We can’t fail on tracing
Test and trace. Test and trace. As provinces start cautiously to restart public life after weeks of lockdown, that’s the mantra from politicians and public health officials alike.
We need testing for the COVID-19 virus on a massive scale, they say. And we need an equally ambitious program of contact tracing so we can quickly figure out who’s been exposed to the virus and alert them before it starts to spread out of control.
Canada’s top public health official, Dr. Theresa Tam, says contact tracing is “absolutely critical” to a successful reopening that doesn’t lead to new outbreaks of the disease. Ontario Premier Doug Ford uses the same words. And Prime Minister Justin Trudeau says he and the premiers are discussing how to do it on a national scale once inter-provincial travel starts back up.
Yet the truth is that while contact tracing may be vital, it’s fraught with problems — technical, social and political. And in Canada, at least, there’s little sign that we’re on the way to the kind of broad, effective effort that all agree is necessary.
Certainly, there’s lots of talk and a flurry of high-profile announcements. In South Korea and Hong Kong, contact tracing apps are credited with helping to break the chain of infection and bringing the pandemic to a halt.
Google and Facebook, meanwhile, are collaborating on an app that would notify people if they’ve been in contact with someone infected with COVID-19. Alberta has launched its own app, while other provinces are busy at work on their own.
Everyone, it seems, sees apps as a way of putting contact tracing on steroids. Instead of doing it the old-fashioned way with armies of public health workers tracking people by phone and email, digital systems offer the promise of quick results and almost-instant response. Not to mention low cost.
But there’s a hitch. Simply put, to be effective, such apps must be intrusive — perhaps too intrusive for those who value their privacy and civil liberties. They may be accepted in some societies, such as China where the government could even make their use mandatory. But Canadians will not — and indeed should not — give up their rights so easily.
Civil libertarians and privacy advocates, as a result, have been sounding the alarm about potential abuses. Mandatory systems, they rightly say, should be used only as a “last resort.” Any measures should be voluntary, time-limited, safeguard the custody of personal data, and be overseen by a privacy commissioner or surveillance ombudsman.
That makes sense, but it’s a trade-off: such guarantees would inevitably make any system less effective, or at least less efficient. If the goal is an immediate response to stop the disease in its tracks, then allowing people to opt in or out and encumbering it with protections doesn’t help.
At the same time, the effectiveness of such systems is still very much in question. Depending on the technology that’s used, contact tracing apps may work only if users leave their phones unlocked and have the app running all the time — which are likely to discourage uptake. Since such systems aren’t effective unless most people are using them, that’s a big problem.
At the same time, existing apps can’t distinguish between family members sharing a dwelling and strangers passing by. Or between open and closed spaces. Human contact tracers can figure out those differences by questioning infected people, and so don’t waste time by alerting people who aren’t at risk.
In Canada, typically, we’re cobbling together a patchwork system since both testing and contact tracing are the responsibility of provincial public health officials. We risk ending up with a mix of technologies, data collection methods, and regulations, leading once again to an unclear national picture as the pandemic unfolds.
And some systems may simply not be up to the job. Quebec, as we know, has been hardest hit by COVID-19, yet the new contact tracing system it is bringing is built around old technology and seems ill-suited to the task it’s designed to do.
Unlike app-based tools, Quebec’s system, built in a matter of weeks by the Quebec company Akinox, uses email. A patient who tests positive for COVID-19 will get an email and be asked to fill out a form identifying those they’ve been in contact with, along with their email addresses. Then the chain continues.
Jorg Fritz, an associate professor of microbiology and immunology at McGill University, tells CBC News the system appears to be “very outdated and old-fashioned” compared to apps being designed for the same purpose around the world.
With all these problems, the best solution in the short run may well be boosting the ranks of human contact-tracers, who have done that work for years with diseases like HIV. California, for one, plans to invest $44 million to train a small army of 10,000 tracers. Sometimes, the traditional ways may be the best.
Canada can’t afford to boot this one. And if there is no easy technological fix, there may be no other way than spending the money needed to strengthen the human-based system here. Compared to the cost of failing, it would be cheap.
The best solution in the short run may well be boosting the ranks of human contact-tracers