I want to write this all into a screenplay. An all-seeing, all- knowing surveillance regime, discovered affairs, mixed alliances, dire warnings, and a complete loss of trust in institutional powers could make for a great Netflix limited series on the world’s reaction to COVID-19. But, to be fair, it will probably end up on HBO because Netflix always ends up flinching on the really good stuff.
As of this writing, we are on the cusp of the third month of the global confrontation with the devastating coronavirus, and the concerns have shifted from mitigation (do we have enough ventilators?) to management. The big questions on everyone’s minds are, “When can we open up?” and “How much can we open up?”
In mitigation, the rallying cry has been to “flatten the curve,” which refers to the concern that the infection rate will be so high that we will overwhelm our hospitals. As we enter the management phase, the phrase “test and trace” has taken its place. We can’t open, we are told, without adequate testing combined with the ominous-sounding practice of contact tracing.
Contact tracing is a complex topic that has been made less comprehensible and more terrifying by the fact that everyone seems to be using a different definition for it.
In what I’m going to call “classic epidemiology,” contact tracing is basically just an interview with an infected patient. An interviewer would take the incubation period (between two and fourteen days) and ask the patient where they were during that time. Were they at home? Did they go out to eat? Did they go to church? Did they visit friends? The interviewer would put together a list of people who might have had close contact with the patient while they were contagious and would check up with them. Those contacts would be tested quickly in the early stages of infection and, if they are positive, quarantined.
The idea in contact tracing is to identify those most likely to be infected and quickly isolate them to reduce the spread of the disease. Contact tracing (sometimes called contact investigation) is a basic part of the epidemiologist toolkit and is standard procedure for tuberculosis, SARS, MERS, measles, and Ebola. In those contexts, it is uncontroversial.
Unfortunately for us, uncontroversial things do not sell newspapers. A lot of media attention has been paid to a much more controversial form of contact tracing, which uses digital surveillance of an infected individual’s mobile device to try to improve on this more traditional form of contact investigation. This form of contact tracing uses automated and highly detailed information about where the infected person has traveled and how long they were at any given place.
The South Korean government has even published the GPS coordinates of infected individuals. Though the government strips the data of its “personalized” markers, it does not take staggering genius to look at a map of a given phone’s GPS patterns and wonder, “Gosh, that person seems to be sleeping at my house, but when he went out for that ‘work meeting,’ he didn’t go to where his work is.” And thus I get my “discovered affairs” subplot to burn a good ten minutes into my screenplay.
The reality is that, even in South Korea, the contact tracing interview is the core component of an effective trace. That part isn’t invasive, excessive, or unreasonable. Humans are actually pretty good at talking to other humans and making judgments about what kinds of behaviors might constitute high risk for transmitting infection. According to an early publication on COVID-19 contact tracing, the infected patient’s GPS data were used only to verify what was said in the interview. It was the human-to-human communication that drove the bulk of the follow-up testing and subsequent quarantines.
Despite the fact that digital contact tracing is not the primary form of tracking infections, there are endless discussions, controversies, and privacy threats related to it. This is driven by the nature of our mobile application culture, that move-fast- and-break-things ethos that would rather be first than be right. There are dozens of COVID-19 tracking apps that monitor the user’s position and, if a user tests positive (and says so in the application), the app sends an alert to all users who come closer than the government-approved social-distance unit of the infected user.
Even Google and Apple have gotten into the game, introducing contact tracing components built straight into their mobile operating systems that claim to use Bluetooth technology to monitor the distance of the user to other phones. The idea is that when any mobile phone user is listed as infected, every person they’ve been “in contact” with over the last two weeks will be notified.
This is the part of the article where I step outside my detached observational façade and just start laughing. I’ve worked in mobile technology for many years, since before the birth of the first iPhone. The concepts behind digital contact tracing are absurd, unwarranted by the situation in which we find ourselves, and a deep threat to user privacy.
If you have ever tried to connect to a Bluetooth mouse or headset and you don’t live on three acres all by yourself, you’re familiar with the Bluetooth device “Maddy’s speaker” or “Kitchen” or “Alexa 3.” Devices can detect other devices through apartment walls or across cars in a traffic jam. Barrier types that are effective deterrents for COVID transmission, such as walls or car doors or open park air on a sunny day, are not effective deterrents according to Bluetooth. The efficacy of this method of contact tracing is tenuous.
Let’s return to the South Korean model (which doesn’t use Bluetooth because that is ridiculous) and investigate the entirety of their efforts to contain COVID-19. Upon entering the country, they take your temperature and you begin the process of quarantine, which involves digital location surveillance, for fourteen days. They test everyone, with results coming back within a day.
