The Pandemic Economy — Part II: How to get out of this Pandemic
Part II describes the immediate actions we must do to actually stop COVID-19 and reopen the country safely, and not like happens today, too unprepared.
Part I describes the current state of affairs in the Covid-19 crisis and why this is a long term world wide problem that requires us to live with it in a permanent way.
Part III describes how different aspects of the economy and society will have to evolve in the context of a permanent presence of a pandemic virus.
Part IV describes how our laws will change to cope with a pandemic environment and how the way governments will use the money creation process to pay for pandemic adaptation.
Table of Content — Part II
Part II — How to get out of this Pandemic.
What we should not be doing with social distancing.
A frightening thought: the plateau is the new normal
What we should be doing in social distancing
- Vision — the new normal
- Communication — inform and educate the population
- Mobilisation — activate the population
- Protection — organise the production
- Testing — know where the virus is
- Contact tracing — outflank and ringfence the virus
- Privacy and other considerations — not Big Brother but Caring Mother
How to get out of this Pandemic
We know that social distancing is effective in stopping the exponential spreading of the virus, but economically, nor socially can this be continued indefinitely.
Sweden has taken a different approach where social distancing has not been enforced in order to balance economic pain with actual casualties. Until now, this approach has led to more casualties than its locked down neighbours Denmark and Norway, but still not to the same extent as in Belgium as shown in the graph before.
Is it because it is in the Swedes’ nature to keep more social distance? Not really. Population density, or, a lack thereof is more likely. Probably more importantly, the very positive relationship between the government and its citizenry, leading to a high degree of trust in and compliance with its guidelines is what sets it apart from many, if not most other countries.
The jury is out on the result, but at this moment, no other country is willing to follow their lead openly. Even in Sweden, there is now uncertainty about the validity of the research that supports their strategy and criticism about the choice of their natural experiment.
Since it does not seem to be the right choice to let the virus ‘wash over the country’ and a vaccine is not to be expected in the immediate future, if ever, how can we make social distancing work with our society and economy? We cannot stay holed up forever.
What we should not be doing with social distancing
Even if a vaccine was found within a year, how to bridge this period?
One thing we can do, is to look at the widely available vaccinations like BCG against tuberculosis which can offer some form of protection and weaken the gravity of the pandemic. Correlation is no causation, but there are promising approaches that merit further research, until debunked.
One proposition made by the Imperial College of London in their famous report that brought the UK and the US to change their “herd immunization” strategy, and that is echoed by other experts, is the pumping the breaks-strategy in which social distancing measures are loosened and tightened, as necessary.
The problem with this approach is that it asks our society to live continually and for years in a stop-start mode in which we change from strict quarantine to reactivation and back. We already see that this is not an easy task. Indeed, in China, Singapore, Korea and Taiwan, where they try to reboot normal life, certain regions need to lock down again almost immediately because of new outbreaks.
Our society’s organisation is based on a certain continuity in which activities keep going. Many of our activities require close contact: cinema, restaurants, public transport, hairdressers, sales in all its forms and many other activities. In a stop-start regime, these businesses will disappear progressively and irrevocably as they stop being profitable. Pumping the breaks appears to be an unstable transitional form which, in time, will converge either to a form of permanent quarantine and a “life-at-distance” which requires a whole other societal organisation than the one we know today, or to a tiredness and desperation amongst the population which, at a certain point, will stop following the rules. This will lead to an uncontrolled pandemic explosion that drives toward destruction, not only of our health care system and resulting in an extremely high mortality rate, but also of our society as a whole at some point.
A frightening thought: the plateau is the new normal
Numbers in the University College of London study reveal that the number of cases in a country, decreases at a much slower pace than its increase, and not symmetrically at all. What if a plateau in the curve, formed by a stabilization in the number of new cases per day, is forming on a high level rather than a dying out?
This might indicate that the current nearly lockdown is still providing enough food to the virus to produce hundreds of new cases per day in a population of 10 million people.
