This article is written by Adv. Arunima Shrivastava, currently working at Madhya Pradesh High Court. This is an exhaustive article which deals with the Regulation of COVID-19 Digital Contact Tracing.
On 11 March 2020, Covid-19 was declared an epidemic by the World Health Organization (WHO), with more than 294,000 cases worldwide. The world is facing a socio-economic crisis and global health emergency. Governments are adopting unprecedented measures to deal with this emergency. To reduce contagion, and follow WHO recommendations, states have implemented non-pharmaceutical measures and conduct outbreak investigations, including surveillance and visualisation of chains of transmission, contact tracing and management,
Early detection of cases and their close contact are important in suppressing the transmission of infectious diseases. Unsuccessful efforts to detect and control the epidemic demand a strong leadership of the National Institutes of Public Health, an efficient policy, and firm political leadership and Support. In the present COVID-19 pandemic, vaccines available but they are not working 100% still people are dying or infected after both doses but the ratio of vaccinated people infected less and it is difficult to vaccinate everyone in a short period of time in our large amount of population, prevention-based on non-pharmacological measures such as quarantine, contact tracing, or isolation as the only way to control the disease. 80% of asymptomatic patients are those who get the infection, and since they are presumed to be contagious who have symptoms, identify close contacts of COVID-19 patients and implement effective quarantine and self-isolation. It is important to do. Along with social distance, large-scale efforts in contact tracing have paid off in preventing the COVID-19 epidemic around the world.
Contact tracing is the process of assessing, identifying, and managing people who are later exposed to a disease to prevent infection. When applied systematically it will break the chains of transmission and thus serve as an essential public health tool to control outbreaks. Manual contact tracing (MCT) has been used to date, including the collection of information from people who tested positive and their contacts, including the collection of personal information and data about the locations with which they were in contact. MCT efforts use these data to uncover ongoing transmissions, provide useful information tailored to the individual, and enable quarantine and isolation as needed.
Diseases that are highly Infectious such as Ebola and Covid-19 are spread through droplets and contact. It is very vital to control the spread to identify people exposed to an infected person so that they can be properly quarantined, isolated, and given proper care. The whole process of management and identification of people who are exposed to any disease which is highly infectious to prevent any other transmission is called contact tracing. If properly applied, contact tracing can effectively help prevent the spread of an infectious disease.
Covid-19 has caused havoc worldwide due to its highly contagious nature. Most parts of the world have had to be shut down and people are forced to live inside their homes to prevent transmission, given the increase in the number of coronavirus cases. In such a situation, contact tracing is an important tool to prevent the spread of the virus.
Purpose of Contact Tracing
- Classifying and identifying the contacts as soon as possible to prevent further spread by transmission. The decision is to test some contacts and quarantine others based on the risk assessment process, considering factors such as duration, proximity, nature of risk as well as other reasons.
- Significant considerations for digital contact tracing
- Through any of the known modes of transmission, a person is likely to acquire infection from contact with any person in a positive case.
- If any person is not isolated before, Anyone exposed to symptomatic COVID-19 case, from 2 days before to 14 days after the onset of symptoms,
- If any person is not isolated before, for pre-symptomatic or asymptomatic cases, the period for digital contact tracing is taken as 2 days before to 14 days after the date sample collection.
- In important considerations in contact tracing the proximity (<1 meter), the duration (>15 minutes) and nature (use of appropriate PPE), etc of exposure are Contact-tracing apps
Various contact-tracing applications have been developed worldwide to help detect people who may have exposed themselves to the virus. The Indian government has launched the Aarogya Setu app to encourage efforts to limit the spread of the Corona disease. The Aarogya app was downloaded by more than a million users.
The application uses your smartphone’s Bluetooth and GPS to determine if you are within six feet of someone infected with the Corona (Covid-19). The application also shows Corona Patient (Covid-19) hotspots and the number of cases within a distance of 500 meters, 1 km, 2 km, 5 km, and 10 km. However, the app has also raised several eyebrows on issues related to privacy and data.
