When it emerged on October 2 that Donald Trump, the US president, had contracted Covid-19, the White House decided against tracing people who had been in close contact with guests at a September 26 event in the Rose Garden. That reception for Amy Coney Barrett, the US Supreme Court nominee, was later described as a “superspreader” — a source of many new coronavirus cases.
The failed opportunity to use contact tracing disappointed proponents of what is seen as an important weapon in trying to suppress the pandemic. Contact tracing maps people who have been near an infected person in order to identify candidates for treatment and to stem the spread of the virus.
Its use after the White House event would also have raised awareness of contact tracing itself, experts say, and demonstrated its benefit alongside more basic prevention measures including masks and testing.
In the UK, events at 10 Downing Street this week stand in stark contrast. Prime Minister Boris Johnson tweeted on Monday that he had been “pinged” by NHS Test and Trace, the UK’s contact tracing system, and would self-isolate as directed.
Is it ethical?
“Contact tracing isn’t new,” says Jeffrey Kahn, a specialist in bioethics and public policy at Johns Hopkins University, Baltimore. It has helped track sexually transmitted diseases for decades as well as Sars, Mers and Ebola in this century, mainly in the doctor’s office or via telephone interviews.
What is new is the digital element. “Essentially we’ve been using it during the current pandemic before it was even beta-tested,” says Prof Kahn, whose guide on ethical digital contact tracing has been downloaded 170,000 times.
While phone interviews still play a part, big data and mobile phones have transformed the process, says Prof Kahn. That raises ethical issues that governments will need to address.
“South Korea adopted a particularly rigorous programme that included linking GPS, credit-card transactions and CCTV monitoring to identify Covid-19 spreaders,” says Prof Kahn. “In Israel, until their Supreme Court prohibited the practice, law enforcement was using surveillance to track infected people.”
Public engagement together with transparency over how data is gathered and used are essential to an inclusive and successful digital public health response, says Prof Kahn. “The public should know how their data is being obtained and agree to its use.”
Jennifer Daskal, the faculty director for technology law and security at the American University Washington College of Law, says rapid adoption of digital contact-tracing apps raises privacy concerns.
“Centralised databases that track individuals’ movements and associations raise much greater privacy concerns than systems that alert users about exposures but store the relevant data in a decentralised manner, on users’ own phones,” she says.
Trust is key to an effective pandemic response, Prof Daskal says. While digitalisation has changed our sense of what is purely private or public, society is more sensitive to potential abuse of personal information.
“We share our location data with navigation apps and post our lives on Facebook, but we’re also aware of increasing threats from hacks and misuse of our data,” she says.
For Prof Daskal, privacy is affected by three key choices made by the developers of contact-tracing systems. These are:
Where data is stored: centralised on corporate or government servers, or decentralised on individual phones. Decentralised systems give better protection to an individual’s private data.
How the app identifies potential connections: for Prof Daskal, using GPS location data to track infections is more open to abuse than the alternative of using Bluetooth data, which traces proximity without mapping a location to identify connections.
Whether users can opt in or out of the system.
Design decisions such as opt in/ opt out can limit effectiveness. A mandatory contact-tracing system, for example, will reach more people but it also encroaches on civil liberties.
“Therein lies the dilemma. Privacy is not an absolute right and has never been understood as such,” says Prof Daskal. “But in general, good privacy and good health should be understood as working hand in hand.”
Privacy vs utility
In April Apple and Google announced a partnership to develop a Bluetooth-based, decentralised opt-in contact-tracing platform in the operating systems of Android and iOS phones. They effectively set the standard for apps worldwide (the UK ditched its homegrown attempts in favour of the Apple-Google model in June).
Siim Sikkut, chief information officer in the government of Estonia, says it was almost inevitable that most of the world would adopt the Apple-Google protocols.
“It made using iOS and Android phones much simpler, and allowed you to concentrate on the customisations needed in your particular country,” says Mr Sikkut, who adds that his country prides itself on being a digital native, with “99 per cent of governmental services online”.
When it came to tracing the spread of Covid-19, Estonia already had experience tackling the challenge of privacy versus utility in a public health system, or indeed any digital system. Estonians have been able to view their medical records online for more than 10 years, as well as a log of people who have seen them.
Every country will have its milieu against which technologists set their approach, says Jason Bay, who led the development of TraceTogether, Singapore’s contact-tracing app. In a city-state of more than 5.6m people, known for prizing stability and security, the opt-in app has been downloaded 3m times so far.
