By Lucie White.
The initial hype about a digital contact tracing app that could control the COVID-19 outbreak until an effective vaccine or treatment can be found has died down – governments are downplaying the potential of what was initially sold as a crucial means of escaping lockdown. At the same time, many countries are experiencing or have experienced a second wave of the virus and, resultantly, many areas are being forced into a second lockdown.
The economic, social and psychological costs of general lockdowns are severe, so it’s time to revisit the question of alternatives – what are our options for avoiding further lockdowns, while controlling the spread of the virus, at least to a sufficient degree to avoid overwhelming healthcare systems? Could a contact-tracing app indeed provide a solution here? And if it could, would the benefits be outweighed by the ethical costs?
In order to have the potential to effectively suppress the spread of COVID-19, a digital contact-tracing app will likely need to meet two criteria. First, it will need to be used by a significant proportion of the population – a goal that is unlikely to be achieved unless the app is made mandatory, or possibly if sufficient incentives are offered for its use. Second, it will need to pick up on infected people, and alert their contacts, really quickly. Waiting until after someone experiences symptoms, gets a test, receives a positive result, and registers it in the app is going to lead to delays that could severely compromise the effectiveness of this measure. What is needed is a way to report on the app as soon as symptoms are first experienced.
The problem here is the possibility of “false positives” – what can we do if people, either because they are genuinely mistaken, or for malicious reasons, report that they are positive for COVID-19 on the app, resulting in an immediate alert to all their contacts that they must quarantine? There are two ways to deal with this. The first is covered above – wait until someone has a confirmed test, and then give them a code that they can enter into the app – ensuring that they indeed have the virus before they report. This, however, leads to the above-mentioned delays.
The other option? Allow people to report as soon as they have symptoms, and then follow up – by looking at whether that person did in fact receive confirmation later, or whether any of their close contacts became infected. If not, this could be identified as a likely false positive, and the initial warning to all close contacts could be rescinded. This still leads to people having to quarantine as a result of false positives, but mistakes can be quickly corrected, while maintaining essential speed in alerting contacts.
In order to conduct a follow-up here, health authorities will need to know who has submitted reports to the app, and who their contacts are (the information, in other words, that they would need to conduct manual contact tracing). However, it is very difficult to make the app work (i.e. accurately identify close contacts) without using the framework developed by Apple and Google for their phones, and they have put conditions on its use – the app must be voluntary, and it must be impossible to identify users and their contacts. In other words, the conditions that Apple and Google have put on the app might preclude the app from functioning effectively enough to present a viable alternative to a general lockdown.
This is not to say that there are not legitimate concerns with a mandatory (or incentivised) app that shares personal data with the government – such a system is obviously vulnerable to government abuse, or could fall prey to hacking attacks. But we need to clearly see what is at stake here, and shed the assumption that a privacy-preserving app is necessarily superior. Effective prohibitions on sharing some data could well result in further general lockdowns (and all the resulting negative consequences). Alternative strategies for avoiding general lockdowns, such as isolating the elderly indefinitely, bring with them their own host of ethical problems. All options here raise serious ethical concerns, but we must consider each carefully, in light of the viable alternatives, in order to identify the least worst strategy. This requires putting abandoned strategies, like a mandatory, non-privacy preserving contact-tracing app, back on the table.
Paper title: How to overcome lockdown: selective isolation vs. contact tracing
Author(s): Lucie White and Philippe van Basshuysen
Affiliations: Leibniz Universität Hannover
Competing interests: none
Social media accounts of post author(s): https://philpeople.org/profiles/lucie-white