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THE ANGELS: A middle-aged woman arrived on April 13 at a tent set up by the St. John’s Well Child and Family Center for the coronavirus test, with her mother in tow. When they both tested positive, the clinic staff began asking more questions.
Can you give us the names of the people with whom you have been in close contact? We need to make sure that his family, friends and coworkers are safe, the employees explained. It turned out that the women shared their two-bedroom apartment in South Los Angeles with two other families, 14 members in total.
Over the next two days, clinic staff were able to contact and persuade other members of the household to be tested, said Jim Mangia, executive director of the nonprofit organization, which operates 18 health centers and school clinics. in Los Angeles and Compton. Another housemate tested positive and received self-isolation instructions.
With California and neighboring regions working to relax restrictions on social distancing and allow parts of life to return to normal, US health authorities. USA They are struggling to stop the next wave of infections before it begins. To prevent an explosion of new cases, Governor Gavin Newsom has emphasized the state’s ability to trace the trail of people exposed to the coronavirus to isolate and treat them.
Many have pinned their hopes of returning to normal in a digital contact tracking regime powered by Google and Apple smartphones. The two rival companies are working with public health authorities and university researchers to build databases on mobile devices for applications that would notify people if they were recently around someone infected. They plan to launch the system in mid-May. Newsom has praised the rare joint effort, and United States President Donald Trump has called the technology “something amazing” and “very accurate.”
But all the attention on the Google-Apple platform is making some public health professionals nervous. Contact tracking work, they say, challenges the notion of a fancy technology solution, which requires intensive work by trained people. Those who have successfully used it to control other diseases worry that an unproven constellation of apps is already being treated as a panacea, despite the United States facing an absence of other necessary elements in any successful response: evidence generalized and freely accessible. the hiring and training of tens of thousands of human contact trackers who can explain, cajole, and make nuanced judgments.
The story of the 14 housemates helps illustrate why. The mother who accompanied her daughter to the clinic that day was an undocumented immigrant, placing her in a category of patients who are often wary of their personal information entering databases. But as a long-time St. Johns patient, she felt comfortable with the staff interviewing her, according to Mangia. Relationships are key, he said, especially among low-income black and Latino communities that are most vulnerable to the coronavirus, such as those living in South Los Angeles.
“I have been doing this for 25 years. I find it hard to believe that an undocumented patient is comfortable with an app that alerts you to someone close to you who has been exposed to Covid,” said Mangia. “It is a fairly large stretch.”
With many patients who do not speak English or have phones with fast Internet connections, St. Johns has had limited success in its ability to get them to use new apps for telehealth visits or appointment scheduling, he said.
“We are discovering that if we use WhatsApp or FaceTime or just an old phone call, it is much, much more effective,” he said.
But interviews take time and can only tell you everything the interviewee knows. The exponential speed of the virus’s spread has generated a demand for new methods to automate and scale contact tracing. With an almost total duopoly in smartphone operating systems, Google and Apple, in theory, have the power to create very broad technology, one that could tell you if you need to worry about that stranger who was too close to you on the bus. stop. By relying on short-range Bluetooth radios within each smartphone, it would be immune to the whims of patients, capable of capturing forgotten interactions and encounters with strangers.
“You will never remember the people in subway car 5 on the 5 p.m. train,” said Ranu Dhillon, an epidemic response specialist and instructor at Harvard Medical School. For every person who discovers they have been exposed through the app and reports that to a public health department, that is one more chain of transmission that would not otherwise have been discovered, Dhillon said.
But trusting an app is technocratic folly, said Allyson Pollock, a professor and director of the Center for Excellence in Regulatory Science at Newcastle University. “He is very superficial. He appeals to the middle classes, to the prosperous, but it is not really good if you think you can control an epidemic with him,” he said.
The foundation of infectious disease containment, interview-based contact tracing is the proven and true strategy that health departments must invest in and the public must trust, experts said. Dozens of health researchers trained to interview patients, call people they interacted with, knock on doors, and point out strangers looking for those who may have been exposed have been crucial to containing sexually transmitted diseases, measles, and tuberculosis, as well as SARS outbreaks in 2003 and swine flu in 2009.
Massachusetts was the first state to invest in an ambitious coronavirus contact tracking program, budgeting $ 44k (RM189.09k) to recruit an army of 1,000 contact trackers. Governor Andrew Cuomo said April 22 that New York would partner with New Jersey and Connecticut to launch a similar program. On the same day, Governor Newsom said California was accelerating to train up to 10,000 people.
