The Challenge of Contact Tracing in America
Something is coming that is well-meant and seriously intended but carries the promise of trouble. It is the planned state-by-state coronavirus contact-tracing regime. It has all the potential to be an onerous system that provokes resentment, spurs anxiety, and invites pushback.
The plan is to curb Covid-19’s spread by tracking those exposed. They will be informed that someone they know has tested positive (for privacy reasons the name will be withheld) and they may have been exposed. They will be instructed or asked to get tested, to self-quarantine for a period, which may or may not be monitored, and to share the names and numbers of those they have recently been in contact with. Those persons in turn will be called, and so on.
Tom Frieden, a former director of the Centers for Disease Control and Prevention, told Statnews.com the idea’s practical intention: “You can prevent the clusters from becoming outbreaks, prevent outbreaks from becoming epidemics, and prevent the epidemics from driving us into our homes again.”
Most of the tracking will apparently be done by phone. But a lot is unclear, including enforcement powers and their limits. States and cities will create their own rules and processes. New York, California and Michigan seem to be taking the lead. This week New York City Mayor Bill de Blasio announced the hiring of 1,700 trackers, who begin work June 1. There is enthusiasm at the federal level. Robert Redfield, head of the CDC, says he supports “very aggressive” tracking — but no national plan.
The Washington Post reports public-health experts estimate that an effective tracking system will require at least 15 trackers per 100,000 Americans. The National Association of County and City Health Officials puts the cost at about $3.7 billion to cover the work of 100,000 tracers. It will be an army, on the ground for a generally agreed upon estimate of 18 months.
But no one is so far really clear on how exactly the army will do its job, what it will be empowered to do, what legal sanctions if any will apply to those who don’t share names or go into quarantine. How will trackers know if people obey quarantine rules? Will law enforcement become involved?
To supplement manual tracing, phone apps are being prepared by private industry, including Google and Apple. Some questions on this from TechnologyReview.com: If people use the apps, “what data will [the companies] collect, and who is it shared with? How will that information be used in the future? Are there policies in place to prevent abuse?” China, they note, “sucks up data including citizens’ identity, location, and even online payment history so that local police can watch for those who break quarantine rules.”
All this is disquieting.
The program will be launched in a particular context and a particular country. The context: a pandemic in which a lot of people have lost loved ones and jobs and fear getting sick. People are under pressure, nerves are frayed. By fall they may be starting to get back on their feet. Then the phone rings and someone tells you a nameless person is sick and named you and you have to stay home …
The political context: We are a divided nation. Some will see the program as Big Brother. Others will think it’s ICE at the door. We’re a whole country dodging bill collectors and afraid to answer our so-called landlines because of scammers who say they’re the IRS or your credit-card company. There’s a lot of understandable suspicion and some paranoia.
The larger context: who we are as a people. We are the heirs of geniuses, of religious visionaries and visionaries of self-government. Read the Mayflower Compact and your eyes fill with tears. Even in 1620 they knew! We also come from people who fled, from rascals and renegades. We came from the nobleman who got the girl in trouble and hopped the next ship. We come from idealists who wanted to bring Catholicism to the Indians. We came from people who couldn’t make “back home” work, impoverished farm girls and boys, people with nothing to lose. We come from people who were oppressed culturally, economically or by their governments. We come from the restless. Once in a history of Wyoming I read of settlers who couldn’t settle down and dragged their children on an endless search for the right patch of land. That is so American.
There’s something displaced in us, and uneasy. Something violent, too.
We fled cartels. We don’t want people following us. We fled the czar’s cossacks. We said, “If only the czar knew,” and then laughed because we knew the czar knew. We came from the enslaved, dragged out of Africa.
We came from people being pushed around, and mistrust of authority is in our DNA. Americans are exactly the people who won’t like trackers asking them who they’ve seen and where they’ve been, and telling them where they can’t go and what they can’t do. They won’t like feeling they’re naming names.
You can see all this in the polls. In 2018 a Monmouth University poll found 53% of Americans very or somewhat worried about government monitoring and invasion of privacy. The response cut roughly the same among Republicans, Democrats and independents. The same year a Chapman University Survey of American Fears found No. 1 was corruption of government officials. (They didn’t randomly meet conservatives: Nos. 2 and 3 had to do with pollution of oceans, rivers, lakes and drinking water.) In July 2019, Pew said 75% of Americans feel distrust for government.
The tracking programs are going to go forward because the politicians have announced them and declared them crucial to the fight. They’re already being budgeted. They’re also a kind of jobs program when people need jobs. And the scientists support them, arguing that they’ve worked well in Asia. But we’re not Asia, and we don’t have an outbreak of 50, or 5,000, or even 50,000 to deal with. More than a million and a half Americans have been infected, and more will be after things open up. So it’s going to get complicated, and probably ragged.
They’d better think through how they do this. So much will depend on execution. Some trackers will be geniuses of tact and empathy. Some will be officious clods. Some will have a natural and internal respect for those they’re talking to. Some will think America is a thing that happens in a petri dish beneath their gleaming microscopes.
Everything will depend on humility of process. Trackers should neither carry nor imply threats or coercion. They should request but not demand information. There’s nothing wrong with asking people to get a test, telling them where to get it and that it’s free. Nothing wrong with asking them to stay close to home for now, and if you test positive stay home for a few weeks. The point is to make it easy — to offer a weekly stipend and see to it that a reliable local agency comes regularly with food or diapers and formula. Offer to call a boss, explain the situation, protect a job. Accept no if the answer is no.
If government is going to do it, they better make it possible for the American people to appreciate it. If it’s done badly, they won’t, and there will be pushback.
Republished with permission from peggynoonan.com.