No, We Don’t Need to Place Our Faith in Downloading Some Untested, Privacy-Infringing App as the Only Possible COVID-19 Slayer; Why Don’t We Look to Places that Have Successfully Limited Disease Spread and Copy Their Policies?

By Jerri-Lynn Scofield, who has worked as a securities lawyer and a derivatives trader. She is currently writing a book about textile artisans.

Ars Technica ran a piece today that clutched its pearls at poll results showing the number of US respondents who intend to use a contact tracing app is declining, More than 7 in 10 Americans won’t use contact-tracing apps, data shows:

Because of the lag between infection and the onset of symptoms, people can contract the SARS-CoV-2 virus and then pass it on, potentially to many others, before they know they’re infected and have to isolate. So being able to identify and warn individuals who have been exposed to an infected person—known as contact tracing—is widely acknowledged to be a vital part of any effective strategy to beat COVID-19. Which is why it is extremely dismaying to see survey data that says fewer than 3 in 10 Americans intend to use contact-tracing apps to allow that to happen.

That’s down from 1 in 2 in  April who would use such an app.

Interestingly, those most at risk appear to be most skeptical:

Most of the resistance to downloading a contact-tracing app came from people over the age of 55. US Centers for Disease Control and Prevention data show that people aged 55 and over account for almost 80 percent of US COVID-19 deaths to date.

Okay then, why?

Survey respondents who replied “no” to the first question were then asked to explain that decision with a multiple-choice poll. The most common reason cited was a concern about privacy; in all, 44 percent of those who said “no” to a contact-tracing app said they would not trust the technology to protect their digital privacy. But nearly as many (39 percent) also said they thought the apps created a false sense of security, and 37 percent said they believed the apps would not work to slow the spread of the pandemic. Thirty-five percent also indicated a lack of trust in the app providers.

You know what?  These skeptics have a point. For Hong Kong, as I’ve written previously, has so far had remarkable results in checking COVID-19 spead, without relying on the use of any app (see Contact Tracing Via Old Shoe-Leather Epidemiology While Spurning the Techno-Fix Fairy: How Hong Kong Quells COVID-19 Without Killing Civil Liberties.)

One month after I wrote that last piece, this city of 7.5 million people – roughly the size of New York City – has so far logged 1113 cases and 4 deaths,  despite being one of the most densely populated cities in the world, where many people would regard even tiny NYC studios as spacious paradises, and being located to close to mainland China, where the COVID-19 pandemic commenced.

Compare these figures to New Yorks: 17,193 deaths, out of 210,000 reported cases ,in  a population 8.5 milllion.

Now, remarkably, Hong Kong never went to full lockdown. Look at my earlier piece if you haven’t already for it outlines some of the common factors Hong Kong shares with the US, such as incompetent leaders, e.g. Carrie Lam, Donald Trump, not to mention Andrew Cuomo, who were slow off the mark in embracing the use of masks.

For more on the mask issue, I refer you to this post from yesterday, Nassim Nicholas Taleb: The Masks Masquerade.

The debate over masks is in some places highly political, Yet in Hong Kong, anti-government sentiment cuts in the opposite direction to how it cuts in the US. The Hong Kong citizenry is by no means conformist and has indeed been in a state of revolt for more than a year. In October 2019. the Hong Kong government invoked a colonial-era antimask restriction, in response to the extensive use of masks by  protestors to foil facial recognition software.

So, when COVID-19 appeared at their doorstep, people in Hong Kong were more than happy to embrace wearing masks, Other factors that contributed to Hong Kong’s success: experienced, competent public health officials, and a recent history of infectious disease outbreaks, with people well aware of their conseuences and more than willing to embrace measures to reduce  their risks.  Plus I shouldn’t forget to mention that the city offers top-notch, affordable health care, and its citizens aren’t afraid to ask for it.

Also key to stopping COVID-19 from taking hold in Hong Kong is a mind-bogglingly thorough test and trace policy (sometimes called track and trace; for more discussion of what such a policy looks like, see my shoe leather piece referenced above, plus U.S. COVID-19 Contact Tracing Programs Designed for Failure, Despite Bloomberg Money; Why Can’t the U.S. Copy the Lessons of Hong Kong’s Success?)