However, the country as a whole is not prepared to deploy the 100,000 to 300,000 contact tracers needed to fight the coronavirus. A NPR survey of the 50 states found that the United States has only 7,602 workers tracking contacts, with plans to increase that number to 36,587.
Overconfidence in technology solutions could detract from these necessary efforts and provide a false sense of security to justify reopening local and national economies long before it is safe to do so, three experts in technology, law and policy and epidemiology they wrote in a document for the Brookings Institution. The authors also warned that apps could be exploited to wreak havoc and misinformation and identify infected people without their consent.
Apple and Google say the architecture they adopted prioritizes privacy. To keep users anonymous from each other, and anyone else trying to control them, the data transmitted and collected via Bluetooth will be encrypted, and the identifiers of the phones will change approximately every 15 minutes.
The explicit consent of the user will be required before the tool begins to collect data about the operating system. A person diagnosed with Covid-19 would enter that information into a health agency app and agree to send a record of other nearby phones, which would be stored on a remote server for 14 days. Any user whose phone appears on that list will receive a notification with information from health agencies on how to isolate and control symptoms.
With these safeguards, the plan has garnered cautious approval from privacy advocates, including experts from the American Civil Liberties Union, despite widespread concerns about tech giants’ control over people’s personal data.
Still, the looming spectrum of privacy concerns could prevent enough people from opting for the system to prevent it from reaching the critical mass required to generate meaningful results. Nearly 60% of respondents in a recent Washington Post-University of Maryland survey said they would not be involved in tracking digital contacts, either because of privacy concerns or technological hurdles.
With such low participation, the probability of an infectious contact being marked by any application would be extremely low, said Farzad Mostashari, a former national coordinator of health information technology at the Department of Health and Human Services during the Obama administration.
When two people get close, the chance that they both have the app would be “like getting a double six,” he said.
The companies have not said how many users would need to opt in for contact tracking technology to work effectively. But a study from the University of Oxford found that governments need 60% of the population to use a Bluetooth-based application to stop the spread of the coronavirus.
In countries that have successfully used high-tech tools to suppress coronavirus outbreaks, they have generally been combined with widespread old-school contact locating methods, and sometimes with a noticeable reduction in personal privacy and punishment for challenge public health edicts. In South Korea, for example, cell phones ping alerts whenever new cases are discovered nearby. Health authorities regularly publish the exact times and routes of movements of infected people. People ordered for quarantine must download an application that alerts officials if they leave isolation; The fines for infractions could reach US $ 2,500 (RM10,743).
There are indications that more countries are taking this route. France has urged Apple and Google to weaken privacy restrictions, to no avail, and the UK National Health Service has said it will create its own centralized system.
Meanwhile, the limited nature of the data generated by applications will make it impossible for public health departments to centralize information and understand the chains of transmission and where exactly the outbreaks occur, or create a patient contact list to monitoring.
Users who receive notifications may have difficulty understanding their actual level of risk. The result could be a storm of false positives: reports of exposure even when the possibility of transmission was very low, said Carl Bergstrom, a professor of biology at the University of Washington, who co-authored the Brookings article.
It’s the context that enables trained contact trackers to focus on meaningful interactions, Bergstrom said. “Humans talk to you during the day,” he said. “Who did you talk to? Did you say hello to your neighbor? Where was she standing? You work on it. It allows humans to make nuanced judgments about what is considered an exhibition.”
An Apple spokesperson said in an email that exposure notification technology is only one element of response to Covid-19, although Apple and Google have heard from public health authorities that it can be a useful tool. The spokesman said the companies recognized that learning the most effective methods of handling the virus is an ever-evolving process. The companies originally called the system a “contact tracking” tool, but have since renamed it an “exposure notification.”
Not that technology can’t be useful here, Mostashari said. Tools that directly help with manual contact tracking efforts, such as training contact trackers, streamlining the questions they should ask, and improving the ability of public health departments to monitor patients daily They could be useful, he said.
San Francisco, which is training librarians, city workers, and medical students to track contacts, has partnered with Dimagi, a company that develops open source software for underserved communities, to digitize the workflow it supports. contact tracking and monitoring of those infected with Covid-19.
But until the technology has proven its worth, Bergstrom said there are many reasons to be skeptical.
“Maybe some technological solution will pass the epidemiological concentration, but right now, I don’t see what that is,” he said. “What we caution is that we should not put all our hopes in this. Let us be transparent about what it can do.” – Los Angeles Times / Tribune News Service
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