CDC is expected to tell Americans to wear cloth masks, save medical masks for health workers

On Thursday, the White House said that it will likely soon adjust previous guidelines that discouraged non-health workers from wearing face masks. The change would be issued as “guidance” from the CDC, but according to the president—who continues to hesitate at exerting federal power during the COVID-19 crisis—it will not be made mandatory.

Supplies of medical-grade masks are still running critically low in many places hard hit—or soon to be hard hit—by the coronavirus. Due to ongoing shortages, the new guidance is expected to concern cloth and non-medical face coverings only.

In Thursday’s White House press briefing, Dr. Deborah Birx, coronavirus task force response coordinator, stressed that the updated guidance was an “additive” protective measure and not meant as a substitute. “When the advisory comes out… if it comes out… it will be an additive piece,” Birx said.

Birx suggested that the White House and CDC hesitated to offer the new mask advice due to concerns that people would relax critical social distancing measures that will prove key to U.S. containment efforts.”We don’t want people to feel like ‘oh i’m wearing a mask, I’m protected and I’m protecting others.'”

As Birx explained the thinking behind the new precaution of cloth masks, Trump offered his own unfounded interpretation of the information. “If people wanted to wear them, they can,” Trump said. “In many cases, the scarf is better, it’s thicker” he added, incorrectly.

The new guidance is expected in the coming days and will come from the Centers for Disease Control and Prevention (CDC). In memos obtained by the Washington Post, the CDC began considering the cloth mask recommendation due to evidence that people without symptoms are transmitting the virus. A draft copy of the policy states that the CDC “… recommends the community use of cloth masks as an additional public health measure people can take to prevent the spread of virus to those around them.”

On Wednesday, Los Angeles Mayor Eric Garcetti urged residents to cover their faces in public while making a point to stress that N95 and surgical masks go straight to medical workers.

A grassroots effort of crafters is already springing up around the country to create home-sewn masks for health workers unable to get proper PPE and others who want to take the protective measure. Many online resources offer patterns and how-to resources on mask construction and even no-sew methods. New federal recommendations around cloth masks could also provide an opportunity for businesses to offer helpful resources in the fight against COVID-19, as many companies make creative moves to stay afloat.

While mask-wearing is routine even outside of pandemic times in countries like Japan and South Korea, Western countries are generally less comfortable with the practice. Social norms may be compounded by confusing messaging from officials who urged Americans to donate medical masks to health workers at the same time as suggesting the masks do not provide protection against the virus in everyday situations.

“Seriously people- STOP BUYING MASKS!” U.S. Surgeon General Jerome Adams tweeted in late February. “They are NOT effective in preventing general public from catching #Coronavirus, but if healthcare providers can’t get them to care for sick patients, it puts them and our communities at risk!”

That messaging may have proved expedient in the earliest days of the crisis as Americans hoarding masks for personal use could worsen an already constricted supply of personal protective equipment for medical personnel.

Cloth masks are less effective than medical masks, but their use, even if imperfect, is better than nothing at helping limit the spread of the virus. In one prescient small 2013 study examining the efficacy of homemade masks in the event of a flu pandemic, researchers recommended cloth masks “be considered only as a last resort… but it would be better than no protection.”

That research, published by Cambridge University Press, found that both homemade cloth masks and traditional surgical masks “significantly” reduced the amount of potentially infectious droplets expelled by the wearer, though surgical masks were three times better for preventing transmission. Because homemade masks are less disposable than medical masks, they should be washed after use to get rid of infectious droplets.

On Thursday, health officials were careful to stress that using a mask does not mean that it’s okay to relax physical distancing measures.

“Just remember it’s not a substitute for everything that we’re asking people to do!” Birx said.

FCC enacts $200M telehealth initiative to ease COVID-19 burden on hospitals

The FCC has developed and approved a $200 million program to fund telehealth services and devices for medical providers, just a week or so after the funding was announced. Hospitals and other health centers will be able to apply for up to $1M to cover the cost of new devices, services, and personnel.

The unprecedented $2 trillion CARES Act includes heavy spending on all kinds of things, from direct payments to out-of-work citizens to bailouts for airlines and other big businesses. Among the many, many funding items was a $200M earmark for the FCC with which it was instructed to improve and subsidize telehealth services around the country.

Telehealth comprises many services, from something as simple as making appointments online, to using internet-connected monitoring devices, to conducting an entire primary care visit via video chat. The latter is an incredibly important option for doctors and nurses who not only need to avoid direct contact with potentially sick patients if possible, but also need every spare minute they can muster.

