The costs and benefits of contact tracing : The Indicator from Planet Money Contact tracing is one of the most effective ways to contain a pandemic and dates back to the 1300s. But the modern versions are coming at a real cost.
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The Cost Of Contact Tracing

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The Cost Of Contact Tracing

The Cost Of Contact Tracing

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Nicole Lennick (ph) lives in Bismarck, N.D. She is a registered nurse, works mostly with children - up until recently, anyway. Nicole just took a new job.

NICOLE LENNICK: The North Dakota Department of Health was looking for volunteers to do contact tracing.

SMITH: Contact tracing is a technique for controlling and shutting down pandemics.


Yeah. If somebody tests positive for COVID-19, a contact tracer will call them, talk to them about their test result and ask them for the names and contact information of everyone they've interacted with over the past couple of weeks.

SMITH: North Dakota was recruiting nurses like Nicole, who could talk people through a positive test result and the health questions they might have. Nicole is about to have a baby, and contact tracing gave her a way to help people without risking her baby's health.

GARCIA: Contact tracing has actually been used since the 1300s, when Western Europe was battling the bubonic plague. And Nicole's job really isn't all that different from what contact tracers were doing more than 700 years ago.

SMITH: But, of course, that is not the only kind of contact tracing that's happening now. One solution that's emerged is the use of cell phones and apps to track people and warn them if they've been somewhere where they might have been exposed to COVID-19.

GARCIA: South Korea, China, Italy, Israel, Singapore - all those countries are using apps to help control the spread of COVID-19.


SMITH: And I'm Stacey Vanek Smith. Today on the show, contact tracing. Contact tracing is seen as key to controlling the spread of COVID-19 and to reopening the economy.

GARCIA: But it's complicated. The old-school method has some real drawbacks. It is expensive, and it takes a long time, and it can get really emotional.

SMITH: And the newfangled methods can get around a lot of that, but they can have problems, too. For one thing most of them are tied to our cell phones and to location tracking. And that gets into all kinds of privacy issues.

Contact tracing is a centerpiece for many of the countries fighting coronavirus. South Korea, Germany, China, Singapore have all credited contact tracing with getting the spread of COVID-19 under control.

GARCIA: Here in the U.S., cities and states are hiring little armies of contact tracers. California, for example, is hiring 20,000 contact tracers, recruiting people with backgrounds in health and research, like nurses and librarians.

SMITH: People like Nicole Lennick, our contact tracer in Bismarck, who says she really loves this work.

LENNICK: I feel like it's so life-changing. And, you know, people look at the North Dakota Department of Health or contact tracers, they look to you for advice on everything. And it's good to give out reassurance or give out information and help them through such a challenging time.

GARCIA: Still, she says, it is not an easy job. It's labor intensive and very emotional. Nicole specializes in nursing homes, and she says this is especially sensitive because older people can be more vulnerable to complications from COVID-19. And it can also mean up to two weeks of total isolation.

LENNICK: The elderly population struggles with loneliness already, and then they're isolated in their room. And we're trying to do it, you know, to save lives, not to make them depressed or feel alone. But it's just hard to know what's always the right answer all the time, I guess.

GARCIA: And sometimes, the calls can be emotional in a different way.

SMITH: A contact researcher has to call up a total stranger, tell them they're sick and then ask them a bunch of personal questions - where they've gone, who they've spent time with over the past couple weeks. And some people kind of freak out. Nicole recalls one man in particular who got really upset.

LENNICK: He was like, what do you want, my bank account number? Just giving me a hard time. And I was like, no, I don't want to know that. All I want to know is if you have any close contacts that you should notify because you have tested positive. And I think I spent an hour on the phone with this guy trying to convince him that I was a real person and not trying to, like, steal his identity or whatever he thought I was trying to do (laughter).

GARCIA: This kind of thing is not unusual. In fact, a survey of Colorado contact tracers found that 70% of them reported having been threatened or harassed by one of the people they were calling.

SMITH: Even in the best of times, though, human contact tracing is cumbersome. It takes around 90 minutes per call - 60 minutes to talk with the person who's tested positive and about half an hour to text and call all of the people that person has come into contact with over the past couple of weeks.

GARCIA: It's messy, and it's hard, and it's expensive for cities and states, all of which has made cell phones and apps a really appealing option in contact tracing.

SMITH: South Korea is reportedly using location data on people's phones as a way to track the spread of COVID-19. It's now developing technology that will send people alerts if they've been in an area where they were possibly exposed.

GARCIA: And in Canada, they've developed something called the CanShake, as in, the Canadian handshake. It's an app that is triggered when you shake your phone near someone else who is shaking their phone. And it shares location data and possible exposure.

SMITH: Here in the U.S., apps have been a little slower in coming. One reason is privacy concerns. After all, the information involved is pretty sensitive.

RYAN CALO: Who you know and where you are and your health status.

GARCIA: Ryan Calo teaches law at the University of Washington. Unlike in many countries, there is no centralized government app in the U.S. Instead, private companies like Apple and Google are involved in developing apps, and so are universities like MIT, and also some local governments.

SMITH: The results, he says, have been a little spotty. For example, three states have developed apps for contact tracing - Alabama, South Dakota and North Dakota, where Nicole Lennick works. And in that case, Ryan says, state health officials partnered with a location tracking app called Bison Tracker. Bison Tracker was a little app used by fans of the Bismarck Bison football team.

CALO: An app that helps you tailgate by figuring out who - what other fans you are close to.

GARCIA: So it's pretty much the same technology that you need for contact tracing. North Dakota partnered with Bison Tracker to make its app. And Ryan says the result was not ideal.

CALO: It was riddled with problems. One, it was sharing some kinds of information with Foursquare and Google. And then when confronted with it, the state and the company they were working with said, oh, gosh. You know, we're going to address this in our privacy policy or make a change.

SMITH: Ryan says this was probably just a mistake, but it was a mistake that handed over people's data to some big private companies.

GARCIA: And meanwhile, he says, the ticking clock on getting contact tracing apps up and running could end up rushing the process and mean that a whole lot of really important stuff falls through the cracks. Money is so tight for local governments right now, and human contact tracing is expensive and time-consuming. So an app that helps people feel safe and can reach thousands of people in an instant and could potentially contain the disease, well, that could seem really enticing.

SMITH: There is legislation in front of Congress now that would regulate the information contact tracers could access and also how they would use that information. Ryan says legislation could help address privacy concerns and give guidance to companies and governments who are making these apps.

CALO: And there are a number of different protections that can be put in place. And those protections range from making sure that you only collect the data that you need to do the job, securing that data against cyberattack but also physically, physical security, and really guarantees or as close as you can come to guarantees that the data won't be used for some other purpose that wasn't expected - some commercial purpose, some law enforcement purpose - and that after - knock on wood - after this pandemic that the data will be deleted.

GARCIA: Ryan says this is a crisis, and we have to move quickly. That is paramount. And there is a chance that apps could save lives and save jobs, maybe help the economy open more quickly. But, Ryan says, there really just still are a lot of unanswered questions about how they should work. Plus, they won't necessarily help some of the most vulnerable people - low-income people who cannot afford smartphones and older people who might not be comfortable with the technology.

SMITH: So, says Ryan, human contact tracers like Nicole Lennick are still crucial - calling people up, asking the more they've been, who they've seen, calling those people.

GARCIA: This episode was produced by Camille Petersen and Leena Sanzgiri. It was fact-checked by Brittany Cronin. Our editor is Paddy Hirsch, and THE INDICATOR is a production of NPR.


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