Indeed, people have to do their groceries, receive dental care, demonstrate risky behaviour, use public transport, etc. At best, the result would be a controlled natural immunisation of the population. At the time of writing (beginning of May 2020), this was confirmed by the senior virologist who advises the Belgian government.
Even if we would pursue ‘natural’ herd immunity (and kill millions worldwide in the process), a scenario in which we fill maximally, but in a controlled way the number of hospital beds without overloading them (Corona parties doing Russian Roulette with 1,5% chance to die, someone?), we could still need around 5 to 10 years to obtain the necessary coverage ratio of 85% immunity amongst the population.
This is on the condition that people keep their immunity and that the virus does not mutate regularly just like the flu, nullifying every year the previously built up immunity.
What we should be doing in social distancing
So, what to do next?
How can we adapt to this new reality as a society, without regressing too much? How can we mobilise our strengths and create something better than what we are living through with quarantine, or even, with what we had before? We now have an opportunity, forced upon us by an externality like the Coronavirus, to revisit our way of living as we know it and reorganise it with a sense of urgency that would not exist if we did not have our feet held to the fire.
The method we propose to permanently suppress COVID-19 is a game of “whack-a-mole”, inspired on “The hammer and the dance” article. The latter is not an episode of Games of Thrones, but a strategy based on immediate oppression keeping the virus at a reproduction rate (R0) far below 1 (originally obtained through social distancing lockdowns), below the line of exponential increase, while still opening the country for business.
This result is reached not by “pumping the breaks” and bringing the whole society in a start-stop mode, but through the continual localisation of infections and their mitigation before they explode exponentially again (the dance part, or the whack-a-mole).
In this lethal dance, we continually place obstacles on the virus’ path so that it cannot spread. Regarding the feasibility of this method, the most difficult issues are the asymptomatic contaminations and the long incubation times; they do not allow us to know who is contaminated or not.
For this to be possible, a holistic strategy must be formulated and implemented:
1. Vision: define what you want to achieve so that everyone can align to it
2. Communication: ensure that both vision and gravity are sufficiently internalized by everyone
3. Mobilisation: create the structure to activate enough resources to support the measures
4. Protection: provide enough direct protection to reduce the risk of infection
5. Testing: find out who carries the virus and quarantine them
6. Tracing: find out who was in contact with carriers and verify them
7. Balance and assure privacy and core freedoms with public health needs
1. Vision — the new normal
It is important to start by formulating a vision of what we want to achieve, to have a basic idea of what the new normal looks like rather than piecemeal actions without a binding story.
What we want to achieve in the first place, is that people can leave their homes in a normal way when it is necessary and take up going about their lives again.
Even if you open the economy without further measures, as some are advocating, people will only go out again when they feel safe and when the chances of being infected are minimal. This is shown clearly in the rapid decline in hotel and restaurant visits and airplane travelling days to weeks before governments decided to lockdown their countries.
Most people evaluate and act before official instances do.
This vision needs to be comprehensive and indicate how people’s lives will be influenced on the short and longer term. South-Korea has provided such a vision for at least the next two years whereas everyone else is looking at next month only.
2. Communication — inform and educate the population
The communication needs to be adapted to the scale of the event. If we want to relaunch society again, we need a clear communication plan with a scope reflecting its severity. Today’s communication is too inadequate, minimalist, and haphazard to be sufficiently effective at population level.
This has led to a detached communication style in which particularly generic and simplistic measures (the “blijf in uw kot” (“stay in your shed”) message went viral though) were announced that the population just had to conform to. Today, the interaction is largely limited to watching briefings with graphics just like a rabbit watching headlights.
Where are the billboards, the one-page-ads, the Facebook ads, the mail with government communications and the posters in the supermarkets?
We need to communicate on a much larger scale in the light of the required next steps.
Call it propaganda if you must. There should be no doubt that the virus is deadly, that social distancing is and remains important, that avoiding and suppressing the contamination means changing our lifestyle for a long period of time, that every person’s collaboration is called upon and remains necessary, that people will be activated to help and be held to account if they refuse to comply.
