PROVIDENCE, R.I. (WPRI) – As the COVID-19 shutdown continues to drag on with no end in sight, Rhode Island is examining whether to implement some controversial tracking measures that officials say could help reopen the economy faster.
The state to date has focused on boosting testing capacity, which is a key first step in identifying where COVID-19 is most affecting Rhode Islanders.
With greater testing now underway, public health officials will likely start shifting more focus to containment strategies — isolating the sick and tracking down their contacts, or “contact tracing” — that have proven successful in other parts of the world.
“To reopen the economy, we need more testing and better contact tracing,” Democratic Gov. Gina Raimondo said Sunday.
To get there, however, the state will need to build a large database of personal information about Rhode Islanders and their contacts, which has already proven to be a controversial idea.
The state started contact tracing after the first confirmed COVID-19 case, announced publicly March 1, but really ramped up efforts when Raimondo ordered the R.I. National Guard and R.I. State Police to seek out New York travelers coming into the state at the border and in seaside communities. Raimondo later expanded the order to include all travelers coming into the state.
The governor has recently started asking Rhode Islanders to help with the effort, urging everyone to write down the places they go each day and the names of people who they come into contact with.
“This isn’t for some people,” Raimondo said on Tuesday. “This is every single person in Rhode Island writing it down every single day.”
If a person gets sick, they are expected to give those records to the R.I. Health Department, so public health officials can track down others who might have also been exposed to the disease. Raimondo on Tuesday said this is so important that she’s considering turning people away from getting a test if they don’t bring their daily log with them to the testing site.
“I need you to be serious about this,” Raimondo said.
‘Go on offense against the virus’
The strategy of contact tracing stems from the idea that comprehensive tracking efforts will allow the state to monitor how the illness spreads.
Knowing who is sick and who they contacted will help give public health officials the data necessary to quickly identify where a flare up is happening in the future – allowing them to quickly stamp it out by putting sick people into isolation and their contacts into quarantine.
The University of Washington projects Rhode Island is still a few weeks away from the peak of the pandemic locally, forcing public health officials to stay in response mode for a while.
But once new cases and hospitalizations begin to decline, Rhode Island will likely need a containment strategy that makes it possible to reopen parts of the economy until a vaccination is discovered and approved — which could still take more than a year, according to public health experts at Brown University.
Raimondo last week said she’s already formed a technology team to look at different ways to leverage existing technology to do better contact tracing and symptom tracking. But specific details are scant.
“We are attempting to weave together different off-the-shelf technology,” Raimondo said on April 1.
Massachusetts Gov. Charlie Baker last week announced his plan to hire roughly 1,000 people to focus entirely on contact tracing. The effort was made possible through a partnership with the global nonprofit Partners In Health.
Baker’s initiative will use private companies including Salesforce and Accenture to help with the technical side of the effort. Raimondo last week mentioned Salesforce — a California cloud-based software technology company — could also be part of the Rhode Island strategy moving forward.
Dr. Jim Kim, Partners In Health co-founder and former president of the World Bank Group, is working on the initiative in Massachusetts. He has consistently advocated for a more aggressive public health response to the pandemic, saying the United States should learn from the successes of other countries where new cases are now dwindling.
“This expansion of a network of contact tracers, social support providers and public health professionals will be massive,” Kim said in a statement about the Massachusetts effort. “But data and experience from countries that have been successful in bending the COVID-19 curve downward have shown us that we have no choice. It’s time to go on offense against the virus.”
Privacy concerns and mobile tracking
With any large-scale effort to collect people’s personal information, however, comes a host of privacy concerns, especially in a society historically not fond of any domestic surveillance.
Rhode Island officials haven’t responded to multiple requests to disclose the number of people currently in the state’s contact-tracing database. But Health Department medical director Dr. James McDonald has offered his assurance that all of the collected personal information will be protected under the Health Insurance Portability and Accountability Act, a federal privacy law related to health care information known better as HIPAA.
“The only reason we would use it would be for our purposes,” he said. “It can’t be shared with the public. It’s private … and will stay that way.”
When asked how long the information would be kept — and whether it would be destroyed after the 14 days typically associated with quarantining — McDonald said he didn’t think so. (The screening survey for travelers is posted on the state’s website.)
“I am not sure how long the information will be kept,” Health Department spokesperson Joseph Wendelken wrote in an email. “Generally, we only keep information for as long as it has utility for preventing the transmission of illness.”
Raimondo has said she expects to provide more details about the technical side of the tracking program this week, but she has said it will involve people’s mobile phones in some way — raising other questions.
Other countries – including China, Germany and South Korea – have adopted aggressive electronic-monitoring programs that use GPS, Bluetooth and spending patterns to piece together people’s movements and others they’ve come into contact with.
Whether such an effort could be effectively adopted locally remains to be seen, but the executive director of Rhode Island’s ACLU chapter, Steven Brown, is among those watching any strategy unfold with interest and concern.
“Beyond the imprecise nature of most location tracking, data collected under an electronic tracing program may contain an enormously invasive and personal set of information about us, with the potential to reveal social, sexual, religious, and political associations,” Brown said. “The potential for invasions of privacy, abuse, and stigmatization is enormous.”
In China, a communist country where domestic surveillance isn’t unusual, the government has set up temperature-taking stations in some major cities where people must be screened when entering and exiting residential complexes.
The government then uses GPS and spending patterns from mobile phones to see where people have come into contact with others, and each person has a QR code on their phone that shows what type of health risk they might pose.
Green is good. Red is dangerous. Orange means you came into contact with someone with the disease.
And while China — once the epicenter of the global pandemic — now says it has a dwindling number of new cases, and has started to reopen parts of its economy, Brown questions the effectiveness of that program and whether it could work in the United States.
“COVID-19 is a grave public health risk, and there may well be some permissible uses of technology to address this risk if they are sufficiently constrained and proven useful,” Brown said. “The types of electronic tracking that have been used to address it in countries like China, however, have not necessarily been shown to be effective or productive, may not be workable here and are inconsistent with the values of a democratic society.”
In South Korea, a democratic society, the government has likewise set up robust tracking efforts using GPS and spending histories on mobile phones. In Germany, another democratic society, the government is using an app that uses Bluetooth to track people’s proximity to other users. People receive a message if they’ve been in close contact with someone who’s tested positive for the disease.
Raimondo referenced Germany during a press conference Sunday, as the country has emerged as one western society that’s been more successful that others in containing the disease.
If something similar is created moving forward, House Minority Leader Blake Filippi – a lawyer by trade – said it must be tailored in a way that respects the privacy rights of Rhode Islanders.
“I’m wary of government maintaining a database of our minute-by-minute movements,” he said. “If this does occur, our data must not be used for any other purpose, and especially not accessed by law enforcement, absent a warrant based on probably cause, and signed by a judge. When the crisis is over, this data collection program must terminate.”