“The toll this pandemic is taking on our healthcare system is clear. To the extent that connectivity solutions can provide immediate assistance with remote care and monitoring, we should use them. There is already evidence across the country that this works,” said Commissioner Jessica Rosenworcel in a statement accompanying the order.

Unfortunately telehealth systems are by no means simple or easy to implement, given that they must not only meet highly stringent privacy requirements like HIPAA, but also be effortless to use for people who might not use video chat for any other purpose. Setting aside space, equipment, budget, and so on for telehealth operations is difficult and time-consuming in the best of times, let alone when care centers are overwhelmed and understaffed. Even hospitals that provide some telehealth services are likely to find demand far outstripping supply right now.

The $200M FCC program is aimed at mitigating this as simply and quickly as possible. “I’m hard-pressed these days to think of any better use case for the agency’s mission of advancing connectivity than telemedicine,” said FCC Chairman Ajit Pai in a statement.

As the order, passed unanimously today, describes it:

The support provided through the COVID-19 Telehealth Program wil help eligible health care providers purchase telecommunications services, information services, and devices necessary to provide critical connected care services, whether for treatment of coronavirus or other health conditions during the coronavirus pandemic.

“Eligible” in this case means on the following list of types of organizations or combinations thereof:

  • Medical schools and teaching hospitals
  • Community health centers and migrant care centers
  • Local health agencies and departments
  • Community mental health centers
  • Not-for-profit hospitals
  • Rural health clinics
  • Skilled nursing facilities (e.g. long term care facilities)

Any given entity may be awarded up to $1M in funding depending on its need and reach. Priority is being given to areas especially hard-hit by the virus and chronically underfunded places like clinics in poor neighborhoods that subsist on Medicare payments and the like.

There are a few restrictions as to what the funds can be used for — for instance, only internet-connected monitoring devices are covered, not ordinary “offline” ones that the patient must relay the results from via other services. But the general idea is to stay flexible and let the recipients of this money decide what to do with it.

Rosenworcel tempered her hopeful remarks with some practical feedback for the order, which was by necessity somewhat rushed.

“This is a well-intended effort, but it lacks clear performance metrics,” she said. “That means it will disburse funds without a system for measuring outcomes or a plan for what comes after this pilot program reaches its end. Moreover, it does not focus on a specific problem in healthcare.”

Better, of course, that the money is available now and accounted for later, since we are presently in the throes of the crisis.

A second $100M program was also authorized, by which money taken from the FCC’s main budget takes a longer-term approach to engendering telehealth over the next two years. That program differs in some key ways (not covering connected devices, for one) and will play out in slower fashion but provide ongoing support.

The FCC has several ongoing efforts to “Keep Americans Connected,” as it puts it, from institutional programs like this one to extracting promises from broadband providers not to fine people for data overages or late payments. You can find a list of its work here.

White House says it is ordering more companies to make ventilators

With national the stockpile’s inventory of life-saving healthcare equipment getting dangerously close to zero, President Trump on Thursday signaled that he will leverage a key national security provision to order additional companies to produce ventilators.

Trump’s reluctance to employ the law known as the Defense Production Act (DPA) has puzzled many as the administration attempts to right the myriad early wrongs that allowed the novel coronavirus to spread within the nation’s borders—an unprecedented modern public health crisis expected to claim as many as 200,000 lives in the U.S.

“Today, I have issued an order under the Defense Production Act to more fully ensure that domestic manufacturers can produce ventilators needed to save American lives,” Trump said in a statement. “My order to the Secretary of Health and Human Services and the Secretary of Homeland Security will help domestic manufacturers like General Electric, Hill-Rom, Medtronic, ResMed, Royal Philips, and Vyaire Medical secure the supplies they need to build ventilators needed to defeat the virus.”

The order will enable Health and Human Services Secretary Alex Azar to use “any and all authority available” to steer production efforts.

After much early confusion around the president’s willingness to invoke the DPA without actually putting it to use, Trump appeared to change course and on Friday wielded the law against General Motors which had already announced its intention to start manufacturing ventilators in spite of a lack of federal guidance. That heel-turn came two days after the Trump was poised to announce a deal with GM and ventilator maker Ventec Life Systems to produce up to 80,000 devices. The announcement was reportedly scuttled when the White House and FEMA balked at the effort’s $1 billion price tag.

