The Covid App: Will you use it?
Contact tracing – the identification and isolation of people who have been exposed to an infectious case – is a vital part in the fight against Covid-19. Used in conjunction with other basic public health measures, swift contact tracing has over 90% efficacy against Covid-19 disease, making rapid tracing and isolation of contacts as effective as any vaccine that might be developed.
The ability and capacity to trace contacts of an infected person becomes more and more important as restrictions are lifted and there is more opportunity for social interaction and community spread. The ‘gold standard’ of contact tracing is that 80% of people someone who has tested positive has interacted with, can be located, contacted and self-isolated within three days. Currently, contact tracing is reliant on someone who has tested positive being able to ‘retrace their steps’ and interactions. While people may be able to report where they have been, this system does not account for the people who are not known to the infected person – for example those that were near them at the supermarket, the petrol station or on public transport.
Established infrastructure within the Ministry of Health, including the National Health Index and the variety of established national screening programmes, means that contact details for around two-thirds of New Zealanders are already held by health agencies. Customs and Police records are being used to assist in tracing those the NHI cannot reach. This is a labour intensive process and resulted in the establishment of National Close Contact Service in March.
Technology via applications on a mobile phone can be used to locate contacts quickly and efficiently. New Zealand’s Ministry of Health has announced that such a contact locating app for mobile phones will be made available for voluntary download within the next two weeks. But at what ‘cost’ to privacy and liberty does such technology come? And what of the approximately 15% of New Zealand’s population that does not have a smartphone? These folk tend to be in more at risk groups within the population, for example the elderly.
For the app to be effective, uptake by more than three quarters of the population is required. In Singapore uptake of their mobile Trace Together app has been around 16%. Such a low level of uptake means that less than 1 in 25 exposures are captured by the app and therefore, the public health impact is negligible. Use of the app is ineffective. Commissioned by the Government to complete a report on New Zealand’s contact tracing capabilities, Otago University infectious diseases physician Ayesha Verrall, favours development and use of a Bluetooth app, contending that it would be helpful even if only 10 to 25% of contacts were covered. This level of coverage would require between 1.5 million and 2.4 million New Zealanders downloading and using the app correctly.
For people to adopt the technology voluntarily requires trust; people need to trust that if they use the app their data is secure and private. In charge of protecting cyber security in New Zealand, the Government Communications Security Bureau (GCSB) is involved in discussions around contact locating technology; any app (or use of other locating technology) would need to be vetted by the GCSB before being introduced. However, this may be insufficient to develop the public’s trust; in fact it may detract from it.
Answers to questions of privacy are important in people’s ability to trust. Where does the information get uploaded to? How secure is that server? Who gets to see the information? How long does it stay on the platform it is uploaded to? How do we exit any contract tracing at the end of the pandemic? When contact tracing is no longer required for Covid-19, and in the interest of public transparency, does there need to be an audit of what information was gathered and how it was used to the advantage of public health? While there have been postulations, no clear answers are currently available to these questions.
So what of the technology itself? The concept of the Bluetooth app is that it sits ‘in behind’ the regular functions of your phone. That the app and Bluetooth must be on continuously uses data and phone energy. Further, in the case of the Singapore Trace Together app, the IOS system used by Apple can was found to intermittently interfere with the app, and the app with Apple’s normal daily phone functions including making calls, browsing the internet or assisting with directions. There have also been complaints of interference with other Bluetooth devices, including headphones. For this reason, people were reluctant to install and make use of the app.
Apple and Google – who between them have the operating systems for virtually all smartphones worldwide – have both announced that they will work together to release new features to Governments “for public health reasons” for both IOS and Android systems, in mid-May. These new features will overcome some of the technical problems – e.g. enable apps like Trace Together to work without interfering with other functions on a phone. The new features will also make interconnectivity between IOS and Android technologies easier – that is, enable the two operating systems to talk to each other. Hmmm, would we be suspicious of these two otherwise oppositional giant corporations co-operating in normal times, so why might Covid-19 times be different? What evidence is there that these two corporations can or cannot be trusted? Once there is an underlying co-operative system between IOS and Android operating systems, what apps might be developed on top of that? Would a co-operative system be more easily hacked? Development of contact tracing technology is happening very rapidly – what risks are there that things get overlooked?
New Zealand’s Prime Minister has stated that use of the digital contact locating app will be voluntary, not mandatory. This contrasts with Israel, where the Israeli government has adapted spy software previously used to track the movement of suspected terrorists, into a widespread surveillance network. When someone in Israel tests positive, anyone who their phone had been near in recent days receives a text message instructing them to self-isolate.
Whether a technical solution to the need for rapid contact locating is voluntary or mandatory, there is also the question of what information the technology should be retrieving – should the technology track a person’s contacts or simply their location? This in turn, raises the questions of whether new privacy laws may need to be enacted that over-ride our current privacy laws so that actions that are undertaken are recognised within our legal system. If enacted, how might such new laws be rescinded and at what point in the future? And what audits or procedures would be required to ensure that any new temporarily legal data collection has been stopped?
While the New Zealand government appears to see a case for the usefulness of technical solutions, both the Prime Minister, Jacinda Ardern and the Director-General of Health, Ashley Bloomfield have emphasised that any such digital tool would not replace manual contact tracing, merely supplement it.
Ultimately, the decision is that we either have something that everyone is forced to use or we have something that people voluntarily use, but we try and get as much uptake as possible. There are huge issues with forcing people to use apps that track their movements, as you can imagine, so we are opting for apps that people choose to partake in. [ ] I think if people understand that it’s one of the things that will help us stay out of stringent measures like Alert Level 4, then they might be encouraged to take it up.
Jacinda Ardern (April 9)
The question is, when the app is introduced within the next couple of weeks, will you download and use it?
1. Wang C, Liu L, Hao X, Guo H, Wang Q, Huang J, et al. Evolving Epidemiology and Impact of Non-pharmaceutical Interventions on the Outbreak of Coronavirus Disease 2019 in Wuhan, China. medRxiv. [preprint, not peer reviewed] 2020; doi:/10.1101/2020.03.03.20030593
2. Newsroom article – Covid Card. https://www.newsroom.co.nz/2020/04/17/1132682/nz-considering-100m-contact-tracing-covidcard.
3.Verrall Rapid Audit of Contact Tracing for Covid-19 in New Zealand. Dr Ayesha Verrall. University of Otago. 10 April 2020. Available at www.health.govt.nz
4. Daalder, M. (2020). NZ considering $100m contact tracing ‘CovidCard
https://www.newsroom.co.nz/2020/04/17/1132682/nz-considering-100m-contact-tracing-covidcard
(https://www.rnz.co.nz/news/national/414617/health-ministry-consults-with-spy-agency-gcsb-for-covid-19-tracing-amid-privacy-concerns)
