Digital Contact Tracing

Digital Contact Tracing

As the entire world anticipates the end of the COVID-19 disease pandemic, everyone is learning the new, socially-invasive term 'digital contact tracing.' These government-sponsored programs may impact their lives for years to come. 

Contact tracing refers to the method that has been used to control contagious disease outbreak for decades. A disease outbreak investigation begins when an individual is identified as having a communicable disease, says the CDC. Previously, non-digital contact tracing of coronavirus cases was essential to control disease outbreaks, said the CDC in May 2005.

The key to controlling any outbreak is the prompt detection of the infected person's contacts. Once identified, those 'close-contacts' are then subjected to 'control measures.'

Contact tracing investigators interviewed the patient, family members, healthcare providers, and anyone who may have knowledge of the primary patient's contacts, anyone who might have been exposed, and anyone who might have been the source of the disease. Then the contacts are screened to see if they have or have ever had the disease.

During the 2020 SARS-CoV-2 pandemic, digital contact tracing technologies offer innovative tactics to deploy case-finding and containment efforts.

On May 1, 2020, the US CDC published an outline detailing the critical features for digital contact tracing apps and cites the “PACT protocol” as an example of the recommended method for using “Bluetooth enabled proximity tracking” while maintaining privacy. 

Also on May 1, 2020, Rep. Bobby L. Rush, a member of the U.S. House of Representatives, introduced H.R.6666 - COVID-19 Testing, Reaching, And Contacting Everyone (TRACE) Act.

This pending legislation proposes the Secretary of Health and Human Services, acting through the Director of the CDC, award grants up to $100 billion to eligible entities to conduct diagnostic testing for COVID–19, to trace and monitor the contacts of infected individuals, and to support the quarantine of such contacts, through mobile health units, and as necessary, testing individuals and providing individuals with services related to testing and quarantine at their residences.

Contact-Tracing News

Digital contact tracing and non-digital contact tracing news are published on this webpage.

Contact Tracing Programs

As of April 28, 2020, NPR surveyed all 50 US states, Puerto Rico and the District of Columbia to ask them how many contact tracers they currently have — and how many they were planning to add if any. We got data for 41 states and the District of Columbia and found they have in total approximately 7,602 workers who do contact tracing on staff now, with plans to surge to a total of 36,587.

To date, 28 countries around the world have launched contact tracing apps, including 11 European countries, while another 11 are developing apps based on GPS or Bluetooth data, according to an analysis by law firm Linklaters, on April 16, 2020.

The European Commission said in a recent statement 'that app usage should be voluntary and not involve any type of data that pinpoints people’s location.' 

The WHO issued interim guidelines on May 10, 2020, which includes suggestions if contacts cannot be reached, the contact tracing team should ask relatives and friends or explore other means to find them. If contacts relocate to known locations in the same catchment area, the contact tracing team should visit them. If contacts move to another catchment area, the contact tracing team responsible for that catchment areas should be informed and follow up. 

The WHO says the monitoring phase ends 14 days after the contact last came into contact with the COVID-19 patient, or if the contact develops COVID-19. In the event that contacts are in close proximity to each other, such as being in the same household, and one of them becomes a COVID-19 case, the follow-up period is reset to 14 days after the last exposure to the new case.

In the USA, the Johns Hopkins Bloomberg School for Public Health published the 'A National Plan to Enable Comprehensive COVID-19 Case Finding and Contact Tracing in the US' on April 10, 2020. This plan concludes saying 'Now is the time for the U.S. Congress, the administration, and the country to come together to adequately fund ($3.6 billion) and implement contact tracing at this required scale.'

'The goal of adding at least 100,000 new contact tracers in the United States and managing their work, while challenging, is achievable with appropriate financial support and a collective commitment.'