Trump has repeatedly called the crisis-level demand for ventilators, masks and other medical supplies into question. “I have a feeling that a lot of the numbers that are being said in some areas are just bigger than they’re going to be,” Trump told Fox News host Sean Hannity last week. “I don’t believe you need 40,000 or 30,000 ventilators.” The president has also repeatedly questioned the nationwide shortage of N95 masks and other basic health protective gear, suggesting that in New York health facilities are somehow losing the masks or allowing them to be stolen, a false claim for which there is no evidence.

As states still compete for vital life-saving resources, federal orders through the DPA would force any private companies on the receiving end of an order to prioritize federal contracts. The law also allows the federal government to use its muscle to ensure that supply chains are able to produce and provide materials every step of the way. While much has been made of the law’s potency to mobilize supplies in the midst of a national crisis, the Trump administration will likely need to actively manage and coordinate with these newly-tapped manufacturers to see such orders through.

In dragging its feet to issue orders through the DPA, Trump appeared to put full faith in the private sector to step up on their own without a directive from the White House. While some companies indeed did just that, those nascent production efforts are nowhere near meeting demand and distribution issues are not resolved. As the outbreak threatens regions around the nation, many states forge ahead without vital life-saving supplies as the acute health crisis unfolding in New York offers a glimpse of a potentially disastrous near-future.

Pinterest CEO and a team of leading scientists launch a self-reporting COVID-19 tracking app

There have been a few scattered efforts to leverage crowd-sourced self-reporting of symptoms as a way to potentially predict and chart the progress of COVID-19 across the U.S., and around the world. A new effort looks like the most comprehensive, well-organized and credibly backed yet, however – and it’s been developed in part by Pinterest co-founder and CEO Ben Silbermann.

Silbermann and a team from Pinterest enlisted the help of high school friend, and CRISPR gene-editing pioneer / MIT and Harvard Broad Institute member Dr. Feng Zhang to build what Silbermann termed in a press release a “bridge between citizens and scientists.” The result is the ‘How We Feel’ app that Silbermann developed along with input from Zhang, and a long list of well-regarded public health, computer science, therapeutics, social sincere and medical professors from Harvard, Stanford, MIT, Weill Cornell and more.

How We Feel is a mobile app available for both iOS and Android, which is free to download, and which is designed to make it very easy to self-report whether or not they feel well – and if they’re feeling unwell, what symptoms they’re experiencing. It also asks for information about whether or not you’ve been tested for COVID-19, and whether you’re self-isolation, and for how long. The amount of interaction required is purposely streamlined to make it easy for anyone to contribute daily, and to do so in a minute or less.

The app doesn’t ask for or collect info including name, phone numb or email information. It includes an up-front request that users agree to donate their information, and the data collected will be aggregated and then shared with researchers, public health professionals and doctors, including those who are signed on as collaborators with the project, as well as others (and the project is encouraging collaborators to reach out if interested). Part of the team working on the project are experts in the field of ‘differential privacy,’ and a goal of the endeavor is to ensure that people’s information is used responsibly.

The How We Feel app is, as mentioned, one of a number of similar efforts out there, but this approach has a number of advantages when compared to existing projects. First, it’s a mobile app, whereas some rely on web-based portals that are less convenient for the average consumer, especially when you want continued use over time. Second, they’re motivating use through positive means – Silbermann and his wife Divya will be providing a donated meal to non-profit feeding America for every time a person downloads and uses the app for the first time, up to a maximum of 10 million meals. Finally, it’s already designed in partnership with, and backed by, world-class academic institutions and researchers, and seems best-positioned to be able to get the information it gathers to the greatest number of those in a position to help.

How We Feel is organized as an entirely independent, non-profit organization, and it’s hoping to expand its availability and scientific collaboration globally. It’s an ambitious project, but also one that could be critically important in supplementing testing efforts and other means of tracking the progress and course of the spread of SARS-CoV-2 and COVID-19. While self-reported information on its own is far fro a 100 percent accurate or reliable source, taken in aggregate at scale, it could be a very effective leading indicator of new or emerging viral hotspots, or provide scientific researches with other valuable insights when used in combination with other signals.

Henry Ford Health System to conduct first large U.S. study of hydroxychloroquine’s ability to prevent COVID-19

Despite false assertions by the President to the contrary, any potential treatments to counter or prevent COVID-19 are still only at the stage of early investigations, which include one-off treatment with special individual case authorizations, and small-scale clinical examinations. Nothing so far has approached the level of scrutiny needed to actually say anything definitively about their actual ability to treat COVID-19 or the SARS-CoV-2 virus that causes it, but the first large-scale U.S. clinical study for one treatment candidate is seeking volunteers and looking to get underway.

