For many Chinese people, checking a virus tracking app has become as regular as counting likes on social media. The country has been in crisis mode since January, when the outbreak of the novel coronavirus now officially known as Covid-19, hit and forced a long national shutdown. The epidemic has been determined by health experts to be more deadly than SARS, the pneumonia outbreak that swept the world in 2003.
Countless online platforms and mobile applications have popped up over the past month—from real-time dashboard that displays figures of the number of deaths, new diagnoses, and infected cases, to proximity detection tools that tell you whether you’ve been on a train or a plane with a diagnosed patient. These tools have become primary sources for information, especially for the young.
But an app can’t solve everything. Experts warn that epidemic control is fundamentally a human problem, and that seemingly neutral apps can provide the illusion of control.
App-based epidemic control
The outbreak paralyzed the country’s crucial transportation systems and still blocks much of its 800 million-strong workforce from returning to the workplace. Governments across the country have scrambled for ways to get the economy going again.
The most extensive is a health rating system called jian kang ma (“health code” in Chinese) that assesses if one should self-quarantine and, if so, for how many days. The QR codes function as a sort of health passport, allowing low-risk citizens to move around with greater ease amid the outbreak. Different versions of the app adopts a slightly different color code system. In Hangzhou, the first city to roll out such an app, a green code means it’s safe to move around the city freely. Yellow means a seven-day quarantine is required, and red 14-days.
The State Council has enlisted the help of Ant Financial, best known as the operator of Alipay, to develop a system, which has already been adopted by over 200 cities in China including that in Zhejiang, Sichuan, and Hainan, and is expected to roll out a national version this week. A similar app has been launched by the State Information Center (SIC) with the aid of internet giant Tencent. The system, called “Tencent Healthcare Code”, is being used in Guangdong, Sichuan, and Yunnan, as well as cities including Shenzhen and Chongqing.
The system is supposed to replace lockdowns with targeted quarantines based on individual risk assessments, allowing low-risk people to return to their normal lives.
People in Zhejiang were quick to embrace the QR code system, as it replaced a regime under which most people were forced to lock themselves at home for weeks on end. The possibility of going outside is a great relief.
The State Council, the National Health Commission, and China Electronics Technology Group Corporations (CETC) joined hands to roll out a “close contact detection” app that assesses the risk of contracting the disease, based on information about whether an individual has been in the proximity of an infected case.
Users register with the platform via WeChat, Alipay, or QQ using their phone number, and then enter their name and ID number. While the information collected varies from app to app, most ask users where they have been in the last two weeks, whether they have symptoms of infection, whether they have been to Hubei, and whether they’ve been in contact with people who have been to Hubei or are ill.
If an app finds someone to have been in close contact with someone diagnosed with the disease, it advises the user to self-quarantine and contact local health authorities. The system also allows registered users to check the status of up to three other people a day using their names and ID numbers.
Informative or fear-mongering
The Covid-19 outbreak is the first epidemic to land in such a digital society. In China, people cling onto these risk assessment and tracker apps as the government struggles to contain the spread of the virus.
Some of these epidemic trackers, proximity detection apps rack up tens of millions of visits a day. Within a week, the health passport amassed over 15 million registered users in Zhejiang, the first province to implement the system.
On Weibo, many praised the close contact tool for helping them navigate amid the chaotic situation amid the outbreak.
But experts questioned whether these “close contact” tools provide useful information, and how they define “proximity.”
Proximity to individuals suffering from a range of diseases occurs daily in most populated urban areas, but actual “exposure” is very difficult to predict, said Alain Labrique, Associate Professor at Johns Hopkins Bloomberg School of Public Health. Other factors should be taken into account, such as individual behaviors, environmental conditions, the pathogen, as well as the general health of the individual. “The claim of being able to determine ‘exposure’ to Covid-19 simply by a history of proximity to a case is quite incredible and unscientific,” said Labrique.
The app raises disturbing questions about privacy, said Labrique. “Sharing information about an individual’s health without their explicit consent is quite problematic, especially when that information is unlikely to have much utility in preventing disease,” Labrique added.