Communication happens also through the deployment of more blue (police) in the streets. At the time of the “Brabant killers” in the ’80 of last century, and after the 2016 terrorist bomb attacks in Belgium, we saw blue and green in the street signaling the severity of the situation loud and clear to everyone.
What we see today, does not convince anyone.
It is time to change that and go big.
3. Mobilisation — activate the population
The current situation is so life threatening for society in its entirety that all parts of society need to be included and mobilised.
So far, the management of the containment of the virus is mainly a matter of a select group of experts, with all due respect for their role and expertise. Luckily, they are experts and the Belgian politicians listen to their advice, as opposed to some other countries, but they are a small group, even with work groups supporting them! Consequently, there is a cognitive limit of things that can be managed. A brain can only process a limited amount of impulses.
There is a clear need to structure and level up the organization in order to deploy activities on a much larger scale. When you want to relaunch society, you need to steer many people in a targeted way via complex processes, activities, and messages than is made visible today.
Strategy, planning, budgeting, procurement, capacity building, setting up structures and (technology) infrastructure, teach-the-teacher, training, setting up self-directing teams, coordination, and reporting… This is still work to be done because nothing seems to have been done yet. The fact there are no links here, is because the author did not find any material about it.
We must also engage the population much more and make it an inclusive effort.
So far, their role was mainly split in either passive couch potatoes, teleworkers, and a bunch of very hard working people at the frontline who, if not keep the country going, at least keep the population fed, lit, warmed, connected and taken care of, at great risk to themselves.
There is a huge potential to mobilise the first group and have them participate much more to reduce the burden of the latter, all the while respecting the social distancing. Only at the end of April, a call for tender went out in Flanders for contact tracers. This should be only the beginning, and it should have been done 2 months earlier.
We need to activate not only the underused workforce, sitting at home because of the virus, like consultants, project managers, civil servants, marketeers, furloughed blue collar workers, and event managers, but also the active workers in the frontline, like grocery store assistants, police forces and industry workers in a coordinated effort rather than each in isolation.
We are talking literally about tens of thousands of people, to participate in the Pandemic Economy.
This coordination should be done through a “Pandemic ministry” with a “Corona Czar” at the head with the necessary mandate to direct the country’s means to face this Pandemic, rather than the kaleidoscopic and shattered set of mandates throughout the different regions and governments. Belgium, just like the US is not served by the fragmented approach today.
4. Protection — organise the production
Assuming that the virus will be present among us for several years, semi-permanently haunting us as an invisible predator, whether or not seasonally, we need to have the basic means to protect us against this virus in absence of a vaccine. They are the shields to defend ourselves.
It is strategically important to preserve durably our health infrastructure, in particular its workforce. Even if not all the beds are taken, we need to have enough competent staff. Our people in the frontline start to be exhausted, burnt out, fall ill and they are dying. They are not easily replaceable, if at all.
We will have to speed up the number of trained people in order to relieve the workload. This being said, the best way to reduce the number of patients and the danger they carry with them is to have people comply with the social distancing rules, which is not sufficiently being done.
Generally, and structurally, the workforce at the frontline needs to be much better protected.
As of this writing, police controls vehicles without much protection. That is a danger for both the officer and for the driver. Cashiers may wear gloves today (many did not until the end of march), but they have people passing their cash register at less than a meter, although most have now added protective shields providing questionable protection. In this way, they are not only hotbeds of proliferation of the virus (superspreaders), but they themselves also become ill and die.
What is, by the way, the situation in slaughterhouses, fisheries and for vegetable producers? All those people are critical links in our food chain that we think of as self-evident. Nevertheless, they work for us largely unprotected, often for a minimal wage. It would be perfectly conceivable that they, just like in any other place, decide to quit one day.
Food supply chains are already out of whack with potatoes and milk that cannot reach their markets and get dumped to rot.
Fears about a global food crisis could be triggered this way.
So, what do we do then? Finish what is in the freezer, and then what?