The study will be conducted by the Henry Ford Health System, which is seeking 3,000 volunteers from healthcare and first responder working environments. Depending on response, the researchers behind the study are looking to begin as early as next week. Study lead researcher Dr. William W. O’Neil said in a press release announcing the study that the goal is to seek a more definitive scientific answer to the question of whether or not hydroxychloroquine might work as a preventative medicine to help protect medical frontline workers with greater risk exposure from contracting the coronavirus.

Hydroxychloroquine (as well as chloroquine) has been in the spotlight as a potential COVID-19 treatment due mostly to repeated name-check that President Trump has given the drug during his daily White House coronavirus task force press briefings. Trump has gone too far in suggesting that the drug, which is commonly used both as an anti-malarial, and in the treatment of rheumatoid arthritis and lupus, could be an effective treatment and should be thrust into use. At one point, he claimed that he FDA had granted an emergency approval for its use as a COVID-19 treatment, but Dr. Anthony Fauci clarified that it was not approved for that use, and that clinical studies still need to be performed to evaluate how it works in addressing COVID-19.

Studies thus far around hydroxychloroquine have been small-scale, as mentioned. One, conducted by researchers in France, produced results that indicated the drug was effective in treating those already infected, particularly when paired with a specific antibiotic. Another, more recent study from China showed that there was no difference in terms of viral duration or symptoms when comparing treatment with hydroxychloroquine with treatment using standard anti-viral drugs, already a common practice in addressing cases of the disease.

This Henry Ford study looks like it could provide better answers to some of these questions around the drug, though the specific approach of seeking to validate prophylactic (preventative) use will mean treatment-oriented applications will still have to be studied separately. The design of the study will be a true blind study, with participants split into three groups that receive “unidentified, specific pills” (possibly anti-virals or some equivalent); hydroxychloroquine; or placebo pills, respectively. They won’t know which they’ve received, and they’ll be contacted by researchers running the study weekly, then in-person both at week four and week eight to determine if they have any symptoms of COVID-19, or any side effects from the medication. They’ll get regular blood draws, and the results will be compared to see if there’s any difference between each cohort in terms of how many contracted COVID-19.

These are frontline healthcare workers, so in theory they should unfortunately be at high risk of contracting the disease. That, plus the large sample size, should provide results that provide much clearer answers about hydroxychloroquine’s potential preventative effects. Even after the study is complete, other competing large-scale trials would ideally be run to prove out or cast doubt on these results, but we’ll be a better position than we are now to say anything scientifically valid about the drug and its use.

Instacart to provide shoppers with face masks, hand sanitizers and thermometers

Instacart will start providing health and safety kits to its full-service shoppers. These kits will include a face mask, hand sanitizer and a thermometer, the company announced today.

The kits will be available for free to shoppers starting next week. Shoppers, according to Instacart, will be able to request a kit by registering with their Instacart shopper email address. In order to keep up with demand, Instacart will update its inventory daily. For in-store shoppers, Instacart will bring the face masks to shoppers at their respective retail locations.

“Our teams have been working around the clock over the last few weeks to proactively secure personal protective equipment like hand sanitizer and face masks, without taking away valuable resources from healthcare workers given inventory delays and global supply scarcity,” Instacart President Nilam Ganenthiran said in a statement. “We want to provide customers with an essential service they can rely on to get their groceries and household goods, while also offering safe and flexible earnings opportunities to Instacart personal shoppers. As COVID-19 evolves, today’s health and safety solutions will be tomorrow’s table stakes, and our teams are working quickly to introduce new services and features to ensure our shopper community is supported as this situation unfolds.”

This announcement comes amid worker strikes led by the folks over at Gig Workers Collective. Last Friday, a group of Instacart shoppers announced plans to strike and not return to work until the company meets its demands. Those demands were for Instacart to provide personal protective equipment at no cost to workers and hazard pay of $5 extra per order, change the default tip to 10%, extend the sick pay policy to those who have a doctor’s note for a pre-existing condition that may make them more susceptible to contracting the virus and extend the deadline to qualify for those benefits beyond April 8th.

Instacart has since extended that deadline and changed the default tip to a customer’s last tip, but shoppers say that’s not enough. In a Medium post, workers called Instacart’s response “insulting” and “a sick joke.

“It’s abhorrent that it took this long for them to act, but on the bright side, it shows that a strike will work to change their behavior,” the group wrote in a Medium post.

