Contact tracing armies in California and New Jersey. Rapid-response contact tracing in Washington. Track and trace in Connecticut. Across the country, governors are putting contact tracing — the tried-and-true public health practice of finding individuals who were in contact someone with an infectious disease — front and center in their Covid-19 reopening strategies.
This is excellent news. Contact tracing, paired with widespread testing, is an essential component of the toolbox for containing a disease outbreak. This is especially true for a disease like Covid-19, which can be spread by people who have no symptoms. Robust contact tracing is one of the reasons why Germany, South Korea, and China have so far fared better than the U.S. in the Covid-19 pandemic.
In the digital age, contact tracing comes with a modern twist: the ability to use smartphones and devices to do the work of walking back through weeks of our lives to find out where we have been, who we have been with, and how widely we may have spread a virus. Digital contact tracing is moving fast. Google and Apple are making test versions of their tracing software available to public health agencies, and Australia’s government already has a contact tracing app called COVIDSafe up and running. Three million Aussies downloaded it in the first three days.
Americans, however, are wary. In a recent poll, 50% of smartphone users said they would not use Apple or Google’s contact tracing app, and only 43% said they trusted the big tech companies with their information.
Americans are rightfully asking: What about our privacy? What are the costs of these safety measures to our civil liberties?
It’s important to acknowledge that contact tracing of any stripe is intrusive. Professional contact tracers will sit with an individual to review his or her social media, text messages, credit card statements, public transportation records, and more to find anyone they could have exposed. Those contacts receive unexpected calls from strangers asking them to potentially upend their lives for weeks to self-isolate or get tested for potential exposure to an infectious disease.
We have allowed these intrusions into our privacy for centuries to combat old killers like tuberculosis and syphilis and more recent ones like swine flu (H1N1). There is no way to contain infectious public health threats without these measures. But until now we have had the reassurance that the public authorities collecting this information would protect our privacy and had no financial interest in the information.
Adding big technology companies into the equation changes that dynamic. For them, data is currency, and their track record of protecting the privacy of consumers is checkered at best.
Nevertheless, we may want to move forward with digital contact tracing. That’s because it seems likely that the ideal approach to containing the current pandemic will involve a combination of new-age apps and old-style contact tracing — a mix that will be economically and socially beneficial. Person-to-person contact tracing is expensive; technology can do some of the work and save vital public health dollars. Meanwhile, person-to-person tracing can do things tech cannot, such as reach high-risk people who don’t have smartphones.
We must move fast. The consequences of falling behind on containing SARS-CoV-2, the virus that causes Covid-19, are all too apparent: thousands of Americans dead, hospitals overwhelmed, millions out of work, and more. Yet we cannot sacrifice privacy in our response to this crisis. All digital contact tracing apps should adhere to a robust standard of obtaining explicit permission to operate, limiting data collection to the bare minimum, securing that information against sophisticated threats, and storing sensitive information on devices instead of central servers.
Apple and Google’s announcement of a common “exposure notification” system is a welcome first step. This system would limit data collection and safeguard sensitive information through privacy-preserving technologies. However, to fully restore public trust and attain broad adoption of contact tracing apps, sound and powerful privacy principles should be backed by the law. A federal consumer privacy law that sets clear and enforceable privacy protections for all Americans at all times is long overdue.
Technology is not a substitute for a robust, traditional public health contact tracing system. Substantial new investments are needed to build the necessary workforce to do that — perhaps 100,000 or more — for keeping track of new Covid-19 cases and their contacts and shepherding them into quarantine. And knowing who has gotten sick — the fundamental requirement for both traditional and digital contact tracing — requires the still-missing capacity for accessible, widespread, and fast testing.
The tension between our privacy and our responsibilities as members of a civil society is always present in American life. But the Covid-19 pandemic has put it in stark relief. If we move ahead with contact tracing in the right way — appropriately balancing privacy and public welfare and using all the tools, new and old, at our disposal — we can stop the spread of this deadly virus, which itself threatens our life, liberty and pursuit of happiness.
David Blumenthal is a physician and the president of The Commonwealth Fund. Richard Blumenthal has represented Connecticut in the U.S. Senate since 2011.