COVID-19 Contact Tracers or Cootie Cops?

As if the viral-lockdown apocalypse wasn't already weird enough, now it looks like we'll be dealing with battalions of cootie cops checking on our comings and goings. Technically, they're "contact tracers" and their jobs involve speaking with people who test positive for the novel coronavirus, identifying those to whom they may have transmitted disease, and advising self-quarantine and self-monitoring for symptoms. It's a tactic that has proven useful in other countries when properly implemented, and it's supposed to focus on actual vectors of infection rather than on whole populations. But "properly implemented" is the key here, because, oh boy, does the prospect of an army of government interrogators set loose upon the land lend itself to abuse.

Much early talk about contact tracing was on technological tools, like phone apps. Those can be helpful, but they raise privacy concerns of their own, which contribute to resistance to their use. That reluctance has revived talk of traditional contact tracing using people to identify and question anybody who tests positive. Words like battalions and army really do capture the vastness of what's being proposed.

"There are many estimates on the number of contact tracers needed to keep the virus at bay as we reopen communities," notes the National Association of County and City Health Officials. "Given global experience with contact tracing, as well as staffing needs at local, state, tribal, and territorial health departments across the many disciplines needed for contact tracing, we estimate a surge capacity of at least 100,000 individuals will be needed."

New York state's reopening guide explicitly refers to "an army of contact tracers" and sets the hiring of 30 contact tracers per 100,000 residents as one criterion for permitting a region to reopen to normal social and business activity. Ultimately, the state expects to put between 6,400 and 17,000 contact tracers in place.

At ground zero for America's pandemic crisis, New York City's "'Test and Trace Corps' will launch with 1,000 contact tracers," Mayor Bill de Blasio announced last week.

There is theoretically potential for doing this professionally and respectfully. The go-to trainer for many of the contact tracing programs is Johns Hopkins University, which has made itself indispensable for tracking the course of the virus. The university offers a free, online, certificate-granting course in contact tracing through Coursera. That course delves not just into the biology of the SARS-CoV-2 virus and the hows and whys of getting information from people, but also ethical considerations including respect for privacy.

But Johns Hopkins University isn't managing the deployment of the contact tracers it trains; that's being done by state, city, and local government agencies. And truly, there is no good idea that government officials can't turn to shit.

In the state of Washington, Gov. Jay Inslee's phased reopening plan, including an initial 1,371 contact tracers, "is raising questions about privacy rights," reports KOMO News. "The requirement that businesses keep a log of customers' names, dates and contact information is getting the most attention."

Specifically, the state requires that restaurants "create a daily log of all customers and maintain that daily log for 30 days, including telephone/email contact information, and time in. This will facilitate any contact tracing that might need to occur." That's records of all customers' information—not just those who have raised medical concerns.

"There are serious concerns with any plan that would require people to disclose their contact information and whereabouts for tracking," warns Jennifer Lee of the ACLU of Washington.

In California, Robert Levin, the director of Ventura County Public Health, went one better than Inslee. He had to apologize after a contact tracing program announcement during which, as he put it, "I gave people the impression that if you were isolated, you would be taken out of your home and put into a hotel room or a motel room or sequestered in some other way."

That's exactly the sort of "impression" that makes people reticent about volunteering the details of their shopping trips and social interactions to government-employed strangers. And, you guessed it, folks receiving official phone calls are holding back.

"Some people are a little suspicious. Some people hang up after I ask for their date of birth and address," Jana De Brauwere, a San Francisco contact tracer, told MIT Technology Review. "I understand that, the mistrust of the government, having grown up under communism. But it's too bad. I feel like they can benefit from this information: how to quarantine themselves, how they can protect their families, and what kind of support is available."

No matter how large an army of contact tracers is hired, winning people over is critical, because there is no way to make unwilling people cooperate.

"Participation in any contact tracing is voluntary, said Amy Reynolds with the state's Department of Health," KING5 reported of Washington's program. "Reynolds said while the state hopes people will cooperate to help protect the health of loved ones and others who may have been exposed, a patient has the right to refuse to share information with contact tracers."

Across the country, Massachusetts Gov. Charlie Baker is just one of many public officials begging people to cooperate with contract tracers.

But even if cooperation with contact tracers somehow became mandatory, enforcement would be a hell of a trick. There's nothing to stop people from lying to government officials they don't trust, and who continue to give the "impression" that they'll abuse any information they acquire.

"Countries with authoritarian governments or high levels of social cohesion have successfully used contact tracing, but we don't have either," bioethicist Jacob Appel told Axios.

Arguably, we do have an authoritarian government—but not one that possesses enough efficiency or enjoys enough support to make its whims stick.

So the burden is on public officials to demonstrate to our satisfaction that they're deploying an army of helpful contact tracers and not a plague of intrusive cootie cops. If they can convince the public of the wisdom of their tactics and the innocence of their intentions, maybe we can work together to resolve our health concerns.