Instacart is not the only company stepping up its safety protocols. Earlier today, Amazon said it would start providing surgical masks for its warehouse workers and employees at Whole Foods.

Google and USCF collaborate on machine learning tool to help prevent harmful prescription errors

Machine learning experts working at Google Health have published a new study in tandem with the University of California San Francisco (UCSF)’s computational health sciences department that describes a machine learning model the researchers built that can anticipate normal physician drug prescribing patterns, using a patient’s electronic health records (EHR) as input. That’s useful because around 2 percent of patients who end up hospitalized are affected by preventable mistakes in medication prescriptions, some instances of which can even lead to death.

The researchers describe the system as working in a similar manner to automated, machine learning-based fraud detection tools that are commonly used by credit card companies to alert customers of possible fraudulent transactions: They essentially build a baseline of what’s normal consumer behavior based on past transactions, and then alert your bank’s fraud department or freeze access when they detect a behavior that is not in line with and individual’s baseline behavior.

Similarly, the model trained by Google and UCSF worked by identifying any prescriptions that “looked abnormal for the patient and their current situation.” That’s a much more challenging proposition in the case of prescription drugs, vs. consumer activity – because courses of medication, their interactions with one another, and the specific needs, sensitivities and conditions of any given patient all present an incredibly complex web to untangle.

To make it possible, the researchers used electronic health records from de-identified patient that include vital signs, lab results, prior medications and medical procedures, as well as diagnoses and changes over time. They paired this historical data with current state information, and came up with various models to attempt to output an accurate prediction of a course of prescription for a given patient.

Their best-performing model was accurate “three quarters of the time,” Google says, which means that it matched up with what a physician actually decided to prescribe in a large majority of cases. It was also even more accurate (93%) in terms of predicting at least one medication that would fall within a top ten list of a physician’s most likely medicine choices for a patient – even if its top choice didn’t match the doctor’s.

The researchers are quick to note that though the model thus far has been fairly accurate in predicting a normal course of prescription, that doesn’t mean it’s able to successfully detect deviations from that yet with any high degree of accuracy. Still, it’s a good first step upon which to build that kind of flagging system.

Forward launches ‘Forward At Home’ primary care service to address COVID-19 healthcare crunch

The global coronavirus pandemic has already caused a tremendous strain on healthcare resources around the world, and it’s leading to a shift in how healthcare is offered. Startup Forward, which debuted in 2016 and has since expanded its tech-focused primary care medical practice to locations in major cities across the U.S., is launching a new initiative called ‘Forward At Home’ that reflects those changes and adapts its care model accordingly.

Forward’s primary differentiator is its focus on what it terms a patient’s ‘baseline,’ which is established by an in-person visit they make when they join that employs a body scanner at a doctor’s office to take a number of readings and produce an interactive chart displayed on-screen in the doctor’s exam room. Forward founder and CEO Adrian Aoun, who previously led special projects at Google before building the health tech company, said that as the company has ramped its efforts to support patients during the COVID-19 pandemic, including through in-clinic and drive-through testing, it also wanted to address the ongoing need for care for non-COVID patients.

“If people aren’t leaving their homes, and frankly, you don’t really want them to leave their homes unless you need them to, you have to figure out how to do all that remotely,” Aoun said in an interview, referring to Forward’s comprehensive biometric data gathering process. “So we’ve we’ve implemented a bunch of different things as rapidly as possible. The first is, how do we collect some biometrics – so we put together a kit that has a bunch of sensors in it that we actually mail to you. This includes an EKG, a connected thermometer, connected blood pressure cuff and a pulse oximeter.”

This approach provides a whole new level of remote care, over and above what’s typically defined as “telemedicine,” which generally amounts to little more than video calls with doctors, Aoun points out. Forward’s approach includes automated vitals monitoring for alerting a doctor if a patient needs intervention, and a patient has access to all their own data in the app as well. The Forward At Home product also take their exam room smart display and brings it to their mobile devices, presenting it for shared consultation between doctor and patient during viral visits, which are available 24/7 to Forward members.

At launch, the service also includes home visits to collect urine and blood samples, as an added measure designed specifically to help patients adhere to CDC and health agency guidelines around self-isolation while also getting a detailed and thorough level of care. Aoun says that this part of the offering doesn’t make sense at scale, and will likely revert to in-clinic visits once the COVID-19 crisis passes.