These posts describes what rigorous testing and tracing looks like, and what the US is doing instead. Test and trace is not, alas, a mere slogan. It must be properly undertaken. And once a sick person has tested positive, s/he must accept the consequences of that testiing. In a nutshell: the citizen must agree to be quarantined or self-isolated, but the state also has reciprocal responsibilities: it must monitor the patient, in self-isolation or quarantine facilities, plus provide health care and other support until a patient recovers (such as care for any caretaker for a child or elderly person who is isolated or taken into quarantine). I elaborate on these poiints in the Bloomberg money piece referenced above.

Now, it may be too late, given how far and fast COVID-19 has spread in the US (and elsewhere, for that matter), and the deficiency of its and trace measures, to eschew the use of an app entirely. But don’t kid yourself that apps are a panacea, nor by any means the approach that’s yielded the best results so far.

South Korea has similarly stopped COVID-19 spread in Seoul, another densely-packed city, again by using masks and test and trace, but also with use of an app. An app thefore might be a useful tool, but as Hong Kong shows, is by no means a necessary condition.

I don’t know much about other places, so I ask readers to weigh in in comments, but I know in Asia alone, Taiwan, Thailand, and Vietnam have shown great success in managing the pandemic, despite the density of Taipei, Bangkok, and Hanoi and Ho Chi Minh City, respectively –  without I believe relying unduly on apps,

One other point. These apps are untested. Do they yield useful information, or is it just case of garbage in, garbage out? They also raise very real issues of who controls the data we surrender.

Whereas other mechanisms also work. And still work well. They’ve been part of the infectious control playbook for quite some time, and are tried and tested.

A vaccine may rescue us. As may discovery of therapies or prophylactics. And maybe contact tracing apps will be part of what one will have to accept in the future, as is now the case in India for boarding a flight. (See In new flight rules, airfare fixed by govt, only one check-in bag allowed.) As of this date, India has yet to restart incoming and outgoing international  commercial flights, but when they are available, it’s overwhelmingly likely that downloading the app will be necessary to purchase an international fare.

As the WSJ makes clear in a lucid discussion of indoor air pollution and controlling the spread of COVID-19, What It Will Take to Make the Indoors Feel Safe Again – which strays IMHO a bit much into technofix fantasy – but then rights itself in its last paragraph:

Experts emphasize that the best approach to reducing illness in shared spaces is to employ many different interventions, not just one magical air filter or light fixture. In other words, you’ll still have to wear a mask, keep your distance and wash your hands.

Indeed.

People are not necessarily deluded, as the Ars Technica piece implies, for saying they won’t download a contact tracing app. As at present, such a tool is neither necessary, nor even the only or even the best way of stymieing the spread of COVID-19.

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37 comments

  1. Barbara

    About the second question – why people reject the app? The older you are, the more likely you are going to remember real privacy.

    I’m 81. I have a cell phone. I never take it with me when I leave the house. The only reason I use it is to keep in touch with the woman who runs the doggie play group my dog goes to. And as I’m hearing impaired, I only use the text app.

    Anybody spies on my phone, they’re likely to see things like “she looooves the puppy”. Good luck to them

    Reply
    1. Jerri-Lynn Scofield Post author

      An excellent point and one I intended to make but then forgot to! Thanks for raising it.

      Reply
    2. Oh

      Google and your phone service provider knows who you are, where you go, who you meet, when you meet someone, etc, etc. The minute you get a cell phone, your privacy goes out the window.

      Now, I wonder why they need a contact tracing app? Just get the info from Google!

      BTW, I wonder what the airlines in India would do if you didn’t have a cell phone?

      Reply
      1. Jerri-Lynn Scofield Post author

        Not let you board the ‘plane. One never wants to get in the way of an Indian official and a hard-and-fast rule.

        Reply
      2. Yves Smith

        Sorry, this is simply not correct. You assume a smart phone that is glued to your hip. You can have a dumb phone, a burner smart phone or two, use a Faraday bag, or leave your phone at home as your default.

        Reply
    3. Sue inSoCal

      Thanks Barbara. Such a great idea. I’m also older, remember privacy, as well as rights given up in the name of the PATRIOT Act.

      As Oh (below) also pointed out, if one has a smart phone, google analytics runs the show. I wouldn’t see the need for a separate app, either. Lots of good comments on this issue.