How Contact Tracing works
If you make contact with an infected person within a meter radius and face to face for more than 15 minutes, or if you have any direct physical contact, or if you have shared food, room, or any other place. You have exposed yourself to infection. In case of covid-19 risk, you will have to quarantine yourself for 14 days and report to the authorities immediately if you have any symptoms.
Essentially, contact tracing, to determine who a person has been in contact with a person known to be Corona positive, identify any person with whom the exposed person has been in contact, and then alert every individual in that chain, as well as the relevant officials/ authorities, to the exposure. Effective and rapid digital contact tracing induces reproduction (R) number and breaks the chain of infection- the number of new corona patients created by each infected person in a particular social context – toward 1 or less, which implicates the Covid-19 (coronavirus).
The main advantage of contact tracing is that it provides a basis for risk stratification so that authorities can limit quarantine to at-risk individuals and infections without imposing lockdown on the entire population. According to the likelihood of Corona infection, people can be classified into five groups. (See demonstration 2). Depending on their classification, individuals may be tested, notified, or quarantined.
A contact tracing system begins with identifying individuals who have tested positive for the disease and therefore fall into the “maroon” group. Individuals in this group should be isolated until they test positive. Known contacts that meet certain criteria — typically, have been within 2 meters of an infected person for at least 10 to 30 minutes during the past 14 days — are divided into two categories — those that are symptomatic (“Red”) and those that exhibit no symptoms (“yellow”). People in either group may become infected, and thus have to remain in isolation for at least 14 days. Individuals in the yellow group who remain without symptoms for 14 days are thought to have had a mild case of the disease or have completely avoided infection. If sufficient quantities of molecular diagnostic tests are available, health care providers may test members of both groups; But if molecular diagnostic tests remain rare, the test should be focused on red group members.
Most individuals have no known risk of the virus. As a result, they sit outside the contact tracing chain and are considered healthy and free to propagate (“green”). Meanwhile, the population of individuals recovering from the disease continues to grow. The hope today is that those recovered patients will be immune to re-identification — and with validation from a reliable antibody test — can safely be excluded from further contact tracing.
The necessary elements of a Digital Contact Tracing system
Speed is important if the contact tracing system is to be effective for two reasons. First, infected individuals can begin to display symptoms of COVID-19 for four or five days, and perhaps even long after becoming infectious. Second, the disease is highly contagious, so an infected person can spread the disease to a large number of people in a relatively short time before diagnosing the disease. A fully manual system will quickly relax and collapse under the strain of detecting a large number of contacts for each infected person, or it will require a very large, continuous capital investment. Therefore, effective contact tracing efforts require technological enhancements – most likely in the form of a smartphone app – that address five key capabilities:
To align with our best understanding of risk exposure, the contact tracing application needs to be able to detect encounters of a certain duration and within a distance of 2 meters over a period of two weeks. The Bluetooth feature on smartphones can easily perform this task, logging all such encounters on the device for the past two weeks or in a local or cloud-based central database.
It is important to identify where an encounter with a COVID-19-positive individual occurs to effectively track the spread of the disease and identify hot spots. Although Bluetooth does not provide location information, such information will be readily available through the smartphone’s GPS function.
To be useful, technology must be easy to use and available on as various devices as possible.
Technology will have to be radically linked with the broader public health system. For example, users should allow health care providers to register symptoms or request a test and send an app official test result confirming the infection. Also, it should be compatible with public health databases and devices used by people engaged in manual tracing, testing, and hot-spot tracking, to allow quick access to rare tests and give relevant information to tracing teams.
In light of privacy and practical concerns, the technology should include a secure encryption feature and robust data administration, including deleting an individual’s data (known as “right to be forgotten”). After the COVID-19 pandemic can be finished declared. Such protection will be important to prevent fraud and abuse and to assure users that their privacy rights will be respected.
For the overall tracing, testing, and tracking approach to be effective, each element must take into account the underlying disease prevalence and spread, as well as the lifting of specific restrictions that will affect the rate of spread. For contact tracing, in particular, adoption rates should be relatively high for a supporting app to prevent spread beyond the control of the disease – and even higher after more restrictions are lifted. But there are significant challenges for widespread adoption.
