Contact Tracing
There has been too little time for an ethics consensus to emerge on contact tracing for COVID-19, in particular for the proposed new technologies. We present here (1) the concerns raised in the media, (2) general ethical consensus principles that apply, and (3) when available, examples of recommendations and practices some have put in place, although they do not necessarily reflect ethical considerations.
Concerns
- The use of smartphone location data for contact tracing compromises privacy. The Washington Post
- There are tradeoffs between privacy and security. The Washington Post
- Smartphone apps are not useful for contact tracing and a distraction to public health. The Washington Post
Ethical Principles
- At a minimum, individuals and communities should be aware of the type of information that will be gathered about them, the purposes for which this information will be used, and any circumstances under which the information collected may be shared with third parties. WHO Ethics in an Outbreak
- The effectiveness of public health policies, practices, and actions depends upon public trust gained through decisions based on the highest ethical, scientific, and professional standards. APHA Code of Ethics, Section 2
- Keep information secret unless its disclosure has been appropriately authorized by the person concerned or, in extraordinary circumstances, by the appropriate authorities. WHO Ethics in Pandemic Flu
- Is it reasonable to expect, based on best available evidence and past experience, that the proposed action would achieve its stated health goals? APHA Code of Ethics, Section 3
- The United States acknowledges the importance of working with and learning from preparedness efforts globally. CDC Ethics in Pandemic Flu
Recommendations and practices
- Researchers need a plan to mitigate potential privacy breaches. Ethical Considerations for Movement Mapping to Identify Disease Transmission Hotspots, CDC
- Privacy trade-offs may be necessary to enact cell phone contact tracing. Cornell University
- Utah’s Healthy Together App with optional location data use. Utah.gov
Concerns
- Lower income individuals are at a high risk for COVID-19 infection and may not have smartphones. New York Times
- Bluetooth contact tracing apps may not gain widespread use because they drain phone batteries. BBC
- The app effectiveness depends on widespread voluntary use. The Verge
- Bluetooth apps will result in several false positives. The Verge
- The Bluetooth signal can be inconsistent and inaccurate. The Intercept
Ethical Principles
- The principle of utility requires that one acts so as to maximize aggregate welfare. This implies an additional principle of efficiency, i.e. the idea that benefits should be obtained using the fewest resources necessary. WHO Ethics in Pandemic Flu
Recommendations and practices
Concerns
- Individuals cannot be sure how their data and posts will be used or reposted. Public Health Ethics Journal
- Use of social network information could lead to the spread of information beyond the target population. Public Health Ethics journal
- Social network data pushes the boundaries of confidentiality, autonomy, and consent. Public Health Ethics journal
- Concerns with privacy, anonymity, confidentiality, authenticity, are rapidly changing. American Journal of Public Health
- If the index case cannot decline the use of their data, questions of autonomy and confidentiality arise. Public Health Ethics journal
Ethical principles
- To protect the public from harm, health care organizations and public health authorities may be required to take actions that impinge on individual liberty. Decision makers should: weigh the imperative for compliance; provide reasons for public health measures to encourage compliance; and establish mechanisms to review decisions. University of Toronto
- At a minimum, individuals and communities should be aware of the type of information that will be gathered about them, the purposes for which this information will be used, and any circumstances under which the information collected may be shared with third parties. WHO Ethics in an Outbreak
Concerns
- Given the infectiousness and the high transmission rate from pre-symptomatic individuals, controlling the epidemic by manual contact tracing is infeasible. Science Magazine
- Contact tracing is too expensive and not extensive enough to contain the epidemic. National Public Radio
- An individual will not remember every place they have been and every person they have contacted. Johns Hopkins University
- States do not have enough contact tracers to effectively slow the spread. Technology Review
- Scammers are imitating contact tracers to gather information. Federal Trade Commission
Ethical principles
- Increase public awareness about the disease- related risks and enable people to take steps at individual, family, workplace and community level to prepare for and respond to an influenza pandemic. WHO Ethics in Pandemic Flu
- Engage, empower, and train community members to conduct and disseminate health assessments. APHA Code of Ethics 4.1.2
Recommendations and practices
- Johns Hopkins contact tracing training informs contact tracers to assess the need for medical care when interacting with people. Johns Hopkins training for contact tracers
- Contact tracers will attempt to find all cases and contacts regardless of religion, race, or sexual orientation. Johns Hopkins training for contact tracers
- Symptomatic contacts should be tested and asymptomatic contacts should self-isolate. Partners in Health training for contact tracers
Concerns
- Contacts may not answer or return phone calls, say they cannot afford to stay home from work, or refuse to give names of contacts. The Washington Post
- Rumors that contact tracing could lead to forced quarantine. National Geographic
Ethical principles
- Restrictions to individual liberty should be proportional, necessary, and relevant; employ the least restrictive means; and be applied equitably. University of Toronto
- Any restrictions on freedom of movement should be designed and implemented in a manner that imposes the fewest constraints reasonably possible. CDC Ethics in Pandemic Flu
Recommendations and practices
- Healthcare personnel who had prolonged contact with a patient, visitor, or healthcare personnel with confirmed COVID-19 should be excluded from work for 14 days after last exposure. Interim US Guidance for Risk Assessment and Work Restriction for Healthcare Personnel with Potential Exposure to COVID-19, CDC