Digital Contact Tracing Examples

  • One example of extensive contact tracing comes from South Korea, with a population of over 50 million. South Korea was able to develop contact tracing plans in response to the spread of a different coronavirus, Middle East respiratory syndrome (MERS) in 2015. This experience also prompted the revision of several laws to help improve the outbreak response. Contact tracing in South Korea during 2020 incorporates patient interviews as well as the use of medical records, cell phone GPS records, credit card transaction records, and closed-circuit television.
  • A second example is the country of Singapore. To mitigate disease outbreaks, SGUnited, GovTech and the Ministry of Health have come up with a way for Singaporeans to track close contacts should the need arise – through a simple mobile app. Using Bluetooth, TraceTogether identifies other nearby phones with the app installed. It then tracks when you are in close proximity to these other persons, including timestamps. If the need arises, this information can then be used to identify close contacts based on the proximity and duration of an encounter between the two users.
  • A recent study published on April 27, 2020, analysis shows that isolation and contact tracing reduce the time during which cases are infectious in the community, thereby reducing the R. The overall impact of isolation and contact tracing, however, is uncertain and highly dependent on the number of asymptomatic cases. Moreover, children are at a similar risk of infection to the general population, although less likely to have severe symptoms.

Contact Tracing Privacy Laws

Privacy advocates fear that governments 'will take away personal liberties in the name of fighting COVID-19 and will never give them back.' In the USA, the HIPPA Law was passed in September 1996, which initiated national standards for various uses of health information.

When the Department of Health and Human Services Commissioner declared a public health emergency on January 31, 2020, he also exercised his authority effective March 15, 2020, to waive sanctions and penalties against a covered hospital that does not comply with certain provisions of the HIPAA Privacy Rule. This rule change has led to substantial confusion amongst privacy groups.

In light of privacy concerns, Google and Apple announced on May 4, 2020, to ban GPS location data from contact-tracing apps that rely on their technology. On April 4, the companies said they will not allow the use of GPS location data in conjunction with their new Bluetooth contact-tracing system. In effect, this decision forces states to choose between tracking encounters using Bluetooth or collecting location data.

On April 21, 2020, the European Data Protection Board (EDPB) adopted guidelines on the processing of health data for research purposes in the context of the COVID-19 outbreak and guidelines on geolocation and other tracing tools in the context of the COVID-19 outbreak.

These EDPB guidelines on the processing of health data for research purposes in the context of the COVID-19 outbreak aim to shed light on the most urgent legal questions concerning the use of health data, such as the legal basis of processing, further processing of health data for the purpose of scientific research, the implementation of adequate safeguards and the exercise of data subject rights.

Digital Contact Tracing Market Research

On May 19, 2020, an Ipsos poll in the USA found 76% of people would give coronavirus contact tracing officials a list of all the people they had recently come into contact with. However, only 56% would give access to their cell phone location data for tracing systems established by public health officials.

As of April 23, 2020, Kaiser Health Tracking Poll finds the US public is divided on whether they would be willing to download an app for these purposes.

Overall, a majority of the public (68%), are willing to use an app on their phone to share results from a coronavirus test in order to allow public health officials to track the spread of the outbreak. Majorities across age groups and party identification, say they are willing to use an app for these purposes.

The public is more divided in their willingness to download an app for their phone that uses Bluetooth and GPS technology to track who they come into close contact with. Half of the public is “willing” to download an app that alerts them if they have come in contact with someone who has tested positive for coronavirus so that they can take steps to protect them and their family.

What Politicians Need To Know About Immunity

A recent article published in The Lancet said ''The linchpin for a strategy to move out of lockdown seemingly rests on increased testing and contact tracing, possible return-to-work permits based on immune status. This approach is broadly sensible, yet immunology is a complex branch of molecular medicine, and policymakers need to be alerted to important aspects of immunology in relation to COVID-19.' 

'There is no certainty as to the immunological correlates of antiviral protection or the proportion of the population who must attain them, making it impossible to identify a point when this level of immunity has been reached.'

'A study of survivors of SARS showed that about 90% had functional, virus-neutralizing antibodies and around 50% had strong T-lymphocyte responses. These observations bolster confidence in a simple view that most survivors of severe COVID-19 would be expected to have protective antibodies.'

'A caveat is that most studies, either of SARS survivors or of COVID-19 patients, have focused on people who were hospitalized and had severe, symptomatic disease. Similar data are urgently needed for individuals with SARS-CoV-2 infection who have not been hospitalized.'

How long is immunity to COVID-19 likely to last? The best estimate comes from the closely related coronaviruses and suggests that, in people who had an antibody response, immunity might wane.'

 

Note:  This content has been aggregated from various sources, such as the CDC, WHO, The Lancet, and media reports by Donald Hackett, who has been following health privacy laws since 1992.