Every day, we are confronted with the failure of existing supply chains to provide us with reliable protective clothes. We have a major shortage of masks (FFP2, FFP3), security glasses, face protectors, gloves, aprons, and alcohol if we want to adequately protect the population. The government takes barely any initiative to provide this, leaving the population no choice but to buy fakes from Amazon, and get gouged for it.
The initially often used argument that people do not know how to use those masks, that they only have a limited efficiency and create moral hazard due to the sense of safety which, in turn, creates risk behaviour, are false. They are used in the first place to avoid contamination rather than as a protection.
Those criticisms sound hollow and were primarily voiced as an excuse to justify the lack of capacity today and the lack of effort to create the necessary capacity so that everyone can use them. So, the advantages of reducing the spreading of aerosol were minimised and the disadvantages magnified.
There are enough audio-visual means and ways to reach people, going from YouTube or Facebook to snail mail, to inform people on how to use protective materials in a correct way.
Therefore, strategic protection materials need to be produced locally again.
Companies like Sioen in Aardooie, the carpet manufacturers in the West, JBC and Vandevelde have production capacity and they work in adjacent industries. Firms like Alpha, Alsico and Deltrian International have the knowhow. Both sides need to work together. If necessary, non-medical security masks, like the ones having ABEK P3 standardisation that are allowed for industrial applications, could have been considered since the beginning. After all, Belgium has a large chemical industry where strong security norms apply and where protection clothes and masks are mandatory. Their suppliers could have been activated.
To the extent that all this was still not possible at the beginning of April, it has become possible at the beginning of May, more than 3 months after the health crisis started, to at least order, not masks, but fabric.
No pandemic will make government work faster.
We have been promised that every citizen will get a mask, with 2 pieces of said cloth to serve as reusable filters. However, these are neither at the level of surgical or FFP2 level masks. The question is, apart from making us feel better wearing them, whether they provide adequate protection.
They might do so to a point, but seriously, is that the best we can do?
In addition, we have world renowned pharmaceutical companies like Janssen Pharmaceutics, and GSK, as well as universities whose experts could have searched for solutions together with the industry.
These are not “Hail Mary” attempts in which industries that do not focus on health specifically, are asked to concentrate on matters that lie beyond their competences. It is a call to join the existing local industry’s knowledge with medical expertise and, through cross-pollination, give it the knowledge that allows them to transform and provide locally for those permanent necessities.
If Apple, and even a church with a 3D-printer, can make face shields (iShield?), we must be able to do so as well, mustn’t we? Who knows, we might be able to make effective face masks from kitchen rolls? (This is not an advice!).
There is no doubt that such cross-pollination happens preferably at EU level, where the member states’ comparative advantages and economies of scale can be mobilised. However, we cannot wait for this to happen. Both paths need to be explored.
The supply chains in China cannot be trusted for quality. In combination with our own control points over there, it might provide a temporary solution, but if the virus inevitably flares up again over there, China will prejudice its production for their own market and we will be confronted with shortages again.
Therefore, we need to have a strategic local capacity, an option that, inconceivably, we are not following, or are we? There seems to be a lot of hot and cold air blown without a clear strategy.
We must get used to the fact that everyone will have to wear a mask and gloves outside of the house and in public spaces. As shown above, it is hard to impossible to find those objects where quality is guaranteed, and people are not gouged on price. This is also a reason to call for their local production, just like for milk.
On top of that, it is important to create a sustainable and circular production. People will need massive amounts of masks which will generate mountains of waste. It is therefore essential to create reusable masks that can be sterilized at home.
5. Testing — know where the virus is
The asymptomatic spread of the virus is the Achilles heel of any control strategy. If we want to end the lockdown, we need to know where the virus is so that we can avoid it, isolate it, and monitor it. As Bill Gates said, to end the lockdown successfully, we need to “test, test, test”.