      Reply
    1. ObjectiveFunction

      Yes, some of our expat friends are in a lather about this.

      But Singapore has never denied that it places limits on even nonpublic behavior, to enforce hygiene (“good cough manners”) and social harmony in a multiethnic city state. You must always assume cameras are watching you in public places. Creepy? A bit, but otoh I have a teenage daughter and love the fact she and her mates can wander about on their own in complete safety.

      In practice though, you need to try really hard to get fined, caned or deported here. I am skeptical that the authorities see value in ‘social credit scoring’ a la PRC, or denying people services or opportunities, especially over minor ‘social offenses’. It’s a hassle, and bad for the stats, to prosecute every jaywalk even if feasible. And of course there are all those 24 hour massage parlors. What’s all this then?

      Reply
  2. Henry

    Judging by how Americans voted in the primaries even after all the massive economic upheaval they have seen for decades, I really don’t trust that survey.

    Reply
  3. Generalfeldmarschall von Hindenburg

    This whole affair jusr proves the Disaster Capitalism thesis. Any Big Event must be milked by big players for all the money but more than that, increased centralization of political power in the hands of said big players. People are figuring out a dangerous virus is being used as a grift platform and Twitter is suddenly full of people stanning for Bill Gates, that cuddly wunderkind- who just wants to help.
    I’m not 55 yet but I have a teenage kid who’d rather not live in an Orwellian Anthill.

    Reply
  4. oliverks

    I agree with the article that contact tracing apps are not a cure all, but I do think they could be useful.

    I spent some time trying to convince people to adopt an open standard for contact tracing apps that would allow for privacy. In fact you could even be a “lurker” and never transmit information, although you lose value by doing that.

    I have link here for the draft of the spec
    https://sourceforge.net/projects/open-source-contact-tracing/

    However, trying to convince people that this was a good idea has not gotten me very far.

    Some of the methods proposed are not very privacy protecting, and I wouldn’t feel comfortable using them.

    Reply
  5. Ignacio

    Bacause apps solve everything! Magically! Come on, if you are using an app for contract tracing you will end disturbing a lot of people for no good reason except that sometime, according to some points in a map in a screenshot, they seemed to be close to some infected person. An app is not a reliable source for contact tracing for several reasons, but some want to believe that apps are all powerful.

    Reply
    1. oliverks

      There are other problems with using maps. Namely they don’t work well inside building, which is actually the high risk area for contracting corona virus.

      They are also somewhat privacy destroying.

      Reply
  6. Chris

    International comparisons are woefully lacking in the United States. The experience of success stories ought to be discussed on local news every night, rather than thinking the US is unique in how it’s being hit

    Reply
    1. Janie

      Yes. Short answer to headline question: because we’ve number one in any category you can think of and can learn nothing from any other country anywhere ever.

      Reply
    2. Jerri-Lynn Scofield Post author

      I agree – which is one reason why I keep posting on the Hong Kong case. And now thanks to a comment below, I know a bit more about factors behind Medellin’s success, and will certainly research that case further.

      Reply
  7. PlutoniumKun

    A point about the successful use of contact apps in South Korea – it appears that the South Koreans overlay mobile phone information with multiple other sources of information such as credit card use, travel card use, and electronic street monitoring – although a democracy South Korea has quite a long history of quite intensive personal surveillance. I would guess that because of the countries history the citizenry there would appear to be much more tolerant of very invasive technology, even more so than we are used to from our Apple/Google overlords.

    Reply
    1. MLTPB

      Hukou in China.

      Hoju in S Korea until 2008…the country’s history.

      Ho Khau in Vietnam.

      Huji in Taiwan.

      All household register systems, in countries previously in China’s thousand year old sphere of influence.

      In contrast, people are more mobile and free to move about here.

      Does it have any impact on how people there tolerate invasion of privacy, vs how Americans feel?

      Does it make it easier to contact trace there?

      Reply
      1. PlutoniumKun

        I think you are right that there is a culture in those countries of monitoring and tracking for other reasons, which has made people more relaxed about the types of controls necessary. I could see, for example, having to scan a bar code before being let into a bar or restaurant being resisted strongly in many western countries, despite the reality that most of us are carrying powerful tracking machines with us all the time.