Balancing tracing, testing, and restrictions
To understand the dynamics at work, we modeled how transmission rates change at various levels of activity restriction, depending on different levels of contact tracing app adoption and testing, using the methodology described by the Fraser group at Oxford University and published in March 2020
We devised four different scenarios (shown in Exhibit 3) depicting increased relaxation of social restrictions, ranging from the most limited scenario (R = 1.2) on the left (perhaps a less densely populated city that is maintaining relatively strict social restrictions as it reopens) to the most permissive (R = 2.0) on the right (perhaps a densely populated city with fewer social restrictions). For each scenario, we identified a set of minimum testing requirements (shown on the x-axis) and app adoption rates (on the y-axis) that allow us to drive the R number down to an effective level of 1 or less—the level required for a containment strategy to be successful. The results are plotted as lines, which differ depending on the number of manual tracers deployed.
The results illustrate the need for more extensive testing and tracing as the authorities lift more and more restrictions. If they lift restrictions aggressively to R = 1.7, for example, they would need to administer roughly 10,000 tests per 1 million people—and at least 70% of the population would need to adopt the tracing app (as reflected in the gray line in Exhibit 3)—to maintain control over disease spread. If we add manual support from contact tracers at a rate of 350 per 1 million people, the required rate of app adoption falls to about 60% (as shown in the orange line).
Barriers to adoption
As our modeling demonstrates, widespread use of contact tracing apps is critical to success. Only a few countries have achieved adoption rates of 60% or more, and those who have been successful have imposed credible civil or criminal penalties for noncompliance.
There are certainly operational barriers to widespread adoption, including how to ensure access to the app, how to set up and use as much as possible, and how to communicate clearly about the importance of participating.
While those issues are important, complex ethical issues are even more challenging. Contact tracing systems are necessarily invasive, as they require detailed accounting of a person’s knowledge of travel and encounters and the person’s COVID-19 status. Properly limiting access to that information requires establishing appropriate security, guard railing, and cryptographic solutions to control access to specific information. Such solutions should limit access to certain individuals or groups by necessity, and possibly limit access to location, health, and proximity data to public health only.
Implication for privacy
The data privacy implications of digital contact tracing are significant, as many methods involve the collection of both sensitive health and location information.
The success of various contact tracing beginning by western governments depends on users’ willingness to participate. The trust of the customer is critical for adoption by a sufficient number of users to render a digital contact tracing application effective. Agencies of government and private entities offering digital contact tracing applications should ensure that individuals receive adequate notice of their privacy and data security practices.
Centralisation vs decentralisation
Under a centralised approach to digital contact tracing, all geolocation, Bluetooth, and diagnosis information are combined in a central system. This is generally managed by public health officials but, in some matters, may be shared with or administered by a third-party technology provider.
Under a decentralised approach, however, Bluetooth or geolocation data is stored locally on users’ smartphones, unless the users decide to voluntarily transmit the personal information to the private company or government agency. The application enables each user’s smartphone to everyday check the locally stored data against a list of infected individuals’ anonymised identifiers to determine whether or not the user’s phone has recently been in proximity with an infected individual’s phone.
The “Data minimisation” refers to the core privacy of the data tenet that an entity should neither collect nor maintain more personal information about a person than is required to accomplish the motive for which it is being collected. A digital contact tracing application that continues to collect users’ geolocation information in the post-pandemic era, for instance, would run afoul of this principle.
To comply with it, companies and government agencies should cease collecting application users’ personal information and delete any collected or stored digital contact tracking information once it is no longer required for COVID-19 mitigation efforts, to comply with legal requirements, or for another appropriate purpose.
Bluetooth data linkage issues
The Bluetooth-data -based digital contact tracing applications typically store only a random Bluetooth identifier from a COVID-19- the positive user who inputs her or his diagnosis. It may, however, be possible for a private company or government agency to link metadata associated with the infected user’s Bluetooth identifier, such as the user’s smartphone IP address, to the user’s identity and location.
