alert other phone users who have been in close proximity within the potentially infectious time period" [7]. Many of the residents of the United States possess either Apple or Android mobile products. Due to the nature of the background ioS and Android technology, other companies would struggle to use the bluetooth feature, as it is blocked from background use [3]. Using Apple and Google’s technology, state health officials are developing apps with specific privacy measures such as limited data access and disabled GPS capability. More specifically, the technology will not be able to locate a user’s specific location and will not allow government officials access to override the GPS setting, ensuring more privacy [3]. In addition, the information collected through this technology can only be used for tracking purposes, not for profit and/or advertising purposes. Since the release of this technology, twenty-two other countries and countless states have submitted a request to Apple and Google for use of the technology [3]. During testing however, researchers at Trinity College Dublin found an issue with the bluetooth. They stated," Bluetooth can perform poorly on the crucial task of proximity detection when a phone is in the presence of reflective metal surfaces. In one experiment on a commuter bus, a Swiss COVID-19 app built on the GAEN system failed to trigger exposure notifications even though the phones were within 2 meters (a little over 6 feet) of each other for 15 minutes" [7]. Another issue that has come up is the use of bluetooth on public transportation systems where radio signals could be poor or interrupted [7]. Before completely implementing the GAEN system, developers would have to mitigate this issue [7]. Some states have chosen to stray from the idea of a more localized system. Utah, for example, has adopted a method that relies heavily on location sharing. Officials there believe that the best and most effective way to contact trace would be to have residents share data regarding location to contact tracers. This is a more centralized approach as the wide array of contact tracers would have access to this data [3]. Much of the work done by Apple and Google has sharply contrasted China’s aggressive digital contact tracing platform, which justifies limiting privacy for public health. States that follow this same rationale believe that tracing would not be as efficient with all the privacy measures that Apple and Google planned to put in place [7]. Again, the question is posed: Can the United States push the boundary of privacy, while still respecting the rights of citizens, in order to develop a successful system?
South Korea’s Approach to Digital Contact Tracing
According to sources from ABC, "per one confirmed patient, contact tracers have to fact check between 10 to 20 traces and, when basic information is confirmed through a phone call, they have to follow that up in person to see if the representations that were disclosed were accurate" [6]. With this amount of tedious work put on the shoulders of human contact tracers, South Korea also took it upon themselves to explore digital options. Having dealt with MERS (Middle East Respiratory Syndrome) in the past, South Korea was prepared to handle COVID-19 using digital resources. During the MERS epidemic, South Korea changed their legislation to allow authorized officials to use GPS location for contact tracing purposes [6]. This was deemed very helpful because this meant that they were one step ahead when the COVID-19 pandemic hit. Using an app, named Corona 100m, users were alerted when they were entering/near a location that had been recently identified as a hotspot due to visits by infected individuals. This application utilized a centralized system similar to China, but already had legal grounds due to the change in legislation. When comparing the geotracking use in South Korea and countries like the United States, South Korea’s system allowed officials to track movement and location from up to 14 days before exposure, compared to just 48 hours that the US system would allow for [6]. With that, however, come ethical concerns regarding individual privacy. As stated in the medical article in the New England Journal of Medicine, “South Korea’s deployment of digital technology to augment contact tracing was an example of speed trumping perfection” [8].
Accessibility with Digitization
Digitizing contact tracing is only effective if people are able and know how to use the software. As stated in the New England Journal of Medicine article about contact tracing for COVID-19, "[D]igital contact-tracing technologies must be made accessible, particularly to people with limited access to smartphone technology, those with limited digital health literacy, speakers of languages other than a country’s primary language, and migrant communities" [8]. Much of the world is impacted by this pandemic, including countries that do not have the same luxuries as some more developed countries. This means that further measures would have to be taken to educate the public of how to properly use these resources. As with most other digital communities, participation is required in order for it to be effective [4]. If digital contact tracing was newly implemented in a country where very few know the intricacies of working with an application, the learning curve would not allow for immediate success. As was shared regarding South Korea's digital contact tracing plan, speed was the key to their success [8]. Sheri Byrne- Haber, author of a Medium article about digital contact tracing accessibility states, “High-risk people with disabilities won’t be able to benefit from knowing what places to avoid. [...]18% of the potential userbase won’t be able to contribute to building the tracing dataset. Which means people with disabilities are occasionally going out and not being able to indicate where they have been. That’s a large number of people to be ignoring” [9]. Along with the issue of digital literacy, Byrne-Haber gave some suggestions regarding how contact tracing applications can be made to be more accessible. For one, “Mobile check deposit is a great parallel to accessible QR code scanning. Bank of America and Chase both have native apps that allow customers to deposit checks without being able to see or touch the phone. That covers additional best practice behaviors such as hints for alignment between the camera and the thing being photographed, auto-capture, use of flash, etc” [9]. Instead of using QR codes, Byrne-Haber suggested using this other system that could make it more accessible for people with disabilities to use and maneuver.