        Reply
    1. Jerri-Lynn Scofield Post author

      Thanks for drawing the Medellin case to my attention. I know a bit more about what’s happening in Asia, but comments always bring up aspects the author may not have considered before.

      I think it’s important to understand that the contact tracing aspect of the app is only one element of the city’s overall policy. From the source you cite:

      Quintero [the city’s mayor] said he knew that in order for many residents to quarantine, they’d need food and cash. Using his tech background, he led the city in launching Medellin Me Cuida (Medellin Takes Care of Me), an app offering aid to those who signed up and requested help.

      The response has been enormous: 1.3 million families – some 3.25 million people in total – from Medellin and surrounding areas registered.

      The aid was key for Maritza Alvarez, who lives with six elderly relatives, two of whom are street vendors. Since signing up, she said they’ve gotten packages of food three times and two cash transfers. That has allowed them to mostly stay indoors instead of going out to earn money and buy food.

      As the WaPo article makes clear, the app told city officials which residents requested aid, and then cash and food deliveries let these people stay home. They weren’t necessarily tested and may never have contracted the disease. The aid is crucial, not that people request it via an app.

      Now, as to the role the app plays in selecting who gets tested and traced, that’s less clear. I mean whether it’s part of many determinants, or the main identifier. I think it’s probably the determinant, but perhaps not the only one. Again, per your source:

      In Medellin, medical workers test anyone suspected of having COVID-19 at their home. Those who test positive are given a free oximeter. If their blood oxygen levels dip, nurses bring oxygen to their homes. Those who don’t improve are taken to the hospital.

      The app has proven key in quickly tracking down those who may have had contact with someone who tests positive. Medellin does about 40 coronavirus tests for each case diagnosed, a number over double the nationwide average, officials said.

      Though Medellin’s per million testing rate is low, several epidemiologists said they believe the city’s more targeted testing is proving effective. Colombian scientists estimate that for each COVID-19 death there are at least 100 more cases. That means in Medellin, which has had four deaths, there should be at least 400 infected people. The city has currently identified about 300 cases on top of that amount.

      Bogota, by contrast, has reported at least 339 coronavirus deaths but has only detected around 14,500 cases, suggesting that despite more testing per million people, they still haven’t found many of the existing cases.

      So, Medellin’s success seems due to the food and cash assistance that lets people stay home, in-home testing at twice the national average testing rate, and medical care, as well as the contact tacing aspect of the app.

      I suppose if you’re going to provide aid and medical care, and test people you suspect of having the disease, contact tracing using an app is one method to try to identify who to test. Just as long as it’s not the only one. PlutoniumKun tells us above that South Korea uses a contact tracing app as one of several means to trace contacts.

      But we should certainly be mindful of what Ignacio says as part of a longer comment above: ‘An app is not a reliable source for contact tracing for several reasons, but some want to believe that apps are all powerful.’

      Which is my point: they are not a COVID-19 slaying panacea. So we should realize that, especially when we consider the privacy they require us to surrender.

      Reply
  8. Falling hickory

    The elderly who don’t want the app cite four reasons that boil down to two: 1) no trust in the app providers, and 2) don’t believe it’ll help. (2) Influences (1) – why would people who stand to profit (tech companies and others) and gain new privacy-intruding insights offer something unproven and expensive-to-produce when other countries have shown cheaper ways work well? This further diminishes trust.

    This article only addresses the utility issue, not trust, and I think trust is more important in that it has to be addresses before discussing utility. Even if Hong Kong had developed and used an app and found it very useful, I still wouldn’t use one – I don’t trust these self-serving tech-purveyors not to profit and gain in power and invade my privacy in subtle new ways. I don’t trust the political-corporate class not to turn them into epic spying vectors. I don’t know all the ways they can steal infoemarion and what Innocuous dots they can connect to learn deeply personal things, so I rely on well-informed intuition: don’t trust serial, extremely well compensated surveillance merchants to spontaneously change form.

    Reply
    1. Yves Smith

      You are showing your prejudice. 70% of Americans would not use a contact tracing app. This has nothing to do with age and a lot to do with privacy concerns.

      Reply
      1. Falling Hickory

        I don’t understand what bias you’re referring to. I mentioned elderly because of this line in the article: “ Interestingly, those most at risk appear to be most skeptical:

        Most of the resistance to downloading a contact-tracing app came from people over the age of 55.”

