Transcriber: Eunice Tan Reviewer: Tanya Cushman
Good afternoon, good morning, good evening.
Welcome to the third installment
of TEDxMidAtlantic Coronavirus Conversations.
We hope you and your families, friends, and colleagues are healthy and safe.
I'm David Troy, host and co-curator of TEDxMidAtlantic in Washington, D.C.
Experts agree that getting our economy back online
is dependent on several conditions,
including widespread testing,
continued social controls,
and contact tracing.
Many countries have implemented smartphone applications
that can help detect exposure to known infected individuals,
but they often sacrifice privacy.
So how does contact tracing even work?
And is it possible to maintain a reasonable level of privacy?
So that's the topic we'll be addressing today.
And I'd like to start today by introducing our first guest, Dr. Lina Moses.
Lina is an epidemiologist and disease ecologist
at Tulane University in New Orleans.
Her primary interest
is the control of viral zoonoses transmitted from small mammals.
Moses utilizes methods from epidemiology and ecology
to understand the interface of human, animal, and pathogen.
And she has led contact-tracing teams
for Ebola, Lassa fever, and monkeypox outbreaks
and currently leads COVID-19 research response
for the Global Outbreak Alert and Response Network.
So, welcome, Lina.
Maybe you can give us some background on contact tracing -
what it is, why it works, and how it might help us get back on track.
Lina Moses: Hi, everyone.
Good ... day, I should say.
So I've got this going here.
I just wanted to give you some background on contact tracing -
what it is
and why it's so fundamental
to infectious disease public health response.
Basically, contact tracing is an incredibly simple concept.
And what it is is you need to find people infected with a specific pathogen.
And then you find everyone who might be infected by that person,
and you monitor them to determine whether or not they're also infected.
And if they do become infected -
through whatever measurement you decide -
then it loops back into the person that is infected,
and you need to find everyone
who might have been infected by that person.
So, pretty simple concept,
but it gets pretty complicated
when you put in a lot of different factors here.
We're talking about diagnostics and testing.
So, who do we consider infected?
Who do we consider diseased?
What kind of measures in terms of isolation and quarantine
do people receive?
And how do we coordinate and make sure that we have good data flow -
that the right people are informed of what's going on
and the wrong people are not?
And also how can we use this
to leverage and reach and promote health promotion and advocacy
to make sure that the people that are involved in this -
and that we're asking to make some personal sacrifices -
have full buy-in and believe in what we're doing?
So I'm going be specific
about contact tracing for COVID-19 right now
to give you an idea of what contact tracing is
and the kind of impact it could have.
So here you have a person, Case 1, who has been infected with the virus.
And based on most of the literature and findings here,
you've got an incubation period of between 12 to 14 days.
So "incubation period" is when a person has the virus replicating in them
but they're not showing any signs or symptoms.
After that, the person will develop illness
that can last between 1 and 20 days
or upwards of 20 days,
depending on what papers you're looking at here.
But the complication with COVID-19 is that there's an infectious period,
and that infectious period precedes when someone starts to develop symptoms,
or the onset.
And this is what makes things very complicated with contact tracing
but also in controlling the spread of this virus.
So during this infectious period,
you have people who are coming in contact
with someone who does have the virus in them,
and some of them will also get the virus.
So now we have Case 2 and 3 that contracted the virus from Case 1.
Those two individuals will also have an incubation period,
and depending on if they remain asymptomatic
or if they are pre-symptomatic,
eventually, they too will develop an infectious period
where they have the capacity to infect others.
And what contact tracing does
is it starts here with the case investigation -
identifying the person that has, by any definition,
either through diagnostic detection or through clinical signs and symptoms -
they are a case.
And then what you do
is you find out exactly who they have come in contact with
who could possibly be infected -
and that's these people here.
With COVID-19,
it's critical that our contact tracing also involves contact quarantine.
So, pulling these contacts out of the general population
so you can control this infectious period even before they develop symptoms.
So once you have that effectively done,
you can actually start to control and reduce that third wave of infections.
And that's why with COVID-19,
all of these different elements
are very essential parts of contact tracing.
So the only other things that I want to try to emphasize here
is contact tracing is a really vital part of a robust epidemic response.
Even when it's far from perfect,
even when we're missing a good chunk of the cases,
documenting contact tracing, collecting this data,
is really important to really understanding
the proportion of asymptomatic and presymptomatic cases.
We can also do things
like identify high-risk activities that increase risk of infection,
protective activities -
all of this data is captured when you're doing contact tracing.
But you can also get some good indicators on the scale of epidemics
by looking at the proportion of cases that were on contact-line lists,
so were known to the public health response,
versus the percentage that were not known.