Companies seeking to use contact tracing in all kinds of workplaces may encounter barriers in the form of employee surveillance laws. Because digital contact tracing applications may track an employee’s location not only when onsite but also when the employee is off-duty, the application may be considered a form of surveillance that may be regulated by data-protection laws or employment.
Digital Contact Tracing – the product of technological advancement
The effectiveness of contact tracing apps has not yet been proved. Therefore, digital contact tracing technology (DCTT) cannot replace manual contact tracing (MCT) and other public health measures. The effectiveness of such an app depends on other factors such as public health measures. At best, it may be a complementary tool in the future. Even in a crisis, a ‘try everything’ approach is dangerous when it ignores the real costs and the opportunity cost of not dedicating resources to something more important. With community broadcasting in all countries, it is time to recognize that travel restrictions and compulsory quarantine alone cannot end the outbreak.
New and efficient creative tools are needed. Ethical preparedness is an important component of the plan to deal with public health emergencies or outbreaks, as it helps to ensure the best standards and quality of delivery without any agreement on human safety and ethical values. Like any health care intervention, COVID-19 apps must conform to ethical evaluation as well as the highest standard of safety and efficacy. Lack of consideration of ethics can destroy confidence in government and public health services. Governments, developers, and deployers should ensure that the COVID-19 contact tracing apps address the above ethical questions satisfactorily and that governments must ensure the necessary but least intrusive measures for disease surveillance.
COVID-19 Digital Contact Tracing Technology – global standards
The COVID-19 DCTT app is inspired by my experiences in South Korea and Singapore. The former is regarded as a model because authorities in Korea claimed it avoided a serious lockdown. As of May 2020, contact tracing apps are available globally. The WHO was used to classify app functions under the categories of clients (general public) data services, health system managers, health workers. Despite the global nature of the epidemic, countries are developing apps independently, and there are no global standards. Like any healthcare intervention, coronavirus apps must conform to the highest standards of efficacy and safety. If a digital proximity tracking application works in a country, these technologies can be effective in other countries with adequate technical infrastructure and security measures for ethical usage. First, a country must already have a widespread of smartphones or other suitable devices and Internet access.
COVID-19 Digital Contact Tracing technology in different countries
There is also some website or app which locate in the map all over world covid infected patient and other than that all countries have their own covid app are as following:
The Corona 100 Meter App shares location and time with officials with CCTV to monitor their movements. The route taken by infected patients will be published online.
The Trace together App requires users to check-in public places using their national identity card or by scanning a QR code with their phone. The population of Singapore has this which means that in any encounter between two randomly selected people.
The Arogya Setu App uses the phone’s Bluetooth and location data and lets users know if they are near the person with COVID-19 by scanning a database of known cases of infection within a proximity of 500 meters. The calculated risk is then shared with the government.
The Alipay Health Code App provides each user with a digital QR code, which is color-coded red, amber, or green to indicate that person’s quarantine status and their ability to move around in this way.
Quarantined people must wear an electronic bracelet that shares their location with local authorities through a leave home safe App.
The COVID Safe App has had close contact with testing positive for COVID, health authorities will be contacted, it is working on a centralized model.
Germany’s Coronawarn up App will store coronavirus data on individuals’ phones. Test results are sent over the phone as alerts. The app was initially centralized but was later decentralized due to protests.
ProteGO App through which citizens in quarantine are required to send geo-tagged ‘selfies’ to the police to prove they are at home.
The NHSX App only works with iOS devices and is incompatible with older Android devices, asking users to self-report their symptoms.
Smittestopp App relies on the user having a formal diagnostic test.
Cuidar App asks users to self-report their symptoms and directs them to treatment centers.
Immuni App can be downloaded voluntarily. It sends a notification to users when coming in contact with positive persons, its launch was delayed due to protests regarding concerns of a privacy breach.
The ways in which Digital Contact Tracing is extending help during COVID-19
How digital data are stored and collected for surveillance and contract tracing. There are two primary forms of contact tracing:
Digital proximity tracing
It involves determining proximity between devices or between an infected person’s location history and is used to determine if someone came into contact with a potential carrier of COVID-19 Yes or No. These data are mainly used for contact tracing.