The rest of the model, though spurred into deployment because of the coronavirus conditions, and the need to limit the number of people going in to medical facilities and hospital all across the country unless they absolutely need to, is here to stay, however. Aoun says that Forward’s goal has always been to address the need for tech-friendly, advanced and comprehensive primary care for everyone, but that it took an approach similar to Tesla’s by addressing the top end of the market first in order to be able to fund development of more broadly available services later on.

Meanwhile, the need to shift as much care as possible to in-home is pressing, and evidence from countries around the world is increasingly pointing to how important that is to stopping the spread.

“The big thing to flatten the curve, the whole point of it, is that the hospitals are going to be overrun,” Aoun said. “So you want to take as many cases as you can, where they don’t actually have to be in the ICU, and treat them outside of the ICU – that’s your first principle. Then your second principle is, and China kind of discovered this early […] they started moving to getting people out of the hospitals, as much as possible for a second reason, which is not that the hospitals are overloaded, but that the hospitals are one of the fastest ways to spread COVID-19.”

That’s a perspective also supported by lessons shared from Italian medical professionals in their effort to deal with the COVID-19 situation there, which has essentially decimated large parts of their medical facility infrastructure.

Forward is also still continuing the other work it’s doing to address COVID-19 needs, including providing its risk assessment screening tool to all, as well as offering testing via clinics and drive-throughs to members, as well as mental health support. It’s also looking to expand its drive-through testing to new sites across the U.S. The Forward At Home initiative, meanwhile, will help ensure that clients who have other pressing health needs aren’t left behind while the effort to combat COVID-19 continues.

Detroit to be first to deploy Abbott Labs’ 5-minute COVID-19 test, mayor says

Detroit Mayor Mike Duggan said today on Wolf Blitzer’s CNN show that the city of Detroit is on track to be the first city to deploy Abbott Labs’ five-minute COVID-19 test. The mayor said that the test would be available for first responders. The goal, he said, was to allow those first responders who are self-isolating but have yet to test positive for the virus.

The city of Detroit received the Abbott Labs tests today, April 1. They will be available for use within the next 24 hours, the mayor said.

This system from Abbott received emergency clearance for use in the U.S. Food and Drug Administration. It’s a lab-in-a-box that is roughly the size of a small kitchen appliance. The small size and rapid test results mean it can be deployed and utilized more quickly than other methods.

The City of Detroit is getting hit, especially hard by the novel coronavirus. According to recent numbers, the counties around Detroit contain 81% of Michigan’s 7,615 coronavirus cases. Over 20% of the 2,500-strong police force is quarantined with suspected instances of Covid-19.

The significant number of cases in Detroit led the mayor to go outside of traditional channels to obtain the tests first.

As The Washington Post tells it, Mayor Mike Duggan secured the cellphone number of Miles White, the chairman and outgoing CEO of Abbot Labs, and woke him up Sunday morning to beg for the test. This early morning phone call netted the city five machines and 5,000 tests.

Today the company said in a tweet that it’s making the system available this week in an urgent care setting in the U.S. where the company already has instrumentation. Abbott Labs says it already holds the most significant molecular point-of-care footprint in the U.S.,” and is “widely available” across doctor’s offices, urgent care clinics, emergency rooms, and other medical facilities.

Abbott expects it will be able to produce 5 million tests in April, split between the new rapid tests and traditional lab tests that received emergency authorization from the FDA on March 18.

An EU coalition of techies is backing a “privacy-preserving” standard for COVID-19 contacts tracing

A European coalition of techies and scientists drawn from at least eight countries, and led by Germany’s Fraunhofer Heinrich Hertz Institute for telecoms (HHI), is working on contacts-tracing proximity technology for COVID-19 that’s designed to comply with the region’s strict privacy rules — officially unveiling the effort today.

China-style individual-level location-tracking of people by states via their smartphones even for a public health purpose is hard to imagine in Europe — which has a long history of legal protection for individual privacy. However the coronavirus pandemic is applying pressure to the region’s data protection model, as governments turn to data and mobile technologies to seek help with tracking the spread of the virus, supporting their public health response and mitigating wider social and economic impacts.

Scores of apps are popping up across Europe aimed at attacking coronavirus from different angles. European privacy not-for-profit, noyb, is keeping an updated list of approaches, both led by governments and private sector projects, to use personal data to combat SARS-CoV-2 — with examples so far including contacts tracing, lockdown or quarantine enforcement and COVID-19 self-assessment.

The efficacy of such apps is unclear — but the demand for tech and data to fuel such efforts is coming from all over the place.