        My point was that privacy / trust concerns were paramount for me and I suspect many people, since we must have trust in app producers to make something of any utility to us. I don’t see where you and I disagree.

        Reply
    2. Jerri-Lynn Scofield Post author

      The article is one of several- 5? many at least – I have written about what you call the utility issue, inspired by my discussions with an old friend who is a HK-based doctor (and whose wedding I attended in that city in January). Check them out if you haven’t already.

      And at the moment, I respectfully disagree .The answer to the question of why HK, a city of 7.5 million, which makes it slightly smaller than NYC, has only seen 4 deaths, and 1100 cases, compared to NYC’s stratospheric numbers, is crucial. What is it? Well, read my previous posts for a fuller answer. Short version comes down to: masks; test and trace; competent public health authorities; good medical care; and border controls.

      It sure as hell isn’t apps, or technofixes. Nor any authoritarian response as I understand has occurred \in parts of mainland China.

      We need to understand why HK’s performance has been so much better, so as to replicate what we can, and save lives.

      I agree trust is important, but let me get to that issue later. Understanding apps aren’t a panacea means they’re not a necessary condition of an effective response to COVID-19. If that fact we’re widely known, we’d be better able to resist the siren calls of Big Tech for widespread use of apps.

      Reply
      1. MLTPB

        I wonder how previous encounters recently with similar contagious diseases impact keys to better performance..keys such as masks, competent public health authorities.

        Will mask wearing be sooner or more widespread the next time?

        Will public health authorities do better?

        Reply
        1. Jerri-Lynn Scofield Post author

          Part of the reason for HK’s success is their recent experience with SARS. People remember that disease, from which far more died in Hong Kong than have succumbed to COVID-19 so far. Public health authorities and public alike were from the get-go eager to avoid a similar result with this new disease.

          Reply
        2. PlutoniumKun

          I think there is a very close correlation between countries that have had experiences with SARS and bird flu and a rapid and effective response. Vietnam is a very good example. They have had an exemplary response – effective, without completely shutting down the country.

          Reply
      2. Falling Hickory

        I have read and appreciated your reporting. You offer insights I don’t get elsewhere. Thank you for that.

        I value the discussion of what has actually worked in other places. I don’t mean to diminish that. And still, I must evaluate any suggestion in the social context I live in: I have very low trust in the institutions that would implement any response. I don’t trust them not to use the virus as a cover story to find new means to rip me or the public off, or establish a new norm that involves lower privacy. When has a good looting opportunity been passed up?

        I consider the us corporate state a bigger threat than the Chinese or the Russians or the virus. I don’t trust the companies or the state to act in the public welfare, except incidentally in protecting the privilege of the rich. That’s the simple reason I’ll never use the app, regardless of any theoretical benefits. And obviously, we both agree the app isn’t needed on utilitarian grounds as well.

        Reply
        1. Jerri-Lynn Scofield Post author

          I share your concern. Big Tech tells us we need an app, even though that’s neither necessary nor the the best way to do contact tracing and carries with it privacy consequences.

          And don’t get me started on big Pharma and the vaccine situation, or its bias towards costly new proprietary treatments.

          Reply
  9. H. Alexander Ivey

    A question about privacy rights. In a time of a public health crisis, like now, is your right to privacy about your location converted to a public right to know your location? What’s private in one situation becomes public in another. But perhaps many argue that once private, always private.

    Here in Singapore, the right to shop and enter buildings is now considered a public right by the government, so no, you have no private right about your being in a not where you live building.

    Reply
  10. Steven

    The most common argument I hear in any discussion of countries that have successfully controlled the pandemic is ‘the US is not a police state.’ So what about New Zealand? What were the components of its successful response?

    Reply
    1. Conal

      NZ had a very limited capacity for testing and tracing, so they went (early!) to a 7 week nationwide lockdown that only gradually became less stringent, and was then wound up when health authorities decided they had completely eliminated the virus.

      Regarding contact-tracing apps, there were no location-based or bluetooth-based apps in use, but the government did produce an app called NZ COVID Tracer, with which NZ residents could maintain a “diary” of their locations by scanning QR codes which where posted at the entrances of businesses.

      Reply

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