Much has been made of the use of “contact tracing” to document and inform people who have been in close contact with someone who tested positive for the novel coronavirus. Close contact is defined as a close, physical or proximate and sustained contact with a person for 15 minutes or more. And this definition in itself is problematic because the virus doesn’t always abide by exact distances and wrist watches. But for now those will be the metrics used to attempt to locate, talk with and encourage these “contacts” to get tested themselves, (and then the contacts of these contacts, etc.). But this is far, far more problematic and herculean than it seems.
Contact tracing is nothing new. In an outbreak of plague in San Francisco at the turn of the twentieth century after a hunter ate an infected squirrel, most of the contact tracing was done my pencil drawn trees or contact clusters I notebooks, rudimentary flow charts if you will, but today we have vastly more technology at our disposal. So where we should we draw the line on the first ethical problem: precisely how to contact trace, and what method to use?
Some public health experts claim that since one’s health and social relations and networks are so personal only a live, compassionate, empathetic health care worker (much like a social worker) should be allowed to interview the coronavirus patient, establish trust and then inform them on the importance of giving then full names and addresses of all their contacts leading up and during their illness. But just think of the gargantuan task this is! To me there are a few issues here. Will a cheating spouse give up the name of a lover? Is it worth the trouble to his marriage? Will the promiscuous teenager want to reveal all his Tinder hookups? What if they amount to say, sexual relations with ten people in the span of just a few days? What if some of those hook ups are with people of the same sex, or even criminal in nature, say, with someone underage? Is it worth it to potentially go to jail to reveal this information? And what if the lover is an undocumented immigrant? Is it worth it to risk having them sent to jail and/or deported? Thus, to me, a solution would be an absolute curtain and separation between the information gained for public health and other uses like immigration, customs or law enforcement. People must absolute faith that the people they “give up” to be “traced” won’t be harassed or targeted by other agencies for other purposes. Keep in mind, there are many multi-generational households – especially in larger cities –and many people live with undocumented relatives or ones who overstayed their visas. And don’t forget the housekeeper or babysitter they pay less than minimum wage.
The next issues is that the infected patient really does have to genuinely care about the health and wellbeing of all his contacts. Maybe the patient does care about the undocumented aunt but not the landscaper she discussed the latest pool project with. Maybe she cares about some lovers and not others. But this is not how contract tracing works: the idea is not so much to save the life of the contact, but to see what other neighborhoods and environments have been exposed. So even one intentional omission is dangerous.
Let’s assume in my hypothetical that the patient identifies her undocumented aunt because she loves her as a contact but does not identify the housekeeper because in so many ways he is replaceable. But the aunt is in the same social group where the pool boy may live in a congested housing project in a different city! This omission would be costly from a public health perspective because the omitted contact has now spread the virus to a new setting and seeded it there. But human beings are not predictable: the opposite may also be true. The patient may do the moral calculus and conclude that she should do the opposite: hide the identity of her aunt and reveal the identity of the housekeeper. Hard to know: not everyone reacts the same. Maybe the undocumented aunt is a nuisance and she really does love her pool boy more than we know.
Then of course there is the fallibility of human memory. To illustrate this, think of the infamous scene in the movie “Twelve Angry Men” where to prove the limits of the human memory, one juror asks another what he did the day before. The juror has no trouble answering. What about the day before that? Still relatively no trouble. But what about the day before the day before yesterday? Now it’s a struggle. By the fourth of fifth day, the mind has drawn a blank and starts to actually misremember. (The juror in question being questions actually misremembers going to a movie.) Now, think on this: all this man was asked to do was retrace his activities a few days in the past. But with the diagnosis of coronavirus, if can take up to weeks for infection to manifest, and then a few more to worsen, and then a few more days to seek medical care and testing, and then time for results to come back. By then, you are asking the person to recreate his steps over one month ago, whom he talked to, where and when. No human can do so. Memory doesn’t work like that. So how can we aid memory?
Well, many of what we do and where we go is recorded digitally in our credit cards or by Apple Pay. Just looking at a bank statement I can relive the last few months of my life: what store or café I went to, where I ate, etc. To augment my movements I can look at my Uber, Lyft or Didi movements too. “Oh right! I forgot I tool a Didi to pick up that birthday cake!” But now, you are giving either the government access to very intimate details of your life.
This then leads to yet another issue: should the public health and thus the government do the contact tracing, or should a private company? There are pros and cons to both, but the cons seem to be that the data will be used for ends other than tracing the coronavirus as data is one of the most valuable commodities. A solution to this then would be to place a time limit on the storage of such data and then perhaps a mandatory erasure of it all. But will it really be erased? Won’t some aspiring researcher want access to this data so she can perhaps write a report documenting how people changed their mobility and transportation use during a pandemic? Why not study that? And all of this is predicated on the patient allowing whichever the inquisitor access to his bank account or Didi locations. Many simply will not. Therefore…
The most extreme but efficient way to contact trace is to simply go back and look at where the cell phone was and whose cell phone in came in proximity to. There is a macro way to do this and a micro way. In the macro way, the government can look at which cell tower my phone’s signal was talking to and monitor when the tower changed. In other words, if my cell phone is continuously and habitually sending a signal to the cell phone tower on top of East Rock Park, and suddenly it stops talking to it and begins talking to another tower on top of West Rock, presumably I have moved. (This of course is premised on the assumption that phones are a) almost always powered on and b) very physically near the person which is probably true in 99% of cases.) The micro level is more precise: it can locate where exactly you were, down to a location or an address, just like Uber does to come get you. Nowadays, each phone sends a unique handshake and companies can simply track our movements like Pokemon go. But then that is literal surveillance of Americans. And if that can be done retrospectively, it can be done in real time, too. If an contact tracer can tell where you were last week moment by moment, he can also keep at tabs on you know, and then, if you violate a stay at home mandate, send you a text – “hey, we know you left the house buddy, go back inside!”
Any aspiring entrepreneur would then look at this data of where you were in the past, and where you are in the present and know to use an algorithm to predict where you will go in the future. Thus, soon the future can be known with some degree of predictability? Is that the future we want?
Oh, I forgot to mention that all of downtown New Haven is actually on camera, so while the USA may be far behind China on facial recognition technology after 9/11 it is has steadily been beefing up the use of public cameras ostensibly for security, public safety and traffic. But soon the day will come when a computer can interpret the grainy face at the ATM not by race, sex, age and body type, but…me. Finally, the use of the word “tracing” is Orwellian to most Americans since to “trace” someone has a nefarious connotation. It is in so many ways invasive, so if I were in charge of the effort I might have thought about using the term “contact notification” or “contact informing” or even “warning” but “tracing” will scare off many people.
And now we are in a time of mass protests which might make all this irrelevant anyway.
So when reporters are asking so many government officials why contract tracing is taking so long, many American government leaders dodge the question and this tells me two things: it is already being done and in a way that the people would not approve of (say monitoring the phones of patients) or they are still arguing about the best most ethical method to do it. But is also may mean something else: that the cat is out of the bag with this virus, has been out of the bag for a long time, and there is somewhat of a futility now in trying to chase it back to “American patient zero” which is also a very ignorant and misleading way to think about a very infectious disease, and the subject of Part Two.
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