This means that we need to test and re-test people, continuously, process rapidly the samples, and see who is positive and isolate them. Once this is done, we need to find out with whom the infected person had contact (“contact tracing”). This was not being done for a long time, with measures being put in place only months after the first case. Even at the beginning of May we are barely getting anywhere in Belgium.
In Slovakia, you can have yourself tested everywhere and buy kits for self-testing. Now, they have much less infected persons per capita and only 2 deaths. Why was this not possible here? We must do much better than that.
Around Easter, Germany was testing between 80.000 and 100.000 people per day. For Belgium, this represents an equivalent of around 10.000 tests. We did not even do half of that for most of the first 2 months of lockdown. Only towards the beginning of May we reached that number, and apparently reaches at the beginning of May around 15000 tests per day.
However, this is only a fraction of what Belgium needs. Let there be no doubt about it: without widespread testing as a cornerstone, there is no successful strategy possible to stop the virus. You only have to look at Korea’s success and the regional differences in approach in the Netherlands and the associated results to be convinced. The correlation between testing and mortality is crystal clear.
It is important to understand the difference between a test for antibodies (blood test) vs actual infection (swab test).
Antibodies only test whether people have been infected in the past. The idea is that this confers immunity upon the tested person. It is easier and faster than the swabs which process genetic material, at least for now (see below). Antibody tests are valuable to understand how far the virus has spread, which might give information on the effectiveness of the measures and policy responses.
It should, however, not be used as part of a containment strategy whereby those with antibodies are given certificates to roam free and the others not. There are several issues with that strategy apart from the obvious historical connotations. First, it is useless to test people for immunisation as a strategy given that this represents only a small minority of the population (2–5%). One would be spending resources that could be much more effectively directed elsewhere. Secondly, having antibodies does not guarantee immunity, according to the WHO as well as the CDC, so people might get a free pass and still be infecting others. Thirdly, the tests are not necessarily accurate. Of the many tests taken, most have measurement errors larger than the 5% that is the % of infections in the population. Therefore, many tested persons would receive a false positive (as if they carry antibodies but have not in reality), which is, for this type of test, the worst possible outcome. These people would get a free pass where they should not. Finally, it would provide a horrible moral hazard, incentivizing some people to enter the life-or-death lottery contracting Corona so they can go back to work because they need the money, while punishing people who did the right thing by social distancing themselves.
In order to relaunch the country, we must cover our bases in the first place and test for infection first (swab test). Frontliners should go first; people in hospitals and in elderly homes, general workforce in the frontline, but also pharmacists, supermarket and shop assistants, food processors, police, firemen, garbage collectors, people working in day care, teachers, staff at the counter and drivers of public transport. Everyone in the centre of interactions should be screened weekly.
Then, inevitably, people visiting meeting places (grocery stores, stations, public administrations, large office buildings, factories, building sites, recycling centres) will need to undergo a compulsory test in order to be allowed entrance, or have to be able to show proof of recent negative testing.
Additionally, randomised statistically relevant sampling needs to be carried out among the population to get a relevant map of where the virus is concentrated (also swab test). This will allow a more targeted test strategy.
Antibody tests are done to finish it off, preferably with the low-error tests and in a randomized statistically relevant sampling way, to understand how many people in the population have already had the disease (and recovered). This also gives information about the virus’ temporal evolution so that the effectiveness of the measures can be, well, measured.
However, this scenario is not about 10.000 tests per day, but many times greater. Maybe 50.000 or even 100.000 tests per day.
Therefore, the industrial and pharmaceutical capacities need to be scaled up and transformed in order to produce those tests in large quantities. GSK stated that it has the capacities to perform 6000 tests per day in Rixensart, but this must be multiplied. To simplify the process, it should be studied if certain steps in the testing process, like RNA extraction, are absolutely necessary in order to detect the virus’ presence.
At the EU-level, this should become an absolute top priority. Some countries are better equipped to create such capacity regarding both machineries and ingredients. It is time to leave the attitude of “every country for themselves” behind. What is the use of the EU if we cannot even work together in moments like this one? Today, we might have the sense of urgency needed to obtain this cooperation, but the spirit of cooperation is still too much in words but not deeds.
