What we must do to beat COVID-19 now and forever, with a big boost from technology

Technology was critical in controlling the COVID-19 pandemic in China and South Korea. Singapore has introduced a mobile phone app to aid in contact tracing, for centuries the cornerstone of stopping epidemics, and says it will make the code available at no charge.

European nations have announced multiple initiatives to develop their own virus-fighting apps and other technology, some of them based on the Singapore model.

In the United States, though, we’re doing little to harness technology to defeat the pandemic, and we don’t seem to have a plan for controlling the virus other than keeping people home, doing more testing, and eventually coming up with a vaccine. What gives?

Dr. Richard Cooper, chair of the Health Sciences Department at the Parkinson School of Health Sciences and Public Health at Loyola University Chicago, says he’s mystified. “The U.S. invented the smartphone,” he says. “That’s exactly the kind of thing that could be leveraged. Other countries are way ahead of us.”

The stakes couldn’t be higher. Social distancing and stay-at-home orders in much of the country have bought us essential time, at the cost of crippling the economy.

We can’t stay home indefinitely. But if we go back to business without rigorous measures to contain the coronavirus, the pandemic will start up all over again. As bad as the current outbreak may be, another one is likely next fall or early winter, as Dr. Robert Redfield, director of the U.S. Centers for Disease Control and Prevention, has warned.

A recent Harvard study suggests that without aggressive contact tracing and quarantining, the only way to control COVID-19 may be a strategy of intermittent lockdowns alternating with renewed outbreaks until “herd immunity” is built up, prolonging the pandemic into 2022 and resulting in thousands of unnecessary deaths.

“That’s not a price anybody should consider paying,” Cooper says. “Contact tracing is one of the right and necessary things to do. You can’t just throw up your hands and say we have too many cases.”

Contact tracing and technology aren’t the only steps needed to prevent the pandemic from resuming once the initial outbreak is under control. Based on conversations with experts plus other research, here’s what I understand must be done before the stay-at-home order can be safely lifted.

Mass testing

Two types of tests are needed. The first is on-demand virus testing to determine if you’re infected with COVID-19 now.

The expert consensus is that Illinois needs to be able to administer at least 4,000 tests per day, about the same as South Korea did per capita during its successful campaign to halt the pandemic. Gov. J.B. Pritzker says the state has reached this level, although days-long delays in obtaining results remain a problem. The governor says he expects testing capacity to reach 10,000 per day by next week.

We need 10,000 tests a day in Illinois to get a better handle on how well the stay-at-home order is working — that’s the major intervention so far. The ultimate goal is to test everyone who needs a test on a regular basis.

The second type of test screens for blood antibodies to determine if you’ve ever had COVID-19, even if you’ve now recovered. The Food and Drug Administration has said it authorized use of a blood test made by Cellex Inc. Wide availability of such a test would likely take time.

Those who have recovered from COVID-19 are thought to be immune to the disease, at least temporarily, and could return to work or volunteer for emergency services. Knowing how much of the population has had COVID-19 would be valuable in determining measures to combat the virus.

Contact tracing

Contact tracing requires tracking down everyone known to have had contact with a COVID-19 patient in the past 14 days and testing them for the virus. The goal is to discover the “index case” — the first person who brought the disease into the community — and then trace out all subsequent links in the chain of transmission.

Traditional contact tracing is labor-intensive — “shoe leather epidemiology,” says Dr. Bala Hota, vice-president and chief analytics officer at Rush University Medical Center. It’s impractical once the virus is widespread, but becomes feasible again if the stay-at-home order works and the initial outbreak subsides.

“It would be really interesting to use technology” to eliminate some of the legwork, Hota says.

TraceTogether, a mobile app recently introduced in Singapore, uses Bluetooth technology to detect nearby phones that also have the app installed. To allay privacy concerns, records of contacts are encrypted and stored locally on the user’s phone, not sent to a central database. The app’s opening screen is shown in the illustration.

If a TraceTogether user becomes infected, public health authorities download and decrypt the data with the user’s permission and call close contacts, telling them to get tested.

Using the app is voluntary, but the public has a strong incentive to do so — they’re protecting their family, friends and fellow citizens, and are notified themselves if they come into contact with the virus. The app was launched on March 20 and now has 950,000 users, a Singapore government website says.

Singapore authorities have said they will make the code for the TraceTogether app available to software developers at no charge. European authorities are investigating a similar approach that will meet the European Union’s stringent privacy regulations.

Even if contact tracing technology comes into wide use, a sizable staff will be needed to call contacts and track down cases that slip through the cracks. A World Health Organization report on the coronavirus response in China found that 1,800 teams of at least five people each traced tens of thousands of contacts per day to help control the outbreak in Wuhan.

“We need to massively gear up the capacity to do contact tracing and surveillance,” Cooper says. “We need training and a command center to manage people.”

Quarantine

People testing positive for COVID-19 must be isolated while contagious. The same is true of visitors from other regions where the virus remains uncontrolled.

Most COVID-19 patients don’t require hospitalization and can self-quarantine on their own. Technology can be used to ensure compliance.

South Korea requires new arrivals to that country to submit to a 14-day quarantine that is monitored by a mandatory smartphone app that tracks their location. University of Illinois engineering grad Ryan Shin, now a tech entrepreneur in Seoul, provided a screenshot of the Korean quarantine tracking app, shown in the accompanying illustration.

Each quarantined individual is assigned a case officer, whose number must be entered into the app. Users are asked to report any symptoms; those who become seriously ill are taken to a hospital.

The app tracks the user’s location. If the system detects that a user has left quarantine, an alarm is sent to the case officer. Quarantine violators are taken into custody, Shin says.

Travel restrictions

Once the virus is under control locally, steps must be taken to prevent visitors from re-introducing the disease. This will require a range of measures both regionally and nationally.

International visitors may need to be quarantined, as in Korea, or given results-while-you-wait virus testing once kits become widely available.

The United Kingdom and Germany are considering “immunity passports” that would allow those who’ve recovered from COVID-19 to bypass restrictions.

Regional restrictions also will be needed within the U.S. to permit normal life to resume in areas where the virus is under control while preventing an influx of visitors from hot spots. In China, authorities set up roadblocks around Wuhan to prevent travel, an approach not likely to fly in the U.S.

In Chicago, an added complication is that the metropolitan area sprawls across three states, with commuters arriving in the Loop daily by train and car from Wisconsin and Indiana. To minimize checkpoints and delays, it may be necessary for the three states to jointly establish a regional pass system or the like until the crisis is over.

In the absence of national guidance, state and local governments will need to figure such things out on their own.

“Ideally what we need is a single plan that every country follows, but that’s not going to happen,” Cooper says. “Regional action could be effective — it obviously helps. Anything we can do, we should do.”

We have till the end of the stay-at-home order — currently set to expire April 30 — to implement a workable plan to prevent COVID-19 from returning. We’d better get on it.

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