In the UK the government has been quick to call in tech giants, including Google, Microsoft and Palantir, to help the National Health Service determine where resources need to be sent during the pandemic. While the European Commission has been leaning on regional telcos to hand over user location data to carry out coronavirus tracking — albeit in aggregated and anonymized form.

The newly unveiled Pan-European Privacy-Preserving Proximity Tracing (PEPP-PT) project is a response to the coronavirus pandemic generating a huge spike in demand for citizens’ data that’s intended to offer not just an another app — but what’s described as “a fully privacy-preserving approach” to COVID-19 contacts tracing.

The core idea is to leverage smartphone technology to help disrupt the next wave of infections by notifying individuals who have come into close contact with an infected person — via the proxy of their smartphones having been near enough to carry out a Bluetooth handshake. So far so standard. But the coalition behind the effort wants to steer developments in such a way that the EU response to COVID-19 doesn’t drift towards China-style state surveillance of citizens.

While, for the moment, strict quarantine measures remain in place across much of Europe there may be less imperative for governments to rip up the best practice rulebook to intrude on citizens’ privacy, given the majority of people are locked down at home. But the looming question is what happens when restrictions on daily life are lifted?

Contacts tracing — as a way to offer a chance for interventions that can break any new infection chains — is being touted as a key component of preventing a second wave of coronavirus infections by some, with examples such as Singapore’s TraceTogether app being eyed up by regional lawmakers.

Singapore does appear to have had some success in keeping a second wave of infections from turning into a major outbreak, via an aggressive testing and contacts-tracing regime. But what a small island city-state with a population of less than 6M can do vs a trading bloc of 27 different nations whose collective population exceeds 500M doesn’t necessarily seem immediately comparable.

Europe isn’t going to have a single coronavirus tracing app. It’s already got a patchwork. Hence the people behind PEPP-PT offering a set of “standards, technology, and services” to countries and developers to plug into to get a standardized COVID-19 contacts-tracing approach up and running across the bloc.

The other very European flavored piece here is privacy — and privacy law. “Enforcement of data protection, anonymization, GDPR [the EU’s General Data Protection Regulation] compliance, and security” are baked in, is the top-line claim.

“PEPP-PR was explicitly created to adhere to strong European privacy and data protection laws and principles,” the group writes in an online manifesto. “The idea is to make the technology available to as many countries, managers of infectious disease responses, and developers as quickly and as easily as possible.

“The technical mechanisms and standards provided by PEPP-PT fully protect privacy and leverage the possibilities and features of digital technology to maximize speed and real-time capability of any national pandemic response.”

Hans-Christian Boos, one of the project’s co-initiators — and the founder of an AI company called Arago –discussed the initiative with German newspaper Der Spiegel, telling it: “We collect no location data, no movement profiles, no contact information and no identifiable features of the end devices.”

The newspaper reports PEPP-PT’s approach means apps aligning to this standard would generate only temporary IDs — to avoid individuals being identified. Two or more smartphones running an app that uses the tech and has Bluetooth enabled when they come into proximity would exchange their respective IDs — saving them locally on the device in an encrypted form, according to the report.

Der Spiegel writes that should a user of the app subsequently be diagnosed with coronavirus their doctor would be able to ask them to transfer the contact list to a central server. The doctor would then be able to use the system to warn affected IDs they have had contact with a person who has since been diagnosed with the virus — meaning those at risk individuals could be proactively tested and/or self-isolate.

On its website PEPP-PT explains the approach thus:

Mode 1
If a user is not tested or has tested negative, the anonymous proximity history remains encrypted on the user’s phone and cannot be viewed or transmitted by anybody. At any point in time, only the proximity history that could be relevant for virus transmission is saved, and earlier history is continuously deleted.

Mode 2
If the user of phone A has been confirmed to be SARS-CoV-2 positive, the health authorities will contact user A and provide a TAN code to the user that ensures potential malware cannot inject incorrect infection information into the PEPP-PT system. The user uses this TAN code to voluntarily provide information to the national trust service that permits the notification of PEPP-PT apps recorded in the proximity history and hence potentially infected. Since this history contains anonymous identifiers, neither person can be aware of the other’s identity.

Providing further detail of what it envisages as “Country-dependent trust service operation”, it writes: “The anonymous IDs contain encrypted mechanisms to identify the country of each app that uses PEPP-PT. Using that information, anonymous IDs are handled in a country-specific manner.”

While on healthcare processing is suggests: “A process for how to inform and manage exposed contacts can be defined on a country by country basis.”