Such tests need to give a quick result. They exist already. Korea has devices that give test results after 7 minutes and mobile ‘phone boots’ where people can test themselves or where a health practitioner tests people in a protected environment.
Abbot developed a portable test that gives its result within 5 minutes. Even better would be a test that is reusable, with a device like a diabetic finger blood prick or skin sensor for diabetics that can be read through a smartphone. This would allow self-testing, when appropriately miniaturised, and industrial produced. In this way, people can be provided almost instantaneous access results. For now, this remains a faraway goal.
A fast test does not necessarily have to offer the highest degree of certainty (the higher the better, of course) provided that the uncertainty implies predominantly a false positive infection, meaning someone receives a positive result, but is not infected. This is less serious than a false negative, where someone is infected, but receives a negative result. It is better to have someone stay at home than have them infecting an exponential number of people without knowing. If we know that quick tests might give a certain percentage of false positives, a second, more reliable and slower test, can be carried out in the following days.
It goes without saying that testing entails risks for the tester and the people taking samples need to receive adequate protection, training (they need to recognise the difference between a cotton swab for the nose and one for the throat),, and supervision. The samples should as much as possible be analysed on the spot with portable analyse devices (see Abbot’s test). If this is unfeasible, they can be brought to labs through the same mechanism as the one that is used to supply all our pharmacies several times a day: the little white vans.
Therefore, all labs’ capacities need to be strengthened and new labs need to be created to ensure geographical proximity and processing. Additional lab operators need to take a crash course to process those tests. Not realistic? In India, they accomplished to reduce the price of a heart operation drastically, splitting up the procedure like an assembly line so that less schooled people can participate, whilst keeping similar results as in our overly complex Western environment. In the following years, pandemic mitigation will become a new industry, and we have every reason to lower the specialisation level required to enlarge the pool of potential workers.
What happens with those test results of infected people? They need to be monitored closely. The principle is that people who test positive, need to be self-quarantined, and all people with whom they had contact during the last 2 weeks need to be tested also, and quarantined if necessary.
In the absence of these tests and in the meanwhile, we need to activate people who are (technically) unemployed today, and have them take samples, in a secure way, at different locations. In the absence of tests, they could at least take people’s temperature or oxygen levels which appear to be a good indication of ‘silent pneumonia’ linked to COVID-19.
6. Contact tracing — outflank and ringfence the virus
Once testing is in place, we need to know who has been in contact with infected people. This is done through contact tracing. We achieve that through both technology and people, complementing each other.
Many people will have to be deployed to organise this monitoring, detection, and data processing process, but most of the data collection can happen electronically through mobile apps as deployed in Singapore, Australia and other countries, and which support critical decision making.
At the moment, the Belgium government’s “Data against Corona” taskforce offers a central contact point for the dozens of apps being proposed to help with this issue. However, this has not yet led to a much-needed strategy formulated by the government. We will try to provide one instead.
In the first place, all tests should be linked digitally directly to the person.
Every tested person has an app on their smartphone allowing them to scan their blood sample taken and send it to the test processing application in the Cloud. At the same time, the app generates a code that is scanned by the health provider performing the test and linked to the test’s barcode. The app keeps track of where and when a certain test was taken. After the analysis, the results are fed back to the app. In the case that the person tested positive, they will be asked to stay home in quarantine.
Through the app, the infected person can ask for a confirmation test (or this is automatically initiated), which is taken at home, and request additional services, like having their groceries done, social, medical and psychological support, and apply for health and social benefits. Automatically, their family doctor is informed who will ask regularly about the evolution of the symptoms. The person can introduce their fever and their oxygen level in the app if they have a measuring apparatus for oxygen. It is important to integrate an alarm button in case the person’s situation gets worse so that an ambulance is sent, or an appointment is made in the hospital closest by.
Not everyone has a smartphone but 85% of the population has. The others, from a certain age on, will receive one, for free, even homeless and illegal persons, and with a data plan, but limited to the use of the app and a limited set of services like email and browsing.
