With a population of 23-million people and just 110-miles of ocean separating the island from mainland China, it is remarkable that Taiwan has reported just 6 deaths from COVID-19 to date. Having learned many lessons from the SARS epidemic it experienced in 2003, Taiwan has been able to both develop digital systems and implement sophisticated solutions throughout the last 16-years. Consequently, Taiwan’s response to the COVID-19 pandemic has been rapid and effective.
One of the innovative solutions that Taiwan deployed this year in response to COVID-19, is contact tracing that integrates an individual’s digital health profile with their travel history. This allows an international traveler’s data to be assessed by the Taiwanese government while the passenger is in transit. Upon the passenger’s arrival at the Taiwanese airport, an SMS is sent to their phone by the government to advise what to do next. Passengers may be granted permission to express through immigration and sent a barcode to facilitate entry. Or, the results of the contact tracing investigation may result in the traveler being required to undergo a mandatory 14-day quarantine, due to being exposed to high-risk populations throughout their journey.
Once quarantined, the Taiwanese government mandates that individuals must not leave their dwelling, and call twice a day to ensure it is upheld. Quarantine records are integrated with cell phone data and geo-fencing technology is used to alert authorities when a quarantined individual leaves the permitted area. Fines of US$33,000 can be issued for an offense against the mandate. These measures, though highly efficient, seem draconian to many in the Western world. And fortunately, the version of contact tracing suggested in the U.S. seems far less invasive in comparison.
A digital contact tracing solution proposed by Apple and Google for use in the U.S. utilizes Bluetooth technology to leave a ‘trace’ when two or more smartphones come into close contact. If a cell phone owner is subsequently diagnosed with the virus they can choose to have the ‘traces’ on their phone sent to public health officials. Others that may be at risk of having contracted the virus can then be expediently notified.
Apple and Google’s contact tracing technology is anonymous and voluntary — those that want to use it must opt-in. There are both pros and cons to this approach; on the pro side, an individual’s privacy and liberty are protected. The con, however, is that efficacy is limited if few people use it. For the system to be useful, and for it to have a positive outcome on public health, many people need to have this contact tracing technology enabled on their smartphones. The more devices it is on, the more data it can provide. Yet, when technology is voluntary, we are not likely to see mass adoption, and therefore from a public health perspective, it would be beneficial for Apple and Google to require users to anonymously participate.
MIT has also developed contact tracing systems and has announced SafePaths, a set of tracing tools that put privacy first. In a recent white paper, MIT makes the case for implementing contact tracing while also cautioning that the technology “offers opportunities for bad actors to create fear, spread panic, perpetrate fraud, spread misinformation, and establish a surveillance state.” The white paper concludes that a series of trade-offs must be made to minimize the spread of COVID-19 while also managing the risk to individuals and societies. MIT advises that care must be taken to design a contact tracing solution that prevents both abuse and mass surveillance.
This is a challenge we are facing at the University of California Institute for Prediction Technology (UCIPT), as we discuss developing contact tracing apps with organizations in Southern California. We constantly weigh the proposition of obtaining information that is valuable to the public health system such as location data, with the need to protect citizens’ privacy and ensure anonymity.
As seen in Taiwan, and in other international virus containment success stories such as South Korea and Singapore, there is digital technology available that can help curb the spread of this devastating virus. The question that we must answer, is what civil liberties — if any at all — we are prepared to compromise on in the United States, to ensure COVID-19 is a pandemic for as short a time as possible.