The Centers for Disease Control and Prevention (CDC) is working on a proposal to massively scale-up testing and contact tracing to tackle the COVID-19 crisis. This effort will involve identifying all of those infected with the coronavirus and notifying everyone they have encountered in the weeks prior to their illness. The scope and scale of this effort is daunting: More than 750,000 people in the U.S. are infected and the number of exposed may be 10 times more. “It will require an army,” Dr. Robert Redfield, CDC director, noted.
Tech companies such as Apple and Google want to help individuals take contact tracing into their own hands. They, and many others, want to equip anyone with a cell phone to anonymously text their COVID-19 infection status or receive text alerts if they come close to someone infected with the virus. As two computer scientists and a physician who is involved in standing up the contact tracing program in Massachusetts, we share deep reservations about the effectiveness and equity of this particular tech approach to contact tracing.
Cell phone data may help, but it is only a partial solution. It will miss, for example, data from an infected person who leaves their cell phone behind when they go grocery shopping. It will also miss the millions of Americans who don’t have their own cell phones or live in rural parts of the country with limited cellular or internet access. More crucially, cell phone tracking alone cannot accurately report the nature of contacts. High risk contacts range from being within six feet of an infected person without a mask for longer than 15 minutes to touching the same surface many hours or even days apart. Successful contact tracing involves patiently helping people recall with whom they have interacted in the preceding weeks and assessing the risk associated with each of these interactions. Irrelevant contact data will needlessly consume precious human contact tracer time.
Most problematic, however, is assuming that locating people is all that contact tracing requires. To succeed, contact tracing programs require that people trust the entity to whom they are reporting. Trust is built on empathy, patience and the ability to help someone who has just been exposed to a life-threatening disease. Human contact tracers need to guide a rattled parent to think through who their child might have played with at a neighborhood potluck a two weeks ago or an undocumented immigrant find support and care should they fall ill. They also need to understand and help people marshal the resources they will need to sustain a 14-day quarantine after they have been exposed. Thus, contact tracing hinges on deeply human exchanges. There is no app for that.
Digital technologies do have a role to play. They will be crucial to successful contact tracing programs. But they must be intentionally built to assist, rather than replace the people in the health care loop vital to success. Here are a few suggestions, drawn from computer science and engineering research, that point us to the assistive technologies that a newly recruited army of contact tracers will need to attack COVID-19 head-on:
- Dynamic electronic reference tools that help tracers offer accurate, consistent responses when asked something they are not sure how to answer;
- Secure, shared databases and local area networks to support networked tracing teams doing intakes;
- Coordination tools for initial calls, particularly to vulnerable, hard-to-reach groups, so that people with the necessary language and cultural background can reach out multiple times;
- Shared contact records that enable tracers to marshal resources for someone who needs support during quarantine; and
- Provide health workers and their agencies across private-public partnerships with trustworthy, secure, centralized data storage that shares information at the local, state and federal levels.
Ultimately, the best technological interventions to fight COVID-19 will be the ones designed in collaboration with contact tracers to enable them to do their best work and integrated into the planning processes of these programs. Human-centered tech can combine the power of data with the irreplaceable compassion of frontline contact tracers to help us keep COVID-19 at bay until we have a vaccine. In fact, doing anything less misses the opportunity of our lifetimes to unleash the deeply social potential of technologies.
Margaret Bourdeaux, MD, MPH, is the policy liaison for Partners in Health COVID-19 Contact Tracing Program, and holds appointments at Harvard Medical School, Brigham and Women’s Hospital, and the Belfer Center for Science and International Affairs at Harvard Kennedy School of Government.
Mary L. Gray is a senior principal researcher at Microsoft Research and an Edmond J. Safra Center for Ethics Fellow at Harvard University.
Barbara Grosz is Higgins Research Professor of Natural Sciences in the Paulson School of Engineering and Applied Sciences at Harvard University and external faculty at the Santa Fe Institute.