That should give you an idea
of whether or not the public health response
is aware of the scope of the epidemic.
The last thing that I'd say is that for any infectious disease containment,
it really is a partnership
between the health system, communities, and public health.
And right now, the way we've rolled it out in the US in particular,
it's the health system and healthcare workers
that are really bearing the brunt of this
as well as communities that are bearing the brunt of this.
We're all remotely speaking right now from very distant places.
We're all hunkering down.
There are huge economic and personal costs to this.
So, really, we need to pull in the public health response,
and an essential part of that is contact tracing.
David Troy: Now we'll turn our attention to John Werner.
John is no stranger to the TEDx community -
he's the curator of both TEDxBeaconStreet and TEDxMIT in Boston -
and he's been a huge part of this COVID Safe Paths team at MIT.
So, please welcome John Werner.
John Werner: Great. And I'm just going to make a few remarks.
This city of Nashik - about a million people live in it.
And every 12 years,
30 million people converge on this city for a Hindu pilgrimage.
Professor Raskar, who I worked with for a number of years -
he grew up in Nashik,
and he remembered being locked down when the Kumbha Mela happened,
when all these people would come.
And he got the idea of
"Let's try to use digital information to help learn about a pop-up city."
He said, "The future of cities isn't infrastructure,
but it's understanding digital."
And we tried to figure out, you know, how we could use data to save lives
and learn from this pop-up event.
And when COVID happened, he said,
"You know, John, there are a lot of similarities to what's going on,
and we could apply some of this."
And he said, "Let's build a group that does solutions,
implements things globally, and provides support."
And we've slowly begun to do that.
And every morning for seven days a week,
we have about close to 50 people on a leadership call,
and we have, I think, now over a thousand volunteers with this effort.
And we're calling it Path Check.
And it's spun out of MIT, but it has a lot of implications.
And we want to work
with local government and public health authorities
as customers.
And one of the things to get this going -
I reached out to Greg Nadeau and said,
"Greg, you know, can you help build a nonprofit
to complement the vision of really taking advantage of this?"
And Greg has done an amazing job orchestrating a lot of talent.
And so I just wanted to give that as a little background,
and now I cede the rest of my time to Greg.
Greg Nadeau: So, I think, as Dr. Moses described,
there's a common understanding about this triangle of trace, test, and treat,
with quarantining being part of the treatment.
While the shoe-leather epidemiology has the personal touch,
it also is extremely time-consuming.
So this one Patient 31 in South Korea
famously had over a thousand follow-up interviews
to trace all the different people who had been in contact,
either directly or indirectly, with that patient.
So the idea that Ramesh brought -
using, specifically, smartphones to help with the contact tracing process -
is one where it's both extremely forward-looking,
it's also very practical.
So what we know from Singapore,
currently Bluetooth-based contact tracing -
where you have to both have a Bluetooth device that is whispering to each other,
and this is basically the foundation
of what the Google-Apple announcement was about -
while that has certain advantages,
the percentage of both having their phones on
with the right configuration
is one of diminishing returns.
So a purely automated solution,
while enticing in many ways,
really doesn't solve the problem.
So what we've been working on is a blended approach
that provides some immediate efficiencies for manual contact-tracing interviews
and then begins to layer in
first GPS and then Bluetooth and then encryption technology,
in a word, to make the automated process more efficient and scalable.
So the way that this will work -
and we have now over 25 jurisdictions inside the US
and over 35, mostly countries, internationally
that have approached us to ask for help,
and we're now developing pilots.
So the way that this will work in the initial phase
is that the first technology, Safe Places,
which is a browser-based,
running locally on the personal computer of the contact tracer,
and it's a mapping program that facilitates the interview process.
So the way this works
is that the contact tracer has Safe Places on their PC.
They then talk to the infected patient.
They then counsel them about how to download this app,
COVID Safe Paths.
The COVID Safe Paths app
then will go through the location history from Google Maps
and parse it into these five-minute snapshots
and then, with a secure transmission, upload it into the contact tracer's PC.
Nothing's going to a server.
It's going directly from the phone of the infected patient
to the PC of the contact tracer, the public health official.
That person then conducts the interview,
and so we expect that it would look more like,
okay, you know, sorry that you're infected,
and we want to make sure that other people in your life are safe.
So let's look now at where you were, in a sort of slider.
So you go, okay, day one of that period, I see that you were in your home.
Have you contacted everyone in your home?
Okay. Then you went to this other location.
Where's that? Okay, that's your friend's house?
We need to contact your friend.
Okay, then you went to Starbucks.
Now, we have no idea who was at Starbucks.
And then you went to the supermarket.
We have even less idea who was at the supermarket.
We have no practical way of contacting those people, right?