It is mainly about providing monitoring to determine the locations of people to ascertain the effectiveness of social distancing measures and ‘lockdown’ orders.
Digital proximity tracing can be done using techniques that do not require a central collection of data (eg, Bluetooth technology), and/or collection can be achieved de-identified data without violating personal privacy. Currently not strong evidence on the efficacy of the use of proximity tracing to prevent the COVID-19 pandemic within various regulatory frameworks and contexts.
Unless a government has a mechanism that allows people to self-segregate (and people) are willing to do so) and they also have the systems and resources to allow critical scale testing, contact tracing would be of questionable benefit.
Digital Contact Tracing and surveillance during COVID-19 – general and child-specific ethical issues
Location tracking allows aggregate data to be used to determine where people are not adhering to social elimination measures, without the need to identify individuals. Facial recognition for surveillance presents several privacy concerns as it is less robust. It can be difficult to identify children, contest elections, and they can be difficult and easy to break. Rearrange in addition, the use of Big Data and GPS Data is subject to bias with respect to capture and how many times.
The risk and value of using digital technologies for contact tracing and public health monitoring are central to the large-scale testing campaign COVID-19 response, but public health monitoring and contact tracing can be useful complementary tools. The more we know about the outbreak, the better we can control the virus and reduce its effects. There is a huge demand for information on how to protect ourselves from communities and digital technologies provide the ability to provide this information.
Surveillance and Digital contact tracing enable better speed, reach, and coverage of detection and, in some examples, greater accuracy (compared with personal recall). They also allow for direct communication with those ‘at risk’. But there are also several risks and systemic issues related to technology use and data collection for digital contact tracing and surveillance, included:
- need for access to internet connectivity and smartphones for various contact-tracing;
- applications, with the consequent marginalization of those disadvantaged communities
unable to afford such technology;
- the bypassing of traditional checks; and
- Balances, and speed of the roll-out of the technologies resulting in a lack of scrutiny and oversight from the communities affected by them;
- The difficulty of removing restrictions on privacy and rights when the COVID-19 crisis is over;
- without comprehensive and clear planning.
There are also impact and risk on persons and communities, included:
- discrimination and stigma that could result from identification of the public of an individual as infected or as residing in an area or locality identified as high risk
- Basic rights and loss of privacy, with no proper or not clear indications of when, how, or if these rights of the infringements will be restored
- coercion to participate in digital contact tracing, and negative impacts of false positives on risk, exposure, and perceptions of violations of ordinances.
When technology is used and data is collected, children need to be considered explicitly. But they are often overlooked in discussions about the techniques adopted and the accuracy and impact of the data collected. That is why UNICEF launched the RD4C project partnership with GovLab.
Children are likely to be psychologically more susceptible to any public dissemination of information about their movement and status. They are also likely to experience more long-term effects of lower rights of privacy and other negative by-products of monitoring.
Children are more likely to be effective carriers of COVID-19 than those who fall ill with the virus. Therefore, children are less likely to be alone in concerns and debates related to COVID-19. This difference in disease presentation implies that digital contact tracing between children may be fundamentally different from that of adults.
Serious concerns still exist regarding the potential effects of child tracking, children’s data use, and the child’s public identity as a COVID-19 carrier. The following are key aspects to help in relation to ethical issues in the use of digital technologies for contact tracing and monitoring. This section sets out in detail, and in accordance with RD4C principles, to ensure that human rights are clearly considered in the adoption, implementation, and decommissioning of digital devices and to ensure that the use of such devices or the approach adopted is consistent with the public health goals and outcomes.
The collection of the data and use associated with modified or any new use of digital technologies for contact tracing(DCTT) or monitoring should be limited by the centrally defined purpose of the applied technology. This means that: the objective must be clearly defined, directly address a clear public health goal, and be publicly documented, limiting data collection directly to what is necessary to achieve the central objective of system data should be not reused for other uses.