Everyone needs to use the app. This is not a matter of wanting, but merely of necessity. If not everyone uses it, then “phantom” users will slip through the cracks of testing and keep infecting people.
In the second place, we must trace people that were close to an infected person, but anonymously.
To this end, the app will scatter electronically a “signature” through the Bluetooth signal of the phone for other smartphones to pick up. This signature is anonymous and changes regularly. In the same way, the app scans the other smartphones close by, at 10 meters, for example (which is the standard Bluetooth range) and collects their signatures.
These collected signatures are regularly loaded into the Cloud, noting the time, but not the location as this is not privacy friendly. If someone tests positive, the signatures of his phone are tagged. The apps that captured those signatures during the 2 previous weeks, will be warned without informing their user of the identity of the infected person. The app’s users are suspected to be infected and will be asked to go in quarantine. At the same time, an appointment is made to take a test at home which will indicate whether they are effectively infected or not.
In order to manage the large amounts of data that would be created through the massive use of this app, we need to create a refined and intelligent architecture.
This architecture will need to consider both the volume and the security of these data, but also provide the necessary tools for the people doing the monitoring. Thanks to the maturity of the distributed Cloud architectures, the emergence of edge computing where notions as event streaming and microservices can realize extreme scalability. Thanks to powerful mobile devices that allow much of the application logic to remain local, app stores that allow the massive roll-out of new updates and the high 4G, and later 5G, mobile network bandwidth, it needs to be effectively possible to cover the whole population.
Nevertheless, it will be a challenge to set up such a structure. This requires an agile model in which one can iterate quickly between different versions in which new functions will be introduced progressively.
7. Privacy and other considerations — not Big Brother but Caring Mother
In a scenario, relying on automated tracing using mobile technology like an app, there are many valid concerns regarding privacy rights that need to be addressed and clarified. The objective to keep in mind, and that needs to be balanced with privacy rights, is the suppression of the virus.
Many concerns regarding the usage of technology are around how it can potentially be abused by other people, companies and governments and that this is a reason we should not be deploying such technology. While certainly a valid concern, this demonstrates that we, as humanity, have not yet agreed that it is the virus that is our biggest enemy rather than other people. Throughout history, more people have died from disease than by the hand of other people, but because of availability bias, we seem blind to recognize that and throw the baby with the bath water. This is not to disparage the concern, but to say, “yes, it is a concern, and yet it is currently still our best option, so let’s do it.”
An additional critique is that the technology is not 100% airtight with Bluetooth also capturing people behind walls and the like so that there will be many false positives leading to many people quarantining themselves unnecessarily. That is correct, but even so, this still beats quarantining the whole population. The technology can also be refined over time to become more precise by iterations of the software code.
Finally, electronic contact tracing should not be seen in isolation but as one of the building blocks in a larger strategy of reopening the economy. The foundation is in ubiquitous testing and retesting, so when you are casted in the Bluetooth net, it should be easy to get (dis)confirmation. As the virus gets beaten back over time, there will less and less positives and hence less people discomforted.
Perfect is the enemy of good. This is what we have, so let us use that until someone has a better idea.
First, we must decide whether the app is a legal obligation, just like an identity card, or optional, knowing that its efficiency depends on the level of full compliance.
A Belgian public broadcast (VRT) survey shows that 50% of the population would want to use an app, but almost 40% does not. That is by itself probably not enough to be effective. On the other hand, 2.5 million Australians did download the app in half a week which confirms a willingness for adoption.
It could be left up to every individual person and organisation whether they require it or not.
Supermarkets, schools, day cares, and public institutions could refuse entrance to people without the app, arguing that they want to protect their clients, pupils and citizens. The same way schools can refuse the children of anti-vaxxers on grounds of public health.
If using the app is made legally obligatory, everyone is equal before the law and individual considerations become invalid, which increases efficiency tremendously, but guardrails have to be put in place to ensure privacy remains legally protected.
