COVID-19 Mistakes to Avoid: Don’t Conflate Contact Tracing with Contact Tracing By App
By Jerri-Lynn Scofield, who has worked as a securities lawyer and a derivatives trader. She is currently writing a book about textile artisans.
One depressing aspect of the COVID-19 pandemic is to see two of the usual suspects – Big Tech and Big Pharma – trying to distort what we hear, learn, and understand about the ongoing situation. Each has a dog in the COVID-19 fight and seeks to convince us they have viable approaches that just happen to maximize their profits, whether it be the necessity of proprietary apps or the need to rely on new proprietary approaches – such as a new vaccine and expensive drugs under patent that have yet to be put forward,
I originally intended to combine discussion of these two grifts into one post. But in the interest of keeping the post short and manageable and also in concentrating discussion in comments on what are actually two separate problems – albeit each falling under the general heading of profiteering – I have decided to split the post, and discuss Big Tech today, and Big Pharma tomorrow.
I have written extensively about Hong Kong’s success in fighting COVID-19. The city’s effective coronavirus control strategy relies on tried and tested public health measures to control spread of an infectious disease: the use of masks; social distancing; and testing and tracing. Background assumptions I should mention are that the city has excellent health care, and public health officials have ample experience and enjoy public trust,
They didn’t hit on their COVID-19 strategy by luck or serendipity. Previous experience in 1968 with what’s still known as the Hong Kong’ flu i and SARS in 2003 informed their infectious disease control strategy.
Beginning in March, I have written at least five previous posts discussing aspects of Hong Kong’s approach,comparing the city’s response and record to that of New York, as they are similarly sized and densely populated (see for my most recent take , No, We Don’t Need to Place Our Faith in Downloading Some Untested, Privacy-Infringing App as the Only Possible COVID-19 Slayer; Why Don’t We Look to Places that Have Successfully Limited Disease Spread and Copy Their Policies?)
Now, to be sure, Hong Kong has recently seen an uptick in cases: today the South China Post reported the total number of cases now stands at 1569 and 8 people have died. And the public health system has reacted quickly and hard to get control again over the very sneaky disease that exploits any weakness or lack of vigilance.
Conflating Contact Tracing and Contact Tracing By App
An integral part of Hon Kong’s successful strategy is effective contact tracing.Yet this is not the same thing as contact tracing via app. In a recent article in the Conversation, Digital contact tracing’s mixed record abroad spells trouble for US efforts to rein in COVID-19, Bhaskar Chakravorti, dean of global business at Tufts University’s Fletcher School conflated contact tracing with digital contact tracing, aka contact tracing via app.
Ignacio, in comments on a previous post, noted that contact tracing via app alone isn’t very good contact tracing. In fact, if I understand him correctly, it can be worse than useless. Maybe, if he reads this, he’ll pipe up in comments with a more thorough explanation, with some details as to why this is so.
It merely alerts you that you at some point were near to someone who has subsequently tested positive for the disease. But, what good does that do? Especially with the increasing number of infections.In fact, it may also underestimate your true chance of infection, since I understand these apps don’t necessarily work very well indoors, and we’re coming to learn that there, particularly in poorly ventilated places, you are at great if not greatest risk of contracting the virus.
Instead, effective contact tracing requires more than a determination that you may have been vicinity of someone who subsequently tested positive for the disease. In fact, contact tracing is not simple, As Dr.Sarah Borwein pointed out to me in a discussion I included in a previous post, Contact Tracing Via Old Shoe-Leather Epidemiology While Spurning the Techno-Fix Fairy: How Hong Kong Quells COVID-19 Without Killing Civil Liberties:
[Crucial to this success] is the importance of painstaking test and trace measures to plot and thwart the course of COVID-19 spread.
Sarah described what has been undertaken as “old shoe-leather epidemiology.” No app. No technofix fairy. Just hard work.
I asked her to explain what test and trace means to Hong Kong health authorities.
Sarah Borwein: So we had 21 days with no local cases and then a case was detected 2 days ago, and now her grand-daughter and husband have tested positive. What they are doing reflects their strategy:
They did extensive interviews with the index case (the 66 year old grandmother) and retraced everywhere she’d been in the 2-3 days prior to getting sick – every market stall etc. She looks after her 5 year old grand-daughter who is also positive – so they have also traced all her contacts. She attends a tutorial school, so the teachers and other kids.
And now they are conducting testing for 860 families who live in her housing block or the grand-daughter’s, or work in the market or work in or attend the tutorial center. At least 5000 people from 1 case!
They actually do something similar whenever we have a local case of dengue fever (not endemic here) – so they do have practice.
Jerri-Lynn Scofield: So, that’s what test and trace means! And not via an app.
Sarah Borwein: No, not via an App
Although there are websites where you can see the locations of all the positive cases, and any flights etc (including seat number) they have been on – so you can self-report if you were near them. But mainly they do the shoe-leather work as the mainstay.
I’m afraid that just turning this process over to an app that notes when a person was in the presence of someone who tested positive is not the same thing. Charavarti discussed problems of trust and privacy in three cases, involving South Korea, India, and Germany, but doesn’t seem to understand there is a flaw in the contact tracing by app approach.
South Korea’s success involves combining the tracking app and correlating it with lots of additional surveillance data. I have not studied their system, but understand that surveillance information is regularly collected about people, and the app this app that tells when you were in the presence someone who tested positive is only one part of the country’s contact tracing approach.Not only did South Korea test widely, but as Chakravorti acknowledges:
Its contact tracing arsenal included tracking apps paired with CCTV footage, travel and medical records and credit card transaction information.
India, for its part. has virtually abandoned the effort as there are considerable concerns about safeguarding the data that is collected. But there are lingering legacy aspects. Originally it was a requirement that one download and use the app before boarding a ‘plane. International flights remain suspended, but there’s confusion about whether the app requirement still stands, with some immigration officials still insisting it does apply. So the prudent person who wants to leave India when that again becomes possible will preemptively download the app.
As for Germany, with its unfortunate history of misuse of data first by the Nazis and then by the Stasi, its citizens are rightly skeptical of contact tracing via app. So, what do they do instead? Seems to be a variation of that old shoe leather epidemiology also practiced by Hong Kong and discussed by Sarah above, Per the Conversation:
Even with a decentralized, privacy-protecting approach, Germany’s new app is unlikely to achieve the level of adoption of South Korea’s. However, the government’s investment in an effective traditional contact tracing approach using public health staff to investigate contacts makes a digital alternative less urgent.
Contact Tracing Theater : Apps
My resistance to use of apps for contact tracing purposes stems from more then idle unconsidered civil liberties concerns – although privacy and controls on data collection are undoubtedly important and should not be surrendered lightly. But just as the security theater we’ve all come to loathe doesn’t really make you any safer when you eventually board the airplane, so contact tracing by app is not very sound contact tracing at all. It just makes big Tech companies and their executives richer, more powerful, and more central to our existence.