Wherever possible, composite data should be used in preference to unknown data. In addition, where possible, non-identifying or anonymous data should be used instead of identifiable data and blanket population monitoring options (such as active facial recognition in public places) should be discouraged. Alternative approaches that may be more appropriate include the use of De-identified data stored on a central server with secure encryption keys via Bluetooth technology, with all or most of the personal data only on the user’s device GPS. Live. Data to be stored and maintained on the user’s device (if necessary, only encrypted, aggregate data that is stored centrally, otherwise must be used).
Contact tracing and monitoring data collection should only be performed where: Use of this information has the potential to take appropriate action to inform individuals and families of the increased risk of COVID-19 infection where mass testing is possible. This is necessary not only to reduce the concerns raised by the notification of potential risk and the need to self-isolate but also to ensure that the technology can, in fact, adequately prevent the spread of the disease. – Something that relies on diagnosis where it can be certified that the technology is sufficiently accurate to meet its intended purpose where it is used to inform response, planning, prevention, or monitoring.
Governance structures should include obligations from companies and partner organizations, including the need to prohibit third-party data transfer in the absence of informed consent, and/or a clear legal order consistent with the original purpose of collection of the data.
The adoption, design, and use of any digital technology/ platform for contact tracing or monitoring must be driven by the best interests of the community, informed by a clear understanding of how specific, including women, children, and other potentially weaker groups. How population groups can occur will be affected differently by technology.
Community engagement must occur as early as possible in the implementation, design, and review of monitoring technologies and contact tracing. A transparent, strong framework of system governance that seeks to promote and maintain trust within the community is significant. This should include clearly accessible mechanisms that communities and individuals can use to identify and report concerns and incidents and to receive feedback on subsequent responses.
Protective of children’s rights (and their communities)
- While various population-wide privacy risks apply to juveniles, they require to be explicitly considered when reflecting on the strong effects of digital contact tracing and monitoring. This is obligated by children’s predominantly asymptomatic profiles and the potential for vitally longer-term individual effects. The implementation and design of any digital contact tracing or monitoring program should explicitly reflect the law of international human rights and other legal frameworks for the protection of children and their privacy.
- Digital Contact-tracing technology or surveillance systems should adopt a ‘ design privacy ’ approach, and technologies should maximize person agency and privacy. For example, the approach/ technology chosen should allow for the retention of personal data and individual redress mechanisms, such as data deletion and correction, wherever possible.
- Wherever possible, informed consent should be factored into the digital contact-tracing design or surveillance systems. Where this is impossible to uphold in practice, In the design this should be explicitly acknowledged, which should be supported by transparent and strong governance and accountability mechanisms.
- In the design, access and equity should be explicitly considered, and the use of technologies for digital contact tracing and public health monitoring. Clear strategies for equitable public health results should be in the place where digital solutions are likely to disproportionately (and potentially negatively) affect marginalized communities. Persons should not be penalized for lacking access to relevant technologies for the purposes of digital contact tracing or surveillance. In such examples, mixed approaches combining digital and manual contact-tracing services should be used.
- A person should not be compelled to install or upload relevant systems or applications unless warranted by necessity, legitimacy, and proportionality tests. In the absence of evidence robust on the efficacy of systems/ applications/, and the absence of their widespread adoption, these standards are presently unlikely to be met.
Prevention of harms across the data cycle
Rights and protections of data should be upheld to the fullest extent possible. If there is any relaxation or suspension of these as an outcome of the introduction of contact-tracing or surveillance measures, such a change should be:
- Clearly articulated, with justification given for the required for the change.
- Considered in relation to the effect on weaker groups and appropriate mitigation strategies put in place.
- Time-bound, with the full provisions restored as soon as possible.
Before any centralized data collection for the explicit purpose of digital contact tracing or public health surveillance, or as soon as reasonably practicable, clear terms should be established within relevant regulations in regard to the storage duration and destruction timing of the data. Such terms should be in place for manual systems and should be adapted and reviewed for any new digital/technology-based system
A functional contact tracing system is hypercritical to the safe reopening of national economies. But should such an administration work on the basis of volunteer adoption of digital contact tracing apps by the public? Cities or countries would need to achieve an important threshold of app adoption as they apostle away from stay-at-home orders to selective quarantine time. Else, they would risk triggering the uncontrollable spread of Coronavirus.