Will we track and stop infected people who leave their homes knowingly through GPS or do we let them walk around, knowing that they represent the equivalent of walking Anthrax envelopes?
Depending on how the question is framed, the answer is easy. Simple rules that everyone follows, behaviourally set-up for compliance, are the most effective. This is what will make the largest difference during a Pandemic. After all, we all want the virus to disappear.
What is the point of the whole exercise if it is not implemented seriously? Its success or failing depends on enforcing the underlying principles. Using it, but not enforcing it, might make things worse as people will have an expectation for it to work and behave differently otherwise
Then, the question remains how much privacy is needed in the app’s functionality. In a way, a lot of concerns voiced towards the government reeks of hypocrisy given that very few critics have the same issue with Apple and Google monitoring lockdown compliance using location data.
The functionality described above is inspired on the one proposed by the Pan-European Privacy-Preserving Proximity Tracing Project, or PEPP-PT, a collaboration collective of several prestigious universities and institutes, amongst which the University of Leuven in Belgium, and proposes this kind of tracking in a fully privacy-protecting way. Apple and Google are also making their phones mutually compatible to allow contact tracing. This could be an interesting approach, but it is better not to be too dependent on them because of their bad antecedents regarding privacy-related issues, also with this app. In addition, Google and Apple, being Google and Apple conveniently use technologies that can be only found in their recent phones, forcing a large part of the population to upgrade, like 2 billion of them.
Structurally, the underlying infrastructure can be developed in a way where the person performing the test at the supermarket or at another location does not have to know your identity, only the anonymised link with your app. Your phone’s Bluetooth does not have to know whose signal it is capturing, nor where. The only important thing is to know whether the owner was in contact with a contaminated person or not.
As long as you have not been tested positively or marked as ‘infected through close contact, no one needs to know who you are, where you have been, and when.
Once you are (deemed) infected, it is legitimate for the government to know who you are and whether you are using the app (when compulsory). After all, it already knows where you live and how much you earn for taxation. Besides, you always need to have your identification with you. Knowing who you are is not abusive in a situation where you represent a public health and safety danger.
Today, there are means to provide your identity in a secure way to the app.
The ITSME app, made by a consortium of banks and telecom enterprises in Belgium that manage your identity, is already used widely by both banks, the government and commercial partners. This app can be easily used to pass on your identity to the tracing app. Alternatively, you could go to the municipality where they scan your identification in the ordinary way. The scan is connected to a device that produces a code that, in turn, is being scanned by the app. In this way, your identity is registered in the app. Again, this identification will only be used to verify that you have registered and use the app, as well as to mark whether you are contaminated. You can even do it at home, where you use your connected card reader and your identity card on a government website that provides you with a QR code, which, again, you scan with the app.
Once you are infected, you are not only recognised as a victim of the pandemic deserving support, but also society must be protected from your illness through compulsory quarantine, and not just social distancing outside the home. To this end, the government should be able to automatically limit your movements and monitor them via this virtual ankle bracelet using the built in GPS of the phone.
People can always leave their smartphones at home but will not be able to have access to shops or public buildings without the app, as there will be guards verifying everyone who enters. Nor will they be able to use other public services without having the app enabled and with them.
Being infected is no stigma, on the contrary. It is a given that can affect us all arbitrarily. When being looked at from this point, it becomes a temporary planification problem and the quarantine a matter of public health.
One can also think of scenarios where you explicitly desire to share your status with others. To restore the normality of people’s interactions, there is a social network aspect that plays an important role. You could allow the app to share your last test status with certain groups of people, your family members, for example. If you are planning a visit, you could agree together to get tested the day before. The same is valid for employers. They can define a group, or even subgroups, in their buildings, for example, so that you can share your status with your colleagues that are part of your work bubble (see further).
As such the app could have an open architecture where, consent based, you allow additional functions to be build on top for legally approved uses, and as such improve the practicability of contact tracing.
Part III describes how different aspects of the economy and society will have to evolve in the context of a permanent presence of a pandemic virus.