Among the other features of PEPP-PT’s mechanisms the group lists in its manifesto are:

  • Backend architecture and technology that can be deployed into local IT infrastructure and can handle hundreds of millions of devices and users per country instantly.
  • Managing the partner network of national initiatives and providing APIs for integration of PEPP-PT features and functionalities into national health processes (test, communication, …) and national system processes (health logistics, economy logistics, …) giving many local initiatives a local backbone architecture that enforces GDPR and ensures scalability.
  • Certification Service to test and approve local implementations to be using the PEPP-PT mechanisms as advertised and thus inheriting the privacy and security testing and approval PEPP-PT mechanisms offer.

Having a standardized approach that could be plugged into a variety of apps would allow for contacts tracing to work across borders — i.e. even if different apps are popular in different EU countries — an important consideration for the bloc, which has 27 Member States.

However there may be questions about the robustness of the privacy protection designed into the approach — if, for example, pseudonymized data is centralized on a server that doctors can access there could be a risk of it leaking and being re-identified. And identification of individual device holders would be legally risky.

Europe’s lead data regulator, the EDPS, recently made a point of tweeting to warn an MEP (and former EC digital commissioner) against the legality of applying Singapore-style Bluetooth-powered contacts tracing in the EU — writing: “Please be cautious comparing Singapore examples with European situation. Remember Singapore has a very specific legal regime on identification of device holder.”

A spokesman for the EDPS told us it’s in contact with data protection agencies of the Member States involved in the PEPP-PT project to collect “relevant information”.

“The general principles presented by EDPB on 20 March, and by EDPS on 24 March are still relevant in that context,” the spokesman added — referring to guidance issued by the privacy regulators last month in which they encouraged anonymization and aggregation should Member States want to use mobile location data for monitoring, containing or mitigating the spread of COVID-19. At least in the first instance.

“When it is not possible to only process anonymous data, the ePrivacy Directive enables Member States to introduce legislative measures to safeguard public security (Art. 15),” the EDPB further noted.

“If measures allowing for the processing of non-anonymised location data are introduced, a Member State is obliged to put in place adequate safeguards, such as providing individuals of electronic communication services the right to a judicial remedy.”

We reached out to the HHI with questions about the PEPP-PT project and were referred to Boos — but at the time of writing had been unable to speak to him.

“The PEPP-PT system is being created by a multi-national European team,” the HHI writes in a press release about the effort. “It is an anonymous and privacy-preserving digital contact tracing approach, which is in full compliance with GDPR and can also be used when traveling between countries through an anonymous multi-country exchange mechanism. No personal data, no location, no Mac-Id of any user is stored or transmitted. PEPP-PT is designed to be incorporated in national corona mobile phone apps as a contact tracing functionality and allows for the integration into the processes of national health services. The solution is offered to be shared openly with any country, given the commitment to achieve interoperability so that the anonymous multi-country exchange mechanism remains functional.”

“PEPP-PT’s international team consists of more than 130 members working across more than seven European countries and includes scientists, technologists, and experts from well-known research institutions and companies,” it adds.

“The result of the team’s work will be owned by a non-profit organization so that the technology and standards are available to all. Our priorities are the well being of world citizens today and the development of tools to limit the impact of future pandemics — all while conforming to European norms and standards.”

The PEPP-PT says its technology-focused efforts are being financed through donations. Per its website, it says it’s adopted the WHO standards for such financing — to “avoid any external influence”.

Of course for the effort to be useful it relies on EU citizens voluntarily downloading one of the aligned contacts tracing apps — and carrying their smartphone everywhere they go, with Bluetooth enabled.

Without substantial penetration of regional smartphones it’s questionable how much of an impact this initiative, or any contacts tracing technology, could have. Although if such tech were able to break even some infection chains people might argue it’s not wasted effort.

Notably, there are signs Europeans are willing to contribute to a public healthcare cause by doing their bit digitally — such as a self-reporting COVID-19 tracking app which last week racked up 750,000 downloads in the UK in 24 hours.

But, at the same time, contacts tracing apps are facing scepticism over their ability to contribute to the fight against COVID-19. Not everyone carries a smartphone, nor knows how to download an app, for instance. There’s plenty of people who would fall outside such a digital net.

Meanwhile, while there’s clearly been a big scramble across the region, at both government and grassroots level, to mobilize digital technology for a public health emergency cause there’s arguably greater imperative to direct effort and resources at scaling up coronavirus testing programs — an area where most European countries continue to lag.

Germany — where some of the key backers of the PEPP-PT are from — being the most notable exception.