The objective of these apps is unclear, said Dr. Christos Lynteris, a medical anthropologist at the University of St Andrews whose research focuses on anthropological and historical examination of infectious disease epidemics.
Contact tracing can be a valuable tool to fight epidemics, Lynteris said, but these apps likely create so many false positives that “any positive impact in terms of contact-tracing is matched by problems created by false positives,” said Lynteris.
There are also concerns over the public data these apps rely on. For example, there is also the question of the method for counting infections, he said.
On Feb. 13, Hubei province reported nearly 15,000 new cases overnight as it revised the method for counting to include clinically diagnoses made by doctors without laboratory confirmation, which Lynteris said is “inherently unreliable.” It is unclear if the health apps have features to recall false alarms.
Misinformation and the manipulation of data for political purposes often hold back epidemic responses, but sharing unfiltered and raw information could lead to public panic.
Data about the Covid-19 outbreak is sometimes being shared as raw, unfiltered numbers, Labrique said. Without meaningful context, he warned, raw figures can promote panic.
People tend to panic when they read that there are 1,347 cases in Guangdong. But when the same information is presented as a .001% infection rate among the province’s 113.5 million people, it allows readers to more accurately assess risk.
Technology can certainly help inform, it often comes at the expense of privacy.
Many of these health assessment systems require residents to register with their name, national identification number, and phone number.
Labrique noted that systems that rely on self-reported information can be easy to circumvent, as people can choose not to report information honestly.
State-run newspaper Xinhua has suggested that the app “received support” from national transport and health authorities to ensure the accuracy of data used by the close contact detection system.
Alipay spokesperson told TechNode the company is not involved in any way the user data collected via the health code system, saying that the company is merely providing development support and its platform. However, Alibaba enterprise management tool Dingtalk’s health code system that allows businesses to apply to resume their operations and closely monitor employee’s health status is integrated with Hangzhou’s health code system, according to Chinese media.
Food delivery giant Meituan is also helping to launch a mobile real-name registration system in Shenyang that requires commuters to provide their personal information via QR code before taking any public transport. The system would enable regulators to track people’s movements and target at-risk individuals.
John Nosta, the founder of digital health think tank NOSTALAB said the outbreak provides an opportunity for governments to collect large amounts of personal data they may later use for purposes other than promoting public health.
“The big question for me is if this represents a step forward in disease detection and management or a governmental overstep that might backfire on China and result in fundamental changes in the perception of privacy. Of course, the confounding factors are that aspects of privacy and surveillance are subordinated by fear of a life-threatening virus,” said Nosta.
An expert recently quoted in Chengdu Business Daily said he expects the health passport system to continue to “increase the efficiency and lower costs for healthcare services” even after the Covid-19 outbreak dies down, which suggests the current track-all close monitoring systems are by no means a temporary measure.
Tech companies stepping in to provide crucial technology support for the government’s tracking app makes one question the degree of involvement they are in handling and managing mounts of personal data and health information.
Stigmatization and public mistrust
Experts also warn that the proximity detection app, the QR code system, and the likes run the risk of exacerbating paranoia and fomenting suspicion.
“Stigmatization is always an important side-effect of epidemic control, and there are no indications that China is doing anything to prevent or mitigate this problem,” said Lynteris.
Systems like the health code can backfire, said Labrique. History is full of examples of groups of people who were discriminated against because of a particular disease. Profiling individuals based on travel histories and exposure to high-risk environments are reasonable places to start, he said, but should be followed up by confirmatory testing or monitoring. At-risk individuals should also be properly educated on the disease, such as what symptoms to look for.
Technology can help inform and provide some reassurance and relief to the public amid the Covid-19 outbreak. It also can have unintended consequences.
“Digital technologies are something people can place their faith in, when faith in the state’s ability to control the epidemic may be fading. This may be a misplaced faith, but even so, this psychological impact is important for epidemic control, even when it does not correspond to reality,” said Lynteris.