So the contact tracer would use the Safe Places tool
to manually delete the home and the friend's house
and retain only the anonymized public spaces,
where no follow-up could practically happen.
So now the contact tracers will accumulate these data sets of anonymized data
and then can post them -
the public health authority posts them -
as an anonymized, aggregated data set
that now uninfected people can download onto their phone.
And without any of their location history ever leaving their phone,
it says whether there's been a proximity.
So that's kind of the version one that we're piloting now across the globe.
The intention is to then use encryption technology,
perhaps distributed ledger,
to bring the same level of privacy and security
without the necessity of the manual contact-tracer anonymization.
David Troy: Awesome. Thanks so much, Greg.
I think one of the challenges that people have
with hearing about this technology
is we've heard so much about the abuse of data
and about privacy abuses.
People are confused about, you know,
what they might be giving up in terms of privacy and whatnot.
And, you know, I think that part of the problem
is we've got to become better storytellers
about what exactly is going on with this stuff
and what different technologies are being deployed,
what is possible to learn about people from these kinds of applications.
So I wanted to get some more clarification
on some of the privacy aspects
from Paul-Olivier Dehaye.
Paul-Olivier is a mathematician and privacy advocate
based in Geneva, Switzerland.
And he's the founder of PersonalData.IO,
which is a Geneva-based nonprofit
promoting digital rights in the field of data protection.
I wanted to, you know, get your insights, Paul,
on kind of what you're seeing in terms of the different protocols.
I know you've been looking hard at the Google-Apple protocol
and what the strengths and weaknesses are.
But tell us more about how you feel that these approaches can work
and their strengths and weaknesses.
Paul-Olivier Dehaye: Hi.
What helps is to go beyond just thinking about privacy in the classical sense,
in the sense of "I've stuff I would like to hide,"
but more in the sense of
"There is information about me.
This is power over me.
Who do I share it with?
And how do I share it?"
This is the most pressing issue, I suspect, for many people.
But the promise of those apps
is that through those apps,
we would be able to more quickly get out of the situation we're in right now,
which is a situation
where we've lost some of our freedoms that we usually enjoy:
freedom of movement, freedom of assembly,
and all of those ideas.
The paradox is that in order to regain those freedoms,
it might help us to install an app,
and that app would mean ceding power to someone else over our own lives,
over our own freedoms.
Because, as Lina just said,
part of the principle in those apps
is that whoever gets detected will eventually get quarantined.
Or that's the public health objective -
that if you're found out to be infected, you would be quarantined.
So this is a bit paradoxical in those apps,
but at the same time, it could be a collective beneficial effect.
There are definitely serious privacy implications
of opening up too much the protocol.
I don't need to be told this -
again, through my involvement in Cambridge Analytica,
I understand very much the risk of propagating too far the social graph.
That is definitely a worry.
But one of the core questions on my mind right now is -
and it changes every day -
is should it be Google and Apple making those decisions
or should it be instead France, for instance,
trying to search our way out?
And again, this is serious.
There are serious issues of power of the government
over the entire social graph of people,
of interactions of people.
And it could get even worse
because the conversation is shifting in Italy
in trying to find out mandatory ways to track people,
to move beyond just the consent that was assumed, I guess,
in all the discussions so far,
and to move into forcibly imposing tracking of citizens.
But we have to recognize
that this might be a necessity in this context - it might be.
I'm a privacy advocate,
but states do have some rights over people.
And it might not be legitimate
for tech giants to decide on how people can assemble through Bluetooth
or how decisions should be made
on how people can assemble through Bluetooth.
In Europe,
power over health, over public health matters
are in the nations.
In the US, it would be in the states.
So it's in the countries.
But individuals have the right to cross borders -
in normal times.
So to me, what seems the most natural place to start
is the individual.
So when I hear Greg say
that this would be data collected around the individual on the device,
that sounds great.
The problem, unfortunately, in the model that Greg presented -
but it makes sense in most places -
is that it starts with a state, a health authority.
So this is a right that individuals would have -
to take ownership over their health.
But there is a structuring agent here that is very unfortunate.
There is the fact that the platforms have decided
to gatekeep access to the app store
by country.
So in order to authorize an app in the app store,
you can't just have an emerging ecosystem of civil society building something.
It has to be approved by the health authority of the country.
So this is, again, a gatekeeper.
I understand why it exists;
it's very legitimate that such a gatekeeper exists.
But there needs to be more options rooted in basic human rights.
David Troy: Awesome.
We want to thank Paul, Greg, Lina, and John -
all for being here today.
And thank you to all of you who have tuned in on Zoom,
and again, we'll post this on our website.
And thank you.
We will see you next time.