The idea of smartphones being used to track and report on people’s movements conjures dystopian visions of state surveillance.
In the case of most COVID-19 contact-tracing apps, the intention is that Big Brother is watching out for you, rather than simply watching you.
The technology is being deployed, aggressively in some countries, to help track and trace people who may have been exposed to the coronavirus.
Nonetheless, privacy and data-protection concerns are challenging many western democracies as they seek to adopt technologies and techniques that have been successful elsewhere.
Decision-makers in the Cayman Islands are reckoning with the same questions.
Alee Fa’amoe, executive director of OfReg’s telecommunications arm, compiled a report on the best COVID-19 apps in circulation at the request of Cayman’s National Emergency Operations Centre.
Using research out of the US, his team looked at apps being deployed across the world, including in Singapore, Iceland and Austria, and rated them using a scoring system that incorporated various criteria, including data protection.
“The report identified the top-scoring contact-tracing apps and recommended if they wanted to pursue this, these would be the best ones to look at,” he said.
There are options that provided greater privacy protection, according to Fa’amoe. He said Cayman has 120% “mobile penentration”, meaning statistically everyone on the island has at least one cellphone.
In that context, he believes smartphone apps could be used to support, but not replace, human contact tracing.
“The most recent feedback we have seen from people using this technology is that it doesn’t replace the army of manual contact tracers calling people and interviewing them. It is a helpful add-on,” he said.
Why contact tracing?
Right now, when a person tests positive for the coronavirus in the Cayman Islands, public health officials get to work.
They interview the patient by phone and in person and try to help them remember who they might have been in close contact with over the previous 14 days.
The aim is to identify, isolate and test everyone who could have been impacted. The process then repeats itself, as they track and trace the contacts of the contacts.
In the absence of a vaccine, this method is widely considered the best way to keep the virus under control and snuff out new clusters of cases before they develop into fully fledged outbreaks.
A US government white paper, produced by scholars at the Johns Hopkins Center for Health Security, identified ‘comprehensive case finding and contact tracing’ as the most important tool in preventing a resurgence of the virus as communities return to work.
“It is estimated that each infected person can, on average, infect 2 to 3 others,” the report states. “This means that if 1 person spreads the virus to 3 others, that first positive case can turn into more than 59,000 cases in 10 rounds of infections.”
The report recommends a massive investment in people and technology to break the chain of transmission before that kind of exponential spread occurs.
While it endorses the use of smartphone apps, the report’s key recommendation is that at least 100,000 new staff are recruited across the US to trace and track cases of the virus.
Cayman is already well-equipped in that regard, according to Chief Medical Officer Dr. John Lee.
“The public health team has been expanded to meet the challenges of this health threat,” he said.
There are currently five teams of contact-tracers, Lee said, with each working under the leadership of a senior public health nurse.
Some staff have received additional training on performing the role from the Caribbean Public Health Agency.
“Contact tracing is conducted by phone and physical visits to the locations under investigation or surveillance,” Lee added.
Currently, a contact is classified, based on World Health Organization guidelines, as household members and anyone who has been within three feet of the patient for more than 15 minutes. Contact tracers can use their discretion to recommend wider notification based on their interviews.
Lee said the government has spent some time and effort looking into the potential of using smartphone apps to assist in that process.
But he said there were implementation difficulties in smaller countries, like Cayman, where significant participation would be required for such solutions to be effective.
The key, said Taylor Langfitt of Cayman-based Salt Technology Group, is finding the right balance between providing enough information to be useful to public health officials without adopting invasive surveillance measures.
She believes the new collaboration between Apple and Google may help deal with some of the privacy concerns while also covering 99% of the smartphone market.
A key element of this technology, said Langfitt, is that it involves an opt-in choice for users at every stage.
“It is the most ethical and least intrusive (contact-tracing technology) that we have seen,” she said. The software platform, which the two tech giants are offering to governments around the world, is the underlying technology which would facilitate the creation of an app that allows smartphones to ‘talk to each other’.
If you were sitting next to someone on a bus, for example, your phones would exchange encrypted keys that would store a digital record of that interaction.
In this way, the app would create a ‘digital diary’ of your connections that it would store in your phone for 21 days.
If you later tested positive for the coronavirus, you could choose to allow the app to share this information with public health authorities who could then contact people you might have passed the virus on to.
OfReg’s Fa’amoe says the Apple/Google collaboration is promising but it is not the only one that government is looking at. He said several countries had created viable apps that were being used to help public health departments. OfReg’s report was submitted to the deputy governor and the National Emergency Operations Centre.
Jan Liebaers, who has responsibility for information rights at the ombudsman’s office, said any contact-tracing app would need to have appropriate privacy considerations at its core to comply with Cayman Islands data-protection laws. He agrees that there are workable solutions that could allow this technology to be deployed in the fight against COVID-19.
“Together with our colleagues in overseas data-protection authorities, we believe it is possible, and absolutely necessary, to balance privacy concerns with the requirements of public health. Indeed, privacy and trust play a key role in the success of any voluntary app,” Liebaers said.
Langfitt believes the key challenge is finding a solution that allows users to opt in or out but still encompasses a great-enough percentage of the population to be effective.
If that can be worked out, she said, such tech could be a very useful tool in allowing the economy to reopen safely without the threat of further island-wide curfews.
“Instead of locking down the whole country, you can very accurately lock down the people who are potentially impacted,” she said.