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Smartphone-based tracing of contacts and notifications may lead to suppression of pandemic if public buy-in is possible: Science magazine (a review below)

2020-04-03

(electron micrograph of sars-cov-2 budding from apoptotic cells by NIAID via Medscape.com)

A new article in Science magazine describes an instant digital contact tracing method that may be fast enough to control the spread of the novel coronavirus.  The problem with manual contact tracing is that it is too slow to keep up with a virus that may be asymptomatic and takes five days to jump from one person to the next.

A smartphone app is being used in China and South Korea and reduces the need for overall lockdowns that disrupt society by instantly notifying contacts of persons identified with infection.  It requires buy-in from the public and needs to be carefully implemented.  The article describes a number of requirements that will facilitate buy-in:

Requirements for the intervention to be ethical and capable of commanding the trust of the public are likely to comprise the following.

i. Oversight by an inclusive and transparent advisory board, which includes members of the public.

ii. The agreement and publication of ethical principles by which the intervention will be guided.

iii. Guarantees of equity of access and treatment.

iv. The use of a transparent and auditable algorithm.

v. Integrating evaluation and research in the intervention to inform the effective management of future major outbreaks.

vi. Careful oversight of and effective protections around the uses of data.

vii. The sharing of knowledge with other countries, especially low- and middle-income countries.

viii. Ensuring that the intervention involves the minimum imposition possible and that decisions in policy and practice are guided by three moral values: equal moral respect, fairness, and the importance of reducing suffering.

The success of this smartphone app requires the public to have confidence that it will work and that it does not unnecessarily compromise privacy.  This is a difficult ask, but it is being used in a democratic society, South Korea, and it is working.  One caveat for the United States is that there is not a “guarantee of equity of access and treatment” because there is no universal health insurance.  This one problem could be solved by Congress, if they legislated “free” treatment for virus infection.  This action would also save the hospitals from insolvency caused by interruption of their most important revenue stream, elective surgeries, and relief from the burden of uncompensated care for the crush of sick people with the viral infection.

There is a very real danger that many American hospital systems will be forced into bankruptcy by the loss of income from elective surgeries and a rush of virus-infected critical care patients.  This problem cannot be over-emphasized, and it will inevitably force us to face the need for universal health insurance in this country.

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