If your test is positive, the process of contact tracing begins, but it is still a blunt instrument. The government sends out a general public safety alert, performs the contact tracing interview, and reaches out to everyone they think might have come into contact with the COVID- positive individual. Those people then start self-isolation and are tested again.
Importantly, the Korean government delivers food and essentials to everyone who is in self-isolation. There is not, as far as I know, any equivalent process in the United States, and even people who are talking about ubiquitous digital contact tracing don’t seem to be considerting the surrounding care infrastructure it would require.
The most dangerous aspect of relying on digital contact tracing as a solution is that it might immunize people against genuine warnings. If someone is getting five notifications a day that they came within six feet of someone who ended up two weeks later being diagnosed with COVID, they may not take it seriously when a contact tracing professional texts them that they have been working in an open office with someone recently diagnosed.
This is where the mixed alliances and dire warnings make a play. I did not initially expect to find myself in the same camp as the American Enterprise Institute, the Brookings Institution, and Harvard’s Kennedy School, but here we are. The consensus among both information security and medical professionals is that digital contact tracing is unlikely to provide enough benefit to actually change anything in this crisis. And I’m being quite generous in my skepticism. To quote data security expert Bruce Schneier:
The end result is an app that doesn’t work. People will post their bad experiences on social media, and people will read those posts and realize that the app is not to be trusted. That loss of trust is even worse than having no app at all.
It has nothing to do with privacy concerns. The idea that contact tracing can be done with an app, and not human health professionals, is just plain dumb.
So why do we still have this push for digital contact tracing? Why is it even still a part of the discussion?
They say that extraordinary times call for extraordinary measures, and I am, in theory, a proponent of that sentiment. In an ideal world, we could say, “This enormous moment of history in which we find ourselves necessitates actions we would not normally contemplate.” The problem is that we know with some confidence that this enormous moment will come and go, but the compromises we made will remain with us for decades. As Schneier noted, “This is just something governments want to do for the hell of it. To me, it’s just techies doing techie things because they don’t know what else to do.”
The concepts behind digital contact tracing are absurd, unwarranted by the situation in which we find ourselves, and a deep threat to user privacy.
As someone who has been closely following this crisis for months, I know the effects of uncertainty. Experts and governments and media figures make promises and predictions, issue warnings, make threats. But it becomes obvious in short order that they have only a weak handle on the situation. I don’t really blame them; the nature of authority is to act as if they have control over every situation, and a key component of having control is to be able to predict what will happen tomorrow. Without predictive foresight, there is no control. But this virus laughs at our predictions and makes a mockery of our control. If you were to design a crisis meant to shatter public trust in institutions and expose the uncertainty that lies beneath the false confidence of our ruling class, you could hardly do better than COVID-19.
It’s hard to see, but we do know this crisis will end. Hopefully it will end before we try literally anything on the off chance that it will make a difference. That is what digital contact tracing is: an off chance. But while it has only an outside chance of making a difference, it has an excellent chance of sticking around after the crisis has lifted.
With any luck, by August or September, we will all be more familiar with contact tracing. Before COVID-19 manages to become a pandemic in any given area, it moves in clusters. It travels among small groups of people (families, neighbors, classrooms) until some super-spreader makes it nearly impossible to contain. Effective disease management in the form of contact tracing interviews, rigorous follow-up, and voluntary quarantine can help keep those clusters from spreading.
This requires an enormous amount of trust among the general population. People need to know that when they are being warned of a close contact with COVID-19, that warning is urgent and meaningful. It needs to be serious enough to require action.
This also requires enormous amounts of trust to be placed in the contract tracing interviewers and the institutions who are managing the tracing process. People have to believe that these institutions are working with clear intention and with respect for individuals and their decision-making processes. And, in return, we need state and local governments to trust their constituents to abide by the issued warnings.
An example of how this trust might work can be seen in Washington state’s plan for reopening dine-in restaurants. Restaurants will be required to collect diners’ phone numbers and email addresses and record their time of arrival, all of which can be reviewed as part of the contact tracing process.
I know many of my admirably liberty-minded friends balk at this, but I see this as an exercise in public trust. Nothing stops me from giving them a fake phone number or email address. But I trust them to use this information only as needed. If I test positive for COVID, there’s no reason to lie to the contact tracers and tell them I wasn’t at that restaurant. And if the person across from me tests positive, I would certainly want to know so that I can also be tested.
Most importantly, this kind of manual logging of dining patrons cannot be “flipped on” at a later date. It is not something that is going to linger just because the government likes to track people. It requires trust from the dining patrons, trust from the business owner, trust from the state government. If anyone starts acting to break that trust chain, everyone will suffer. We are interdependent on the goodwill and honesty of all the involved institutions and actors.
Trust is the only way that any of this works, but that trust must work in all directions.