Conclusion
When dealing with a problem as large scale as COVID-19, government officials have the difficult task of balancing safety with the privacy of their citizens. Some nations, like China, with the use of Alipay Health Codes, have utilized their central government and its ability to make safety their priority [2]. Using data regarding individuals’ locations and close contacts, the software develops a QR code that has a color. Each color is associated with risk level: red, yellow, or green [2]. Other countries, like the United States, are still developing a system that holds equal importance to both safety and privacy. Some states chose to utilize Apple and Google's technology to attempt to digitize contact tracing while respecting privacy [3]. Whereas, some states looked to a more centralized approach, similar to China, to make contact tracing more effective. The GAEN method has been implemented to utilize bluetooth in order to track close contacts; however, several concerns were identified regarding signal usage [7]. South Korea has proven to use digital contact tracing in a successful way. Using legal backing from the change in legislation, South Korea was able to quickly use geolocation data to track patients’ locations and potential close contacts from as long as 14 days before their case was confirmed. This helped officials be able to more accurately track the potential spread by that positive individual [6]. The use of digital contact tracing is an idea that is still being explored as new variants of COVID-19 appear around the world. As the pandemic continues to claim more lives, government officials continue to search for the right balance between public health and privacy to deliver an effective digital contact tracing solution.
References:
[1]Contact Tracing – CDC’s Role and Approach, CDC, 13 Nov. 2020, www.cdc.gov/coronavirus/2019-ncov/downloads/php/contact-tracing-CDC-role-and-approach.pdf.
[2]Huang, Yasheng, et al. How Digital Contact Tracing Slowed Covid-19 in East Asia, Harvard Business Review, 14 Aug. 2020, hbr.org/2020/04/how-digital-contact-tracing-slowed-covid-19-in-east-asia.
[3]Leswing, Kif. “Three States Will Use Apple-Google Contact Tracing Technology for Virus Tracking Apps.”, CNBC, 20 May 2020, www.cnbc.com/2020/05/20/three-states-commit-to-apple-google-technology-for-virus-tracking-apps.html.
[4] Rehse, Dominik, and Felix Tremöhlen. “Fostering Participation in Digital Contact Tracing.” Information Economics and Policy, North-Holland, 20 June 2021, https://www.sciencedirect.com/science/article/pii/S0167624521000263.
[5]Mozur, Paul, et al. “In Coronavirus Fight, China Gives Citizens a Color Code, with Red Flags.” The New York Times, The New York Times, 2 Mar. 2020, https://www.nytimes.com/2020/03/01/business/china-coronavirus-surveillance.html.
[6]ABC News, ABC News Network, https://abcnews.go.com/International/south-koreas-contact-tracers-struggle-slow-spread-covid/story?id=74621480.
[7]Hsu, Jeremy. “Contact Tracing Apps Struggle to Be Both Effective and Private.” IEEE Spectrum, IEEE Spectrum, 28 July 2021, https://spectrum.ieee.org/contact-tracing-apps-struggle-to-be-both-effective-and-private.
[8]O’Connell, James, et al. “Contact Tracing for Covid-19 - a Digital Inoculation against Future Pandemics: Nejm.” New England Journal of Medicine, 10 Feb. 1970, https://www.nejm.org/doi/full/10.1056/NEJMp2102256.
[9] Sheri Byrne-Haber, CPACC. “Why Covid-19 Contact Tracing Apps *Must* Be Accessible.” Medium, Medium, 27 May 2020, https://sheribyrnehaber.medium.com/why-covid-19-contact-tracing-apps-must-be-accessible-ec959bc13312.
[10] Review of the Role of Big Data and ... - Journals.sagepub.com. https://journals.sagepub.com/doi/full/10.1177/20552076211002953.
