Last week, California Gov. Gavin Newsom outlined what the state will need to see happen before coronavirus restrictions begin to ease: Hospitalization rates must flatten and testing must become widespread.
Otherwise officials in San Diego and across the state would be risking new outbreaks of COVID-19 as massive numbers of people leave their homes.
Even then, the process of restarting life and the economy will depend on how effectively local public health officials can identify sick patients and reconstruct their steps to alert others who may also be infected, a practice known as contact tracing. Some governments are now evaluating apps to bring investigations to a much larger scale, causing researchers and activists to worry that the present emergency will open another door to surveillance.
San Diego County has no immediate plans to ease social distancing, let alone digitize the contact tracing process — testing is still only available for the most ill — but officials said they’re looking to the state for more guidance on how an app might be adapted locally.
Private companies with enough resources may get into contact tracing game in the meantime.
For instance, San Diego Gas & Electric, one of the region’s biggest employers, has developed an internal dashboard to identify which employees might be sick, where they’ve gone on the job and who they might’ve contacted. If a worker tests positive, managers can back-trace that person’s steps and alert other employees who they need to isolate.
“It’s not about invading privacy,” said Andrea Smith, SDG&E’s director or marketing and communications. “It’s about doing what we need to do to protect the safety of our employees and customers.”
During the pandemic, the company is still sending its employees into the field and may have to go onto private property.
Jamie Exon, SDG&E’s director of digital acceleration, said the company started contact tracing its employees a few weeks ago by leveraging badge access and other data points already in its possession. The information that goes into the dashboard, he said, is limited to employees, not customers.
If the state or the county ends up endorsing any particular app to facilitate contact tracing on a digital level, the company would likely continue tracing its own employees on top of that official, public effort.
“Ultimately,” Smith said, “we’re responsible for our own workforce, so we’ll use any tool made available to us, but I don’t think it would stop us from doing our due diligence.”
Access to the dashboard, she noted, would be limited internally to a select group of people.
‘The Best App for California’
At press conferences last week, Dr. Eric McDonald, medical director of the county’s epidemiology and immunization branch, said he’s had preliminary discussions about retraining the county’s workforce for contact tracing. He also said he’s intrigued by the possibility of leveraging technology to help with investigations, but he doesn’t have the capacity to do it alone.
He may not have to.
For months, local public health officials have been contact tracing the old-fashioned way. About 100 government workers are tasked with interviewing patients to understand where the virus is headed next. It is labor-intensive and not necessarily a quick process, which is why an app that logs one’s movements is so appealing.
Newsom just tossed cash-strapped governments a lifeline: He told reporters Tuesday that he’s interested in expanding the number of contact tracers to assist at the local level and in partnering with tech companies.
“We’re trying to figure out what exactly we believe is the best app for California,” he said.
There are quite a few proposals on the table — several have gotten national press in recent weeks — and some of those apps pull from cell phone location data, giving privacy advocates pause.
Other proposals are offering to be less invasive by relying on Bluetooth technology that allows cell phone users who’ve tested positive to send out alerts to others without necessarily going through a third party or government authority. By decentralizing the process, and only allowing health clinics access to the data, it minimizes the possibility of one’s identity being exposed.
The point is to make participation on a large scale voluntary and anonymous while still being effective, and avoid what’s happened in other countries, like China, where citizens are being required to download an app. Reports have emerged of people being banned from apartment complexes and grocery stores, their access determined by colored coins that are distributed digitally by the state.
The level of harassment has been so intense in South Korea, where the movements of the sick are broadcast to the public, that the chair of country’s human rights commission has expressed concern that people are now less willing to get tested.
The ACLU has also raised a number of serious concerns about what even the best-intentioned method of digital contract tracing might sacrifice in the United States all in the name of public health. Even in dense areas, cell phone location data is not precise enough to tell how close two people were to each other.
“Using the wrong technology to draw conclusions about who may have become infected might lead to expensive mistakes such as two weeks isolation from work, friends, and family for someone — perhaps even a health care worker or first responder — who was actually not exposed,” the organization wrote.
County Taking Wait-and-See Approach
Whichever app or apps the state of California ends up endorsing — if any — the next question will be who’s planning to monitor and audit it all for any potential abuses.
Austin Choi-Fitzpatrick, a political sociology professor at the University of San Diego’s Kroc School of Peace Studies, encouraged officials to attach a sunset clause to any new technologies they might endorse so that short-term triaging efforts stay short-term. It’s also important to ask when evaluating one app over another, he said, whether the company behind it is serving the public or its shareholders.
Choi-Fitzpatrick has gotten a close-up view of the contact tracing process. His wife was among the first to test positive for COVID-19 after coming home from an international trip, he said, and the interview seemed like it came from a hastily written script — including only questions about where she’d been overseas and not about how she’d been spending time in more recent days.
“High-tech contact tracing is great, but first we have to get low-tech contact tracing down,” he said.
Other states and cities are already boosting their contact tracing efforts for when social distancing eases up. Massachusetts is hiring a “small army” of contact tracers.
San Francisco just launched a task force, made up of furloughed librarians and other public employees, to help trace infected patient and ensure they have access to shelter. The task force is also using an app to manage cases and ongoing care, sending daily texts to gauge developing symptoms.
Apple and Google also recently announced that they’re tweaking the operating systems on their phones so that soon users who test positive can voluntarily give up information about who they might have contacted, which would then be used by app makers to send out alerts. That effort is being tested out in the Bay Area.
Local researchers are eagerly watching how San Diego County responds to the options in front of it.
Cedric Whitney, a visiting scholar at UCSD’s Institute for Practical Ethics with a background in health care artificial intelligence, said digital contact tracing is being discussed as though it were a magic pill, but there are still a lot of unresolved questions surrounding privacy, consent and the accuracy and longevity of any app and how it could be abused.
Until there’s been a thorough and public accounting of how that app is going to be built and used, he said, he would put his trust in the traditional process and on allowing public health officials to scale up their current operations.
“I would tend towards trusting [epidemiologists] to conduct deep, thorough interviews for contact tracing than cobbling together an app that nobody understands,” he said.
In the meantime, he urged the region to keep widespread testing the priority.
For now, San Diego County is taking a wait-and-see approach to how contact tracing might be taken to a digital level.
At a press conference last week, Supervisor Nathan Fletcher said the immediate task for the region was to continue sheltering in place and on decreasing the number of hospitalizations. The recovery process would come later.
“The worst thing we could do would be to prematurely move and undo the progress that’s been made and undo the lives that have been saved and be in a position where we have to reimpose efforts and actions,” he said.
Disclosure: Mitch Mitchell, SDG&E’s vice president of state governmental affairs and external affairs, sits on Voice of San Diego’s board of directors.