Mar 21, 2020 - Health

The pandemic's coming health surveillance state

Illustration: Sarah Grillo/Axios

COVID-19 became a pandemic because too many of the countries struck by the virus failed to detect and suppress outbreaks as fast as possible. But the coronavirus could usher in an era of intense health surveillance.

Why it matters: From location-detecting smartphones to facial recognition cameras, we have the potential to track the spread of disease in near real-time. But the public health benefits will need to be weighed against the loss of privacy.

Background: Epidemiologists can lay claim to being some of the first data scientists, going all the way back to John Snow discovering the source of a cholera epidemic in London in 1854. Today they use rapid contact tracing to track an outbreak from its source to its spread in an effort to contain it.

  • But contact tracing is laborious detective work, requiring doctors to locate suspected patients and reconstruct their movements and contacts going back days.
  • When a disease breaks out in the community — as COVID-19 is clearly doing in parts of the U.S. — that work becomes much more difficult, especially if testing continues to lag.

Modern technology, though, offers the potential to surveil exactly where people are and where they've been, through the location data on their smartphones and the trail of transactions they leave in their wake.

  • China used data from state-run mobile carriers to track down people who had slipped out of quarantine during the worst stages of its COVID-19 outbreak.
  • Major companies like Alibaba developed apps that could classify people based on their travel history and risk of exposure to the virus.
  • "In the era of big data and internet, the flow of each person can be clearly seen," epidemiologist Li Lanjuan told China's state broadcaster in February. "With such new technologies, we should make full use of them to find the source of infection and contain the source of infection."

In the U.S. and other Western countries, such efforts would likely face major ethical, legal and regulatory barriers, as my Axios colleague Scott Rosenberg wrote earlier this week.

  • Those barriers are in place for a reason — Israeli Prime Minister Benjamin Netanyahu has come under fire for authorizing a plan to tap a secret collection of cellphone data to identify those who may have come into contact with the virus.

Yes, but: We are entering unprecedented territory with COVID-19. The fundamental challenge the U.S. faces in its response is a lack of data about who is sick and contagious and who isn't. Without that information, state and local governments have been forced to rely on blunt force tools of mass closures and social distancing that seem poised to kill the economy.

  • There are less intrusive tracking tools that might help epidemiologists ahead of the outbreak, like Kinsa Health's internet-connected smart thermometers. By instantly gathering reports of fevers around the country, Kinsa can alert medical officials "so the system can respond before an outbreak becomes an epidemic," says the company's founder Inder Singh.
  • As COVID-19 worsens, though, expect to see a greater willingness to trade privacy for effective health surveillance, just as 9/11 led to a tightening of security around airports and other public spaces.
"A situation like the pandemic creates a fundamental shift in how people react to technology. This is the direction we are going to be moving in."
— Labhesh Patel, chief technology officer at Jumio, an ID verification company

The bottom line: We've already given up so much in the fight against COVID-19. Some elements of personal privacy may be the next to go — and don't expect the surveillance to end when the pandemic does.

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