In March 2020, when contact tracing apps were first created, they struck me as a mirage – a fantasy embraced by the smartphone and jet-set class who wanted to believe that technology could do them. ignore the pandemic.
However, prejudice does not make good science, and in a pandemic, good science is what we need. Today, a year and a half later, in People Matter: Contact Tracing Apps and Public HealthTufts University professor Susan Landau set out to do a sober assessment.
You must feel for her here, because writing a book on such a quick topic is a bit like trying to nail the ceiling. Landau completed his book in the fall of 2020. At this point, many countries were too locked down for contact tracing apps to matter much; now everyone is focusing on vaccinations.
It begins with a general history of contact tracing, moves on to technology-enhanced contact tracing, the conflict between contact tracing and privacy, and an assessment of the effectiveness of contact tracing applications, and then follows. ends with a brief discussion of the future.
The big conflict in the spring of 2020 was whether contact tracing apps should be centralized or decentralized, that is, whether they should collect user data in a giant government-run database or keep the data. data locally on each user’s phone, to be shared only with that user’s consent following a positive test.
Landau follows this story and the near-universal adoption of the decentralized GAEN (Google-Apple Exposure Notification) platform now used by almost all applications. Landau discusses the European effort (which included UCL in the UK), which developed open source protocols protecting privacy whose principles were similar to GAEN’s final design. However, she leaves out the 2011 FluPhone project, led by Jon Crowcroft and Eiko Yoneki at Cambridge, which established that the use of cellphones could provide real-time measures of social activity and help identify super -spreaders via infections appearing around them.
Trust and local context
Landau concludes that while contact tracing apps can clearly help reduce basic breeding numbers by uncovering cases that without help people cannot, so can human contact tracing. As an example, she cites the Fort Apache Indian Reservation in Arizona, which ignored testing in favor of looking for symptoms such as low oxygen saturation. The result, despite numerous infections, was a lower death rate than the surrounding state.
Trust and understanding of the local context is essential, as is ensuring that public health infrastructure is working for those who need it most. A better approach than GAEN, she argues, is to build applications that help outsource plotters; as an example, she cites the NHS application which collects recordings by QR code.
Now, as things can open up, this is a time when contact tracing apps might have a bigger role to play. We should, Landau concludes, have the public debate on how and when these tools should be used, which we did not have last year. This pandemic will end, but it will not be the last. We need to prepare now.
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