By Tim Dare
Bluntly, our management of contact tracing has been shambolic and it has important lessons beyond the COVID pandemic.
New Zealand’s response to COVID-19 seems to have been effective and certainly looks assured. The Government seems to have had a plan, and so far, it appears to have worked (more or less). Neither our health services nor our ability to trace the contacts of confirmed cases has been overwhelmed. New cases per day peaked at 104 on March 28th, and by mid-June, no new cases having been reported for more than two weeks, restrictions on domestic movement were removed.
But the subsequent failure of processes intended to avoid any risk of the virus being reintroduced by incoming travellers makes clear that we must not be complacent. In particular, we should be aware of what has gone well because of good luck rather than good management: management can be replicated; luck may not go our way again.
One area in which we might think ourselves lucky is that we have managed, thus far, despite the lack of a clear contact tracing strategy and without sophisticated contact tracing processes. Bluntly, our management of contact tracing has been shambolic and it has important lessons beyond the COVID pandemic.
In the absence of an effective vaccine or widespread lockdown contact tracing is central to COVID-19 management and it’s easy to see why. Viruses spread exponentially: a person with a virus infects (say) two people, each whom infects two people, and so on. The numbers get very large very quickly. The aim of contact tracing is to stop this spread by identifying and isolating those who have been exposed to the virus before they spread it to others. The COVID-19 virus is such that contact tracing has to be fast to be effective: the virus is not terribly infectious (someone with the virus passes it to around 2.5 others) but is infectious for some time before symptoms emerge. Someone who has it is likely to be moving about infecting others for several days before they have any reason to believe they have the virus.
Early on, the NZ Government seemed to appreciate the need for effective contract tracing. In early March it was announced that a locally developed contact tracing App was two weeks away. By mid-April, perhaps because the level 4 lockdown seemed to have the virus under control, high-tech tracing options seemed to have been put on the back burner. As we moved to level 2, businesses were encouraged (the level of encouragement was always unclear) to keep records of those who visited. Names and addresses and times were kept by some but not all businesses, often on paper lists to be managed by the business in ways which were never very clear (and certainly without clarity about whether the businesses had the capacity or processes to manage the information they were (perhaps) required to collect).
The idea was that if someone was confirmed to have the virus, they could tell a tracer where they had been and that tracer could contact the business to see who visited around the same time (and then track those contacts through the paper records held by businesses they had visited, and so on).
This was always pretty hopeless. The record keeping was haphazard: some businesses had them, and other didn’t; there was no check on the accuracy of the lists; and had there been a confirmed case, there’s no reason to think manual tracers would have had any hope of keeping up. Most countries quickly abandoned manual tracing.
When the Government’s NZ COVID Tracer App did appear it turned out to be little more than digital version of this inadequate paper process. People were to scan a QR code when they visited a venue creating a log of where they had been and when. But the system was not used by every business (let alone every customer); there was no way to check whether a customer who waved his smart phone at the QR Code (when there was one) had the App; the process did not record contacts at places like bus stops and social gatherings, and it still relied on manual tracing: in the event of a confirmed case, the digital diaries the App generated were to be accessed by manual tracers. There was, from the outset, ambiguous talk from the Ministry of Health that the App might evolve into a ‘true’ tracing tool, and there was talk of tweaks which would allow users to know whether they crossed the path of a confirmed case. And there is still talk of a more sophisticated COVID Card.
From the outset the Government was offered more sophisticated Apps and processes. The options varied, but typically they involved a Bluetooth App which exchanged encrypted contact information when they came within a specified distance of another device on which the App was installed and maintained that proximity for a specified time. The exchanged information was to remain on users’ phones for the period that someone with the virus might have transmitted it to others. At the end of that period the information would be automatically deleted. If one of the App users was diagnosed with COVID-19, a health professional would give them a code which automatically sent a signal to all the Apps for which it held contact information: i.e., it would tell everyone who had been proximate to someone confirmed to have the virus that they may have been exposed, without manual tracing.
The key to these Apps was that they automated the contact process. They can keep up with exponential growth in a way no process which relies on manual tracing can manage.
There are, of course, many issues which would have needed to have been addressed were the Government to have endorsed one of these more high-tech approaches. They would have required technical and institutional privacy protection; that information was held and processed securely; and that the Apps were used only for COVID-19 management. They would have required implementation in ways that respected the autonomy of users through adequate consent processes and which addressed any inequity in access and potential stigmatisation. And they required a minimum level of uptake; one typical smart phone version required about 60% of smartphone users to use the App.
Ironically, while the government and their consultants mentioned some of these issues while explaining their preference for lower-tech options, many of them are raised at least as clearly by those options – without the countervailing potential effectiveness. The pencil and paper lists kept on store counters and who knows how by business owners afterwards would pass no stringent privacy test; there is simply no guarantee that the information gathered under any of the processes will not be used for other purposes or retained indefinitely; and they all require (and appear to be failing to secure) minimum uptake. Issues which appear to have led the Government to turn their back on potentially effective high-tech processes have been happily brushed over for less technical – and less effective – alternatives.
The shambolic management of contact tracing doesn’t bode well for anything that is done from now on. When public trust was high and there was a sense we were engaged in an important community endeavour, “Jacinda and Ashley” could have brokered the introduction of safe, effective, sophisticated, contact-tracing technology. As the gilt has worn a little, that will be harder: there is less trust, less sense the government has a plan. Countries who have less commitment to autonomy and privacy have simply compelled data collection. For us, all the options from here on require buy-in. If people aren’t confident that there is a clear and coherent plan, they’ll leave their COVID Cards at home.
There is a broader issue. The Government’s dithering seems to have has rested in part on their appreciation that there is a quite deep public suspicion of technology: people are sensitive to privacy threats posed by an App, never mind the actual level of data protection. It is appropriate for governments to be aware of strongly held concerns, but they should also be leading the way. Technology can be used badly, but it also promises tremendous benefits. COVID-19 was an opportunity to see that it could be used well.
For more information on COVID-19, head to the Ministry of Health website.
Tim Dare is a Professor of Philosophy at the University of Auckland. He is an expert in professional and applied ethics.
Photo credit: Ministry of Health
Disclaimer: The views expressed in this article reflect the author’s opinion and not necessarily the views of The Big Q.