So how can governments address persons’ privacy concerns and create the right incentives for people to volunteer to opt into the system by adopting the application and following the rules related to the selective time of quarantine? Three points that can help make this happen are as follows:
Citizens of the whole world will be more comfortable with a digital contact tracing system if it incorporates strong protections for privacy. For instance, while it is true that an application provider will have access to certain interaction data and location, they are not required to be privy to sensitive data of health and while systems of health required access to data of medical, including a Corona patient test status, they don’t need access to the location of the data. One could speculate a system in which a broke perhaps a public or private health institution which tightly controls personalized, sensitive information.
That entity would forge the very important link between location information and health information, sharing the consistent information with digital contact tracing teams and public health authority surveillance for geographic hot spots, but not with other private or public organizations such as immigration authorities or law enforcement. To provide maximum protection for patient privacy, the digital contact tracing application could include an automatic delete function that disinfects sensitive, individual-level information after 14 days. If the option to remove the data purges were more commended, however, if aggregated anonymized data were not canned, researcher and public health authority would lose access to anonymized data about the paths, rates, and outcome of the Corona transmission, the information that is not valuable for tracking hot spots now and for anticipating the likely path of future threats.
Public and private leaders might treat the risk stratification system discussed before as a roadmap for creating incentives within a volunteer adoption system. In principle, downloading and using the application would be voluntary.
However, certain activities—for instance, entry to certain stores, public spaces, bars, restaurants, or public transit—could be limited at the door, via a QR reader, to people who are using the application and are in the green risk category. Not using the application would curtail access to those venues, effectively mimicking the restrictions of a shelter-in-place order. To further encourage application adoption, governments must address technology accessibility barriers, including by offering people financial incentives to upgrade their smartphones. They might also offer other social or financial incentives as an inducement for application adoption.
Quarantine permittance may be interrupted as much by unconcern as by privacy concerns. As a result, governments may find it is needed to enforce and encourage compliance with quarantine permittance. As part of such efforts, governments must provide aid to those under quarantine. Else, if faced with social hardships and severe economic hardship, persons may break their quarantines, undeterminable the effectiveness of containment efforts. A contact tracing application or welfare checks (home visits by nurses or other public health officials) could easily spot quarantine-breaking travels, but they should also be used to reward compliance with food aid, financial support, and essential services for the duration of the self-quarantine.
A unified viral Invigilate system anchored by a technology-enabled contact tracing system offers a work plan for our restart. A system could permit us to move away from universal lockdown measures, instead of implementing selective quarantine rules to thwart the advance of the invisible foe, restore balance to our overloaded health care systems, and put our financials/ economies back to work.
In preparation for reopening after lockdown, the government of India announced its Aarogya Setu digital contact tracing application to be necessary for office workers, with police enforcement in few cases but then concerns mounted. The application had few privacy safeguards. It collected data using both Bluetooth and GPS technologies and stored what it gathered in centralized servers with no protection of data law in place. In response, the Indian government switched the application form necessary to “advisable,” with enough loopholes for institutions to set individual mandates. Further, the application was uploaded to a public GitHub repository, which, in principle, opens the app though not the data it collects to public scrutiny. However, the application stored citizens’ data on centralized servers, which compounded fears of digitally enabled state monitoring systems and this made voluntary adoption difficult.
In considering the adoption of digital contact-tracing technologies, public health departments and governments should be aware of the potential benefits, technical limitations, and inherent trade-offs between privacy and effectiveness. Thresholds that determine the sensitivity and specificity of digital equipment, informed by real-world field testing before release, must be determined for their intended use. The success of digital contact tracing will depend on the ability of underlying technologies to identify clinical trials, widespread adoption, and exposure. The benefits of each approach can be reaped and limitations can be reduced by combining traditional and digital contact tracing.
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