By Vamshi Lingampally, Venture Partner at Corniche Growth Advisors

How effective can technology be in slowing the spread of the Coronavirus pandemic globally? We review the multiple technology solutions rolled out by countries for quarantine monitoring and tracing, and try to understand which model can be adopted at scale for effective outcomes, in the light of the recent announcement by Apple and Google.

As we write, countries are either reopening or identifying best approaches for rebooting parts of their economy; this means, our discussions have turned to the capabilities required for the next stage and what role technology should play.

First, let’s understand – offered by the scientific and public health officials – four benchmarks constantly reviewed by healthcare officials for reopening our economies.

1. Hospital bed supply should match infectious patients’ demand
2. Testing processes in place to test everyone who needs testing
3. Ability to monitor confirmed cases & trace the contacts of the people they may have exposed (digital or analogue)
4. Daily drop in confirmed cases every day for 14 days

Technology companies are asked to play a role in monitoring and tracing as governments relax the lockdown restrictions.

Quarantine enforcement

 Taiwan has won global praise for containing the spread of Coronavirus. Taiwan rolled out a mobile phone-based “electronic fence” that uses location tracking to ensure people who are quarantined stay in their homes. The tool monitors phone signals to alert police and local officials if those in home quarantine move away from their address or turn off their phones; authorities will contact or visit those who trigger an alert within 15 minutes.

Technology behind the electronic fence app is developed in collaboration with telecommunication companies to track citizens’ phones. Although very effective, it is very invasive and not clear how such a solution can be implemented elsewhere without new legislation giving telecommunication companies’ explicit permission to share location data.

Technology is necessary but not adequate for enforcing quarantine. We also need processes to house quarantined people, ability to call patients to check in when they are on the move, leave their phones at home, and various other spot checks as required. A less invasive, passive quarantine tool, and building capacity for manual intervention could be an effective model for wider adoption.

Contact tracing

 The most challenging part is contact tracing. Contacting people, who have been exposed to infected patients, has been the most important means to contain the spread of any infectious decease. Even missing one contact can lead to continued spread and hence a robust toolkit for tracing is crucial for highly infectious diseases such as COVID-19. We see a plethora of tracing applications around the world, but it is unclear how effective these apps are. Let’s review how both intrusive and passive tools played out in few countries.

Broadcast & Intrusive

South Korea, a democracy, has arguably been more successful than any other in containing the first wave of Coronavirus spread. Through satellite-based phone tracking, any person with smart phone in the country will receive location based emergency alerts when they are near a location where active cases have been found – people get messages automatically and cannot opt-out.

The contact tracing apps use several sources, such as GPS location data, CCTV, credit card records to monitor citizen’s activity. When someone tests positive, local authorities can broadcast an alert, which reportedly includes individual’s sex, age, district of residence, credit-card history, with granular details of their comings and goings from local businesses. Although the names are kept anonymous, the amount of information in South Korea’s tracing alerts could ultimately reveal a patient’s identity. Koreas’ digital broadcast platform compromises citizens’ privacy and safety, and authorities in other democracies will challenge the approach.

 Targeted & Intrusive

 The effort in China has been bottom-up effort from local municipalities and technology companies to create local responses that consolidated into a national response. Personal health QR code has become central to digital platform for reporting worker’s health, enabling authorities to consent reopening of enterprises and movement of individuals. The QR code is scanned before admission into offices, train stations, public facilities, apartment complexes and grocery stores – green for admission, yellow for ordering people to quarantine for seven days, and red for ordering people to quarantine for 14 days.

The actual algorithm to decide which risk category one falls into is not clear, though it seems it is largely a combination of the information in the questionnaire, geo-tracking, travel bookings, how long someone has waited since getting the code, and the locations the code is later scanned in (along with the public health situation in those locations). Such targeted and intrusive model comes with problems of its own – with lack of transparency, some found their codes inexplicably change from green to red during the day, and others found themselves locked out of their apartment complex.

It is unlikely that we can implement personal Health QR code in the west, but we can look at the ways Chinese tech companies contributed in other ways – a plethora of tools to keep people healthy, well stocked, and at-ease during the crisis.

Targeted & Passive, with low adoption rates

 Unlike South Korea, Singapore – like many countries – took a passive and targeted approach. It’s TraceTogether app uses mobile phones’ Bluetooth signals to passively track the proximity between individuals and inform potential contacts if someone gets infected. It is not mandatory to download the app and the solution relies on infected people informing the Ministry of Health, when tested positive. Although TraceTogether is close to a solution that West could build on (Singapore is making the app available as open-source project), still many privacy issues need to be addressed. Due to voluntary nature, the adoption rate is only 12%, which makes the solution less effective.

Germany is tweaking the Singaporean solution for EU privacy models. As the Singapore solution requires registration with mobile number, and when tested positive the authorities can easily match the app ID to the patient and can impose direct measures. To encrypt the information from both government and tech companies operating the solution, German approach is for the mobile phones to broadcast a new ID over Bluetooth every 30 minutes. If tested positive, healthcare professional would ask the patient to upload their app data and an algorithm would match temporary IDs to a push token, a unique code that connects each phone to the app.

German and various other passive tracking solutions can potentially have robust privacy models and guardrails for data protection; but success of such solutions relies on mass adoption and public trust to share their test status.

Apple & Google’s API – Could this break the adoption barrier for passive tracking?

 A highly unusual collaboration of technology giants Apple and Google’s API could potentially solve barrier to downloading an app. As the API solution is embedded at the OS level, just by upgrading the OS – and opting in – the mobile phones will begin sending out Bluetooth signals to nearby phones, and recording signals sent it by other phones. Apple and Google say that they will be able to reach most active mobile devices in the world.

The alerts will be routed through public health agencies to minimize system abuse. For example, Britain’s NHSx is collaborating with these two tech companies to develop tracing app; instead of people triggering alerts. Initial reports also state that a person will be alerted about exposure even without downloading partnered public health app.

By creating a central API across our two major smartphone operating systems, Apple and Google are providing a valuable tool for public health agencies working on contact tracing apps that will work across jurisdictions around the world, even as people begin to resume travel.

What we know so far gives us confidence that the API system is designed to maximize individual privacy. The app does not collect location data and only records proximity of mobile phone, and changes the ID every 15-30 minutes. Having said that, policy makers might want to have guardrails in place for targeted ads and discontinuing the system when appropriate.

The big unknown is if the API will address Bluetooth proximity issues, thereby generating more “noise than signal”! Let’s see.

Maybe a hybrid approach can be effective

 Considering the information we know, Apple & Google’s API can help develop a coherent global solution with higher adoptions, as we urgently need tools that will identify contacts fast and work across borders.

Let’s also consider if relying solely on technology for contact tracing is the best approach? Historically, public health agencies have long used human resources – both on the foot and on telephone – to effectively track people who may have been exposed to an infected patient. But some researchers argue that COVID-19 spreads too easily (unlike SARS) to make manual tracing alone a feasible solution, and technology solutions are required for such time sensitive tracking.

While technology companies develop and deploy passive and automated solutions, governments could look at engaging furloughed gig economy workers to carry on with proven public health agencies manual tracking methods. Increased capacity for manual tracing, along with passive tech tools, will be most effective if coordinated with health care providers, health systems, and supported by timely electronic data sharing.