As most of America approaches the one-month mark since shelter-in-place orders began, there is increasing talk of “plateauing” and debate of strategies for resuming “normal” life. Unfortunately, we continue to find ourselves without a clear path out of this unprecedented pandemic. Now more than ever, in the setting of an infectious disease crisis, health care providers must be at the forefront to advocate for those most at risk of a premature/unsafe return to normality and to pursue a safe way back for all of us. A sense of independence and rugged self-determination has always defined the American psyche, and yet, when confronted with this crisis, we complied with these social distancing measures, valuing our neighbors’ lives over our own freedoms. But this precarious balance may be tipping as the number of unemployed rises, children and young adults unable to socialize with their friends grow more frustrated, and the general stresses of being confined to our homes accumulate. Technology may be one tool to hasten our recovery while still actively monitoring and tracking disease. Smartphones are used by 80 percent of the U.S. population and have built-in GPS and Bluetooth capabilities. Other democracies such as Taiwan and South Korea, have already used smartphone-based tracking capabilities with good success to monitor citizens on home quarantine as well as to identify potential contacts. Google and Apple have recently announced a collaboration to use Bluetooth Low Energy (Bluetooth LE) from our smartphones to enhance contact tracing abilities of public health authorities. The interesting part of this project is that Bluetooth LE could allow our phones to perform digital contact tracing during our everyday activities. Bluetooth LE is a personal area network technology that allows smartphones to communicate with other “smart” devices in the vicinity, mostly without us even being aware. The Google/Apple project aims to utilize those communication records to identify what other devices (and their attached people) you have come into contact with. Take the example of Doug and Stacy. These two strangers sit down at opposite ends of a park bench to feed the pigeons and have a nice chat. Several days later, Doug begins to cough and is found to have COVID-19. Doug cannot remember the name of the nice lady who he chatted within the park, but the public health authorities use a program to access a list of the devices his smartphone has come into contact with using Bluetooth LE logs and notifies their owners, including Stacy. But of course, these capabilities do not come without potential risks. We see headlines of authoritarian governments using similar tracking technologies like facial recognition to track down dissidents. And we know that invasions of privacy happen in democracies just as well (see Edward Snowden and Cambridge Analytica). However, during this pandemic, we can clearly define beforehand what data will be shared, how it will be shared, and for how long the system will be in place. Physicians already know how to advocate for health interventions that infringe on personal freedom. When hearing about the measles outbreaks last year, what physician argued against mandatory vaccines for school participation? When treating active TB in the hospital, what physician would lightly discharge the patient without notifying the public health department and ensuring a plan for continued monitoring of that patient? Why wouldn’t we give up our privacy for a short amount of time in order to save lives? Samuel Yang is a hospitalist. Jennifer Lee is a pediatric gastroenterologist. Juan Chaparro is an infectious disease physician. Source
