Researchers at NUI Galway have highlighted how different approaches to digital contact tracing during the Covid-19 pandemic were shaped by whether or not jurisdictions had prior recent experience of epidemics.
In their work, James O’Connell and Professor Derek O’Keeffe from the university’s College of Medicine, Nursing, and Health Sciences discuss how South Korea learned important lessons from the MERS (Middle East Respiratory Syndrome ) epidemic in 2015 and put in place a political, legal, and technological foundation that enabled an agile digital health response to the first wave of Covid-19.
By comparison, Western countries struggled with both the societal and technical requirements needed to implement a digital solution to augment traditional manual contact tracing, a critical tool in managing infectious disease outbreaks.
The analysis has been published by the prestigious New England Journal of Medicine.
Automation using geolocation tracking allowed teams of epidemiologic investigators in South Korea to trace not only contacts but also the setting in which contact occurred up to 14 days before symptom onset or diagnosis. This information allowed them to gain a greater understanding of the settings in which SARS-CoV-2 transmission was occurring and to implement more targeted health protection measures in response.
In contrast, traditional contact-tracing systems in most Western countries had the capacity to identify and notify only people who had come into contact with an infected person within 48 hours before symptom onset or diagnosis. This digital limitation perhaps contributed to the first wave of Covid-19 in Western countries, which outpaced the epidemic in South Korea. By the end of its first epidemic wave in April 2020, South Korea had reported 10,423 infections and only 204 deaths — a remarkable achievement given the population size of just over 50 million. In contrast, European countries saw more than 2.1 million cases and 180,000 deaths by the end of their first wave in June.
“This analysis highlights important learnings from this pandemic that will enable a better response to the next,” said James O’Connell, author and HIVE lab postgraduate researcher at NUI Galway. “We have all seen how important proportionate, effective, efficient, and timely contact tracing is during this pandemic. Digital technologies can enhance the capacity of contact tracing systems to perform in this way, aiding efforts to achieve and maintain epidemic control.”
Professor Derek O’Keeffe, consultant physician, professor of medical device technology and director of the HIVE lab at NUI Galway, added: “This research highlights the importance of learning from critical events and then creating the necessary technological tools and political and legal frameworks, so that when it occurs again, we are ready to respond quickly.”
The work also highlights the importance of realising the limitations of using digital contact tracing solutions in populations who are not able to access such technology (such as the digital divide ) and also in non-native language speakers (such as migrant communities ).
The NUI Galway authors also discuss the apparent idiosyncrasy that many people freely share significant amounts of personal data with large multinational corporations for no health benefit, and yet had significant ideological issues in sharing similar data with governments during an emergency health scenario.
As the first epidemic wave came to an end and the imminent threat of further loss of life eased, geolocation-based digital contact-tracing systems and their interference with personal privacy and data protection rights became less palatable. They became the subject of intense scrutiny in countries that used them, including South Korea, Norway, and Israel. In a pandemic that had the potential to last several years, many Western countries recognised the need for trustworthy, transparent, privacy-preserving digital contact-tracing technologies that were acceptable to Western populations.
Following the example of Singapore’s Bluetooth Low Energy digital contact-tracing app TraceTogether, Germany, Ireland, and the United Kingdom, among others, set out to develop their own systems, which had varying uptake by target populations. Western countries tended to favour a decentralised, privacy-preserving, protocol for contact tracing — meaning that rather than being sent to central government servers, the data collected stayed on the user’s device, are encrypted, and are automatically deleted after 14 days. By the end of 2020, there were at least 65 Bluetooth Low Energy–enabled digital contact-tracing systems worldwide, including 26 in the United States.
The full study entitled ‘Contact Tracing for Covid-19 — A Digital Inoculation against Future Pandemics’, is published in the New England Journal of Medicine and can be read at www.nejm.org/doi/10 1056/NEJMp2102256.