31/03/2020

Since the outbreak of the COVID-19 virus, first reported by Chinese authorities on New Year’s Eve 2019, governments around the globe and their public health agencies have been racing to find solutions that economise the use of health infrastructure, mitigate the risk to citizens, and buy time for virologists and epidemiologists to find a longer-term solution to the rapid arrival of a ‘once in a century’ pathogen.

It may surprise some to find that much of the advice provided by governments and global health organisations today is remarkably similar to that which accompanied last century’s most infamous pandemic, a H1N1 variant known as the ‘Spanish Flu’: restrict social interaction, practice vigilant hand hygiene and quarantine yourself if feeling ill. That advice remains as relevant today, however, 100 years of technological advancement has also provided a sophisticated arsenal of tools with which experts can strategise for the more effective management of pandemics and citizens can be nudged (or in some cases compelled) to aid in that effort.

Foremost among these is the possibilities provided by the immense data capture that is a routine part of mid-digital life. Location data attributable to individuals via smart devices and wearables is proving to be a powerful source of information for public health authorities tasked with reverse engineering the movements and interactions of individuals who may have been an unknowing vector for the virus.

The coupling of personal data with immense public and private data sets relating to health, aged care, transport and community demographics is also providing novel approaches to case detection, treatment as well as providing governments with the means to communicate critical messaging to communities overwhelmed with an ‘infodemic’ of COVID-19 related information.

As the pandemic continues to disrupt communities and economies, much of the success of nations that have managed to ‘flatten the curve’ is being attributed to capitalising on Big Data. As goes the adage in scientific communities, ‘in God we trust, all others bring data’.

Old enemies, new friends

While the approaches taken by different countries and among their communities vary, several models of coronavirus-related public health technologies have emerged in the short months since the virus emerged. ‘Dashboard’, ‘contact tracing’, ‘geofencing’ and other phrases have entered the expanding coronavirus lexicon, reflecting the role technology is increasingly playing in the management of the crisis as it spreads across the globe. We examine some of the more popular iterations of these technologies and the governments making use of them below.

1.1 Data Dashboards

‘Dashboards’, interactive visual information management tools that provide statistics, graphs and, in some cases, geographic information presented via an online graphical user interface, have emerged as popular and powerful tools of public health agencies and health organisations in pooling and simplifying the data most relevant to communities. Critically for the current public health crisis, these applications are well-suited to providing historic and point-in-time epidemiological data related to the status of coronavirus spread that is accessible to, and digestible by, lay-persons.

Both the Singaporean Ministry of Health and the Government of the Special Administrative Region of Hong Kong maintain strikingly transparent coronavirus dashboards which provide a high level of detail relevant to active cases including their status, the gender and age of the individual and the treating hospital. Unlike the Singaporean product, the Hong Kong ‘Local Situation’ dashboard does not provide interactive graphs to assist in visualising the aggregate COVID-19 case load. However, the Hong Kong dashboard sets the high-water mark for the granularity of data - going as far as providing the names of individual buildings in which coronavirus-positive individuals may have resided.

In the United States, Johns Hopkins University’s own COVID-19 dashboard, modelled from a dashboard developed to track the spread of measles, aggregates public health data from a variety of sources from around the world. The dashboard has emerged as one of the most frequently cited sources of current coronavirus infection rates and national ‘epi-curves’ in print journalism and has had more than 1.2 billion feature requests (requests to access the data on the dashboard) since its launch on January 22.

1.2 Contact tracing

Contact tracing refers to the identification of active cases of a communicable disease for the purpose of isolation and treatment of the affected individual and the interruption of the next generation of cases.

The process relies both on an understanding of the transmission pathways of the disease and the networks through which it may be spread. Contact tracing has been a linchpin of public health strategy for decades. However, it has often relied on a largely manual process whereby a carrier voluntarily discloses a list of social interactions they have had and investigators are then tasked with interviewing and screening the relevant contacts. In the case of highly virulent pathogens like COVID-19, success in containment may be a function of the speed at which contact tracing can be achieved.

The instant and immense data capture attributable to smart phones and other wearable technologies has provided the foundation for many public health authorities to super-charge the contact tracing process. Foremost among these examples is the ‘TraceTogether’ app developed under Singapore’s Smart Nation Initiative by the Singaporean Government Technology Agency and the Ministry of Health.

The TraceTogether app leverages Bluetooth technology from an individual’s smart phone to register other users who have been within a 2-metre radius for an extended period (30 minutes). Individuals that test positive can later alert those who may have been exposed through proximity to them, reducing the potential for asymptomatic carriers to continue acting as a vector for the virus.

Singapore’s foreign affairs minister, Vivian Balakrishnan has announced that the Singaporean Government will be making the TraceTogether app open source in the hopes that other governments and public health agencies may be able to replicate its success in Singapore. While the app is currently unavailable in Australia, the Department of Health has confirmed that it has road-tested the application, pointing to its potential inclusion in the next iteration of Australia’s ‘Coronavirus Australia’ app.

In the interim, other governments including that of the United States, Israel and the United Kingdom are pressing ahead with developing their own data driven contact tracing capacities making use of the digital bread crumbs every individual drops as they move throughout the world today.

1.3 Isolation verification

For countries that have adopted mandatory mass-quarantines or other highly restrictive measures in the hope of avoiding or containing the pandemic, technology is also providing a means with which public health agencies and law enforcement can monitor compliance with these emergency measures.

In Taiwan, authorities are working with telecom companies to leverage smart phone geolocation data to monitor the compliance of individuals required to be in home quarantine.The system, described as an ‘electronic fence’, alerts authorities within 15 minutes of when a phone’s GPS moves too far from the registered location, or the phone is switched off, and is being combined with twice-daily phone calls from authorities to ensure that individuals adhere to quarantine requirements.

Hong Kong has adopted similar ‘geofencing’ technology called ‘Signature Home’ for new arrivals who are issued with geo-tracking bracelets to ensure that they adhere to the mandated 14-day quarantine on arrival. The bracelets require individuals to step out the dimensions of the accommodation they will inhabit for the quarantine period and alerts authorities when the bracelet moves outside of the ‘fenced’ location.

Privacy concerns

The rapid development and adoption of COVID-19 related public health technologies is not without concern in some quarters. Privacy experts and civil liberties groups have noted that the technologies detailed above require the collection, use and disclosure of significant amounts of personal (in most cases, sensitive) information and the widespread monitoring of individuals and communities.

Consequently, the risk of a serious interference with an individual’s privacy may in fact increase in line with the usefulness of a COVID-19 technology to the public, as the right to be informed of the nature and spread of active cases is weighed against the individual patient’s right to privacy. As has been proven in several overseas cases involving the identification of COVID-19 positive individuals using supposedly anonymised data, the risk is far from academic.  

Balancing the risks and rewards of a technology-driven response to COVID-19 will only be of increasing interest to governments, business and civil society as data continues to provide novel ways to combat and contain a novel virus.

Author: Mitch Bennett

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