Singapore’s alternative system uses an open-source protocol called BlueTrace, developed by the Singaporean government and now adopted by countries including Australia, Poland and Canada. While the Apple-Google protocol stores and processes data on the individual’s mobile phone, Singapore’s system decentralises data collection and storage but centralises data processing and alert notifications by the country’s health authority.
“The Covid-19 pandemic is ultimately a public-health crisis,” says Mr Bay. “You don’t start by trying to solve a privacy issue and then hope that your solution also just happens to address public health objectives.”
The case studies below are a shortlist of entries to the FT Intelligent Business awards event held online on November 19.
All the entries showcase the combined use of data and tech in business operations. Source: RSG Consulting
New Jersey State Judiciary and UiPath
The New Jersey state courts made a name for themselves as digital leaders in 2014 with the introduction of fairer bail decision-making using artificial intelligence. In 2017 they implemented virtual courts to avoid having to keep courts open on weekends. In the past six months the New Jersey state courts have switched fully to virtual courts for everything except trials. They have processed 100,000 court events so far and implemented robotic systems with software company UiPath to process payments and enable people to submit files online.
Booz Allen Hamilton
The management information and technology consulting firm relaunched the booking process on recreation.gov, a US site for booking visits to about 4,000 public attractions such as federal parks. The contract was negotiated on the basis that Booz Allen Hamilton took on the cost of building the platform and is paid via the site’s transactions. One example is back-country hiking permits, which used to have a 15-minute manual booking process. The 20,000 annual requests for back-country hiking in the Olympic National Park are now digitised, saving approximately $150,000 annually in administration fees.
Capgemini and Dijon
The French city of Dijon collaborated with IT services provider Capgemini to develop a central control room for infrastructure in the municipality's development as a smart city. This will enable Dijon to achieve its long-term goals of using data to improve mobility, ecological impact and other areas. The digitally enabled city was able to respond to Covid-19 by developing a platform that connected emergency response units and facilitated increased communication with citizens, plus remote management of equipment for the upkeep of infrastructure during lockdown.
City of San Jose and SimpliGov
The Californian city San Jose implemented SimpliGov's workflow automation tool in March to automate five of the city's most inefficient workflows. The Covid-19 lockdown accelerated the project because of the increased need for online services, and the San Jose city IT department will have automated 30 services by the end of the year. Newly automated processes include the application for federal aid to buy emergency equipment and applications for businesses to set up outdoor dining under social-distancing restrictions.
Government of Estonia
The Baltic nation implemented a national digital identity programme in 2000 and uses a centralised healthcare database. This enabled Estonia to introduce a decentralised contact-tracing app built by a consortium of the country’s tech companies. The government's digital strategy, called Kratt, currently focuses on artificial intelligence experiments. The government planned to implement 50 projects by the end of 2020 — so far, the figure has reached at least around 40. Use cases include transcription of minutes in parliament, reviewing criminal record databases in light of the EU’s General Data Protection Regulation, chatbots for handling citizens’ queries and automatic activation of child benefits.
In March the Singapore government's technology unit launched TraceTogether, the first Bluetooth-based contact-tracing app, and subsequently introduced a plastic token that works in the same way, via Bluetooth, that people without smartphones can use. Engineers developed software for a robot that uses machine learning to take temperatures and detect face masks. The software runs without storing data in the cloud or connecting to the internet. The technology unit is currently developing software for robots with legs to move about in “unstructured terrain”, testing Boston Dynamics’ Spot as a mobile robot that acts as a monitor in public spaces.
New York City Mayor’s Office of the Chief Technology Officer and US Digital Response
In partnership with US Digital Response, a voluntary group of technologists doing pro bono work to support the US public sector's Covid-19 response, the New York City Mayor's Office of the Chief Technology Officer helped to develop a PPE dashboard. The dashboard tracks inventories of medical equipment. They also created a tool to co-ordinate the logistics of quarantining medical workers and Covid patients, and a prototype for onboarding new staff to conduct testing and contact-tracing. Through their NYC[x] Innovation Fellows programme they have also supported the development of a continuous translation tool that helps New Yorkers access public health information in various languages on government websites.
Tel Aviv Foundation, Tel Aviv-Yafo Municipality, Rockefeller Foundation and Colu
When a construction project closed Jerusalem Boulevard in Jaffa for three years, the Tel Aviv-Yafo municipality used an app from Colu, an Israeli start-up, to incentivise residents to use the 220 local businesses that were affected, offering them 30 per cent cashback in “city coins”, which could be redeemed in other local businesses. The app also provides shops with an additional marketing platform. The city invested further in the app when Covid hit. An investment of $370,000 in 2020 has seen more than $4m worth of economic activity at local businesses, with 12,500 unique users of the app.
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