For all the unknowns surrounding the COVID-19 pandemic, one thing is certain: Containing and rolling back the disease is only possible with reliable information about the prevalence of the infection and its spread. The greatest difficulty now is identifying individuals carrying the virus and all the people who interacted with them.
New technologies can help surveil and monitor diseases and their transmission, but that infrastructure is not yet in place. The new coronavirus outbreak is forcing a reassessment of plans to develop those capabilities and making plain the problems that they will face.
The key to success is “contact tracing,” the identification of infected individuals, who they contact and to whom they risk spreading the disease. Contract tracers have to immediately interview individuals with the virus, warn contacts of their exposure, assess their symptoms and risk, and get individuals with symptoms to testing and care.
In Japan, doctors must report all cases of infectious diseases to the National Institute of Infectious Diseases, which immediately gives it a case number and assigns a team to do the contract tracing.
The U.S. Centers for Disease Control warns that “Communities must scale up and train a large contact tracer workforce and work collaboratively across public and private agencies to stop the transmission of COVID-19.”
Good contact tracing is a lot like detective work. It requires detailed and accurate knowledge of a person’s movements and contacts, information that can be difficult to acquire; people withhold details for a variety of reasons, some good, some bad which makes the job labor-intensive and time consuming.
Not just anyone can do it. It requires empathy, training, supervision, and access to social and medical support for patients and contacts.
The scale of the COVID-19 outbreak demands a large number of contact tracers and dealing with this disease is especially challenging because it spreads quickly, can be asymptomatic and because there can be a two-week delay between acquiring the virus and getting sick.
Technology can help overcome human shortcomings. Thermal cameras deployed by the thousands across the world where people gather, like transit hubs and facilities, can be used to identify people with fevers (a reliable, but not certain sign of infection); closed-circuit TV (CCTV) networks can follow and trace the paths of those individuals.
Apps on phones can identify when infected individuals are proximate, alerting the owner to potential infection. Imagine the data that could be generated with the inclusion of smart or wearable fitness devices. All would provide quicker, more accurate information about exposure, and could create a data base that would offer greater insight into infection and exposure.
Some governments have deployed those technologies. Singapore launched the TraceTogether app, which uses Bluetooth to scan nearby phones. If a user gets COVID-19, he or she can opt to send health records to the health ministry, which makes that information available to contact tracing teams.
More than 2 million people downloaded a similar contact tracing app released Sunday by the Australian government. South Korea is using its Smart City Data Hub to track the movements of individuals that might be infected.
Israel has gone still further and adopted emergency rules that allow security agencies to use phone geolocation data to track individuals that have, or may have, COVID-19. Several tech giants, Google and Apple among them, are developing systems that would use their geolocation data to get a better grip on infection patterns and outbreaks.
The medical Holy Grail is artificial intelligence that would mine data to create disease surveillance systems and uncover patterns and anomalies, which would speed up disease containment or, better still, develop predictive models. This process will be exponentially accelerated by the data collection and networks that are the essence of “smart cities.”
Smart cities are an integral part of Society 5.0, Japan’s national vision that “aims to realize a data-driven, human-centric, next-generation society that uses technology such as artificial intelligence and the internet of things.”
To put it more simply, a world of unlimited connectivity will generate data that can be used to solve all sorts of social problems, among them disease surveillance. As the Education, Culture, Sports, Science and Technology Ministry explains, Japan seeks to create “a super smart society” that develops “problem-solving IT utilization models based on the internet of things and artificial intelligence in advance of the rest of the world.”
That last bit, where emphasis was added is key. Japan is focused on the international implications of domestic social initiatives and critical to its effort is selling its solutions to the rest of the world. The Prime Minister’s Office notes that one of its main objectives is building “a smart city model that can be rolled out to overseas markets.”
It’s early days yet with smart cities, most are still pilot projects but Japan has joined international initiatives such as the World Bank Smart City Partnership Program, the Group of 20 Global Smart Cities Alliance, the Asia Smart City Conference and the ASEAN Smart Cities Network to disseminate its work.
Once again, it is competing with China as it does so. China has trumpeted its success in containing and rolling back the COVID-19 outbreak, and is urging other countries to follow its lead and use its techniques. Those solutions include mandatory registration and downloading of apps that identify individuals and their status to use public transportation or enter buildings.
Facial recognition technology is being used to confirm compliance with lockdown orders. The Chinese government is working with digital payment companies to acquire instantaneous information on the location of citizens and monitor their contacts.
That campaign assumes additional significance as China promotes a Health Silk Road in tandem with its “Belt & Road Initiative”. A cornerstone of that effort is the memorandum of understanding signed with the World Health Organization on collaboration in BRI countries. The MOU builds on “The Healthy China 2030 Plan,” and promotes cooperation in the prevention and control of communicable diseases.
Cooperation becomes more worrying in light of Beijing’s embrace of smart cities to promote its indigenous technologies and solve the same social problems with which other governments are wrestling. China is enthusiastic about smart cities, but to goose the economy in the aftermath of the COVID-19 outbreak, Beijing is reportedly accelerating development of “new infrastructure,” especially that of smart cities.
This intersection of health policy, infrastructure development and smart cities is where things get worrisome. Systems designed to ensure physical safety can be adapted to disease surveillance. But there are few standards for smart cities and in their absence, whoever underwrites an infrastructure project will have great say about the operating systems and procedures it uses.
Consider, for example, the standards to govern data use and protection. China has no opt-out feature in its monitoring apps, unlike Singapore’s TraceTogether; neither is there the data anonymity promised by Apple and Google.
More broadly, China’s approach to and definition of “social problems” rings alarms in the West. Experts have reservations about the use of technology for disease monitoring and surveillance, but the most worrying in Japan and like-minded societies is the potential for the abuse of data that is generated.
In the West, surveillance capability that feeds an omniscient state is a bug; in China, it’s a feature. That information, available for use in real-time, creates mind-bending opportunities for social control: “Orwellian” is the word that comes immediately to mind.
Standardized protocols and procedures are a necessity. Failure will mean that information cannot be shared between urban entities and that will undermine perhaps fatally disease surveillance and containment. But that does not mean that the lowest common denominator, anything goes is the right approach. Viruses are indifferent to bureaucratic distinctions, but we can’t be. The cure can’t be worse than the disease.