Public health officials are paying attention to countries flattening the curve with regards to COVID-19. When the pandemic broke out, it was discussed that China was able to contain the spread because of strict measures taken to trace the carriers with the help of digital tracking. While China was able to bring the epidemic under control using digital tracking, there are other countries that have also been able to do a great job in reducing the spread and they all happen to be in East Asia. Countries like South Korea, Singapore, Taiwan, India etc. are applying technology to contain the spread of COVID-19 and trace the thread of carriers; also known as contact tracing. Contact tracing is a tool that has been around for decades. Primarily used for helping control the spread of infectious diseases, it has been successfully used in the past to contain Ebola, SARS, MERS, and other disease outbreaks.
Technology and contact tracing
Countries as per their capabilities and data regulations are using different types of technology for contact tracing. While some techniques are contact management software based, others are app based. Contact management software based tracing, which is mostly being adopted by US and Europe regions, allows for registration of cases and their contacts for data collection analysis and report generation. Based on the characteristics of cases, the software will generate contact follow-up lists and will facilitate the visualization of chains of transmission. The process is lengthy and requires many resources, as once a person or case has been identified as infected, they need to follow a series of activities which include:
- Interviewing the case
- Creating a list of contacts and classifying them into high and low-risk exposure
- Interviewing the contacts
- Testing of contacts
- Follow-up of contacts
Different states in the US are following this method; the state of Massachusetts has partnered with public and private institutions and launched a “Community tracing collaborative” where program contact investigators have tested residents and further identified more than 1000 close contacts, which means someone they spent more than 15 minutes within six feet of during the three days before testing positive. Similar efforts are being expanded now to other cities too. This test is not just about numbers, but also quality, which is why the US needs about 1, 00,000 tracers which would cost them about $3.6 billion. For now authorities and health workers are looking to hire and train people who lost their jobs due to the virus itself to support the limited number of staff. The contact management tracing software is time consuming and requires a large number of skilled and trained resources, not to mention the funds and costs that it requires. Having said that, the process of direct communication over the phone has been considered valuable and effective by countries using it.
Countries in East Asia are relying on Bluetooth and GPS based apps for contact tracing; these apps come with their own set of problems like; willingness to download the app, privacy concerns, technically challenged elderly people or people who don’t own a smartphone etc. While the use of technology in this region is raising questions regarding privacy, the digital infrastructure that has been enabled by these countries have a seamless data sharing regulation between the government and the individuals. India has its own contact tracing app, ‘Aarogya Setu’, the installation of the app has been made a mandate by the Govt. However, not all East Asian countries have made the installation of the tracing apps mandatory.
Let’s have a look at a few in detail:
Singapore – A country praised early in the pandemic for curbing the spread of the virus, came up with a Bluetooth technology app called TraceTogether to do contact tracing. How the app works is that it first attaches a random ID to your mobile number, it then uses Bluetooth to detect other users who come within 2 to 5 meters of you and records their IDs internally. In case someone tests positive for COVID-19, the health ministry will contact the person through a code requesting their app logs. Once they receive the app logs, they will be able to decrypt the random IDs to determine the mobile numbers of the close contacts. The authorities have integrated multiple measures to protect user’s privacy and personal data. For starters, the usage of the app is not mandatory, secondly and most important, the app only collects your mobile number. Furthermore, the health ministry is the only authority that will be able to decrypt the data. With this the authorities will be able to contact you quicker if one has been in close contact with an infected person. This helps minimize the spread of the virus and makes work easier for contact tracers.
Taiwan – Taiwan has one of the lowest confirmed cases and tapping into big data has played a crucial role for them. Although many people were put in quarantine, the government is using techniques such as geofencing, which helps them track their phone signals and alerts the police in case someone is breaking or interrupting the isolation period. They are also using a mass rationing system which helps people purchase their weekly ration of 3 masks at a pharmacy to ensure there is no shortage. People have to present their health insurance card, which once entered into the system, will show your last purchase and your travel history and any recent medical record. Using big data to track possible infected cases. A person’s health insurance card will alert the doctor if they’re a high risk COVID-19 patient. While Taiwan might not be a part of the WHO, its handling of the global pandemic has become a case reference for many countries.
South Korea – South Korea’s steps towards flattening the curve was taken up by private developers. The app, Corona 100m, collects data from public government sources and alerts users of any suspected or diagnosed COVID-19 patient within a 100 meter radius. People are required to download an app to report any symptoms to health authorities, in which case they will be closely monitored. Once it is confirmed that someone has coronavirus, their cell phone and credit card data is used to chart where the person has recently been and the people they have come in contact with. The contacts of the people that the suspect came in touch with can be traced instantly, giving a much better idea of who requires immediate testing. South Korea uses big data and AI to analyze their whereabouts, which means within 10 minutes, all information can be gathered automatically due to which the contact tracing time has been drastically reduced. People also receive alerts of contacts with infected patients in the neighborhood. If there is a COVID-19 patient in their vicinity then they get an alert. Although it seems like there is a breach of privacy, there is no private information shared with anyone that allows people to identify whose information they are receiving, as only gender and age is mentioned.
India – With over 9 crore users at current, India’s Aarogya Setu app has scored positive on the timely deletion of user data and collection of only useful data criteria, however, it failed to score on voluntary use, limitations of data usage, and transparency criteria. It is designed to keep track of other app users the person came in contact with, it then alerts users if any of the contacts test positive. The app uses the phone’s Bluetooth and GPS capabilities and keeps a record of all other Aarogya Setu users that it detected nearby using Bluetooth. It will also use a GPS log of all the places the device has been at 15 min intervals. These records are stored on the phone till a user tests positive or declares symptoms of COVID-19 through self-assessment. These records are uploaded to the servers. Available in 11 languages, the app uses your location and the government database to determine if you are within six feet of an infected person or in an area designated as the COVID-19 hotspot. In case you test positive, your data including details of everyone you came in contact with over the past 30 days is shared to cloud which is accessed by the government.
While these are great examples of countries in the East Asia region that are using digital contact tracing by relying on people’s phones to map their physical interactions, countries in Europe, the United States, Australia etc. are struggling with contact tracing and their legislation specifics on data collection.
United States – While some of the states have launched their own apps, for e.g. South Dakota residents can install the voluntary Care19 app that works on location tracking ability, President Donald Trump’s administration is looking at the upcoming joint initiative by tech giants Google and Apple, which is expected to introduce an app based Bluetooth technology to help the United States contact-trace past cases. Apple and Google are creating a system where an effective contact tracing app can be created for iPhone and Android users. The system requires Bluetooth data for contact tracing, and the generation of a dynamic user ID which would be refreshed every 15 minutes, the good part is that data will not be stored centrally and the app will not be allowed to collect GPS location data either.
Europe – For countries in Europe, the reaction to the rise in infection rates led to targeted lockdowns. One of the reasons for this was the lack of adequate information. Now that they have some hold of the situation, if not completely, there are numerous obstacles before a contact tracking app is pushed out. While some issues are technology related, one of the most likely issue is the privacy of citizens. Europe is split over the approach to take for a contact tracing app. While many countries including France, Italy, Norway, Switzerland etc. have backed US tech giants’ initiative while praising its stronger guarantee of anonymity, this challenge requires a multidisciplinary approach as they need to follow telecom and privacy guidelines. Questions arise in citizen’s minds about elements such as the kind of data that is being collected, who is developing the app, who has access to the data, exact use and purpose of the application and for how long and where will this collected data be stored. These countries have to think about the situation post pandemic and what will happen in the days after we all survive the novel coronavirus. Some even fear the late acknowledgement of the idea of unbraiding privacy in healthcare.
United Kingdom-The UK’s health department rolled out the first trial version of the NHS tracking app on May 4th. It works on Bluetooth handshake and randomized ID generation and can pinpoint exactly who needs to be in quarantine and who does not. Users can voluntarily opt-in and record details of their symptoms which the app will analyze using artificial intelligence. If a user is suspected to be positive they will be directed to the nearest NHS (National Health Services) health swab test. If the person tests positive, an alert will be sent to those who have been in close contact in the last 28 days. The app stores data on a centralized server for 28 days.
Australia- The COVIDSafe app in Australia works on Bluetooth handshake and records physical contacts of the past 21 days, similar to how the UK’s NHS tracking app works. The data is locally stored on the users’ device unless they test positive, in which case it is sent to a centralized server. The data collected by the app includes the users’ name, age, phone numbers and postcodes. The installation is voluntary but the Prime Minister has urged citizens to install it. Although for the tool to be effective, millions more installations would be required.
COVID-19 has brought many lessons and we learn something new as more days pass. Maybe coronavirus is a learning of how prepared we are for the future. Different countries are making choices as per their legislations on how to respond to the next pandemic. Western democracies have a different take from the eastern ones. The question is: To tradeoff between personal privacy and public safety in a pandemic? Or to accelerate technology innovation and development of laws and policies that can preserve both? Countries showing success with their tracing apps have unique legislation with regards to pandemic and collection of data. Most companies face policy challenges, and it’s time we accepted that this is the new normal. These tracing apps are not here for a short term, they will stay until a vaccine arrives and who knows maybe even after, so we are better prepared for another pandemic.
Gurmeet Oberoi is a researcher and writer of change tactics and technologies in travel and other verticals, she frequently posts across the digital ecosystem. With 9-yrs of experience in communications and marketing, Gurmeet has a passion for travel and reading among other things. She can be reached at firstname.lastname@example.org