Public health experts agree that robust programs to test more people and trace their contacts are vital for countries to safely reopen while also preventing a surge of new coronavirus cases.
But as restrictions loosen around the world and travel cautiously increases, there could be “blind spots” in how we trace potential cases across borders, said Kerry Bowman, a professor of bioethics and global health at the University of Toronto.
“And those blind spots will grow with time,” he told Global News.
“If you look at China — which was originally the biggest problem and then did well — when they had an outbreak in Beijing it’s because the virus was coming in from contacts from Europe. That could easily happen in Canada as well.”
Canada will launch its first digital contact-tracing effort next week. The smartphone app, called COVID Alert, will notify users based on a number of criteria, including if they were within two metres of a person who tests positive for the virus and if that contact was over an extended period of time. It will first be piloted in Ontario starting July 2 before launching nationally.
The borders between the U.S. and Canada remain closed to non-essential travel, allowing only those who are relatives of Canadian citizens to pass, but that doesn’t mean we shouldn’t plan for a future when the traffic flows freely, said Bowman.
“When the day comes and people go down to the U.S. for a weekend, and that data is blinded from the app, it won’t be very useful if those people were down in Houston or Miami where there’s a lot of outbreaks at the moment,” he said.
There are dozens of contact-tracing apps in practice around the world, including South Korea, China, Italy and, more recently, Germany.
In the United States, however, privacy concerns and a lack of national policy have stalled any national efforts. While other countries are taking a country-wide approach, the U.S. is leaving it to states to come up with their own programs, whether through apps or contact tracers.
Despite surging cases, states have reopened — many without a contact tracing plan in place.
Alabama, North Dakota and South Dakota have either deployed or are developing apps. Others are relying on contact tracers. California is training between 10,000 and 20,000 contact tracers but many other states are falling short of adequate numbers.
The piecemeal efforts in the U.S. would make collaborating on data-driven tracing risky, Bowman said.
“You need large aggregate for this to work well. In the United States, as we know, there’s 50 different states and they’re going to need to have some compatibility,” he said.
“Plus, the United States is under different laws than we are, so our government could offer us nothing on data protection from them.”
He added that, at the end of the day, the U.S. “will take their own national interests ahead of other national interests.”
Other measures upkeep protection
Steven Hoffman, director of the Global Strategy Lab and a global health professor at York University, isn’t too worried about cross-border travel skewing the effectiveness of contact tracing in Canada.
While contact tracing could be limited by borders, he said it’s the other measures Canada has in place that will upkeep protection.
“Contact tracing is best used when we’re trying to contain an outbreak, but there are more blunt measures, like the 14-day quarantine, if they’re at greater chance of catching the virus, such as if they return from outside the country,” he said.
“The chain of transmission gets stopped by adhering to the 14-day quarantine order.”
The Quarantine Act has been applied during the pandemic to legally require Canadians coming back to the country from travelling abroad to self-isolate for 14 days. They must also have “credible” quarantine plans. Should they not, travellers are forced to stay at a quarantine facility, like a hotel.
Plus, the rules come with penalties if broken, including a fine of up to $750,000 and/or imprisonment for six months.
Hoffman doesn’t believe borders will open anytime soon, and if they do, he said it’s likely those protections will remain in place for much longer, continuing to act as a protective layer.
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“The contact tracing app isn’t meant to be a panacea, it’s intended to be one additional tool in the toolbox,” he said.
“Ultimately all of our efforts have to be about reducing the risk, as opposed to eliminating it, because there’s no way of eliminating it entirely.”
Collaboration and participation
Where there’s room to improve contact tracing is on a global scale, Hoffman said.
Apple and Google have formed a partnership to build software into smartphones that would tell people if they were recently in contact with someone infected with COVID-19. It’s one of the more far-reaching attempts to combat the spread and trace cases, but one of very few.
International collaboration around the COVID-19 pandemic “hasn’t been figured out,” Hoffman said, and wasn’t in the right shape to begin with.
“When this pandemic hit, within a month, countries were no longer working as they should through the World Health Organization and other mechanisms… We need that commitment to tackle this globally — so far we’ve seen the world reverting to the national during this outbreak.”
Both Hoffman and Bowman agree the app is a welcome development, but acknowledge that it comes with a trove of privacy implications — some of which have yet to be answered or green-lit by the federal privacy watchdog.
Travel and privacy limitations aside, Bowman said the success of the app in Canada will rest on how widely it’s used.
“That becomes an element of trust, it’s going to be a challenge,” he said.
“If we’re going to convince people to adopt all this, the arguments are going to have to be largely ethical. And with them, it’s going to have to come with some